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  1.  
  2.  
  3. <!DOCTYPE html>
  4. <html>
  5. <head>
  6.  
  7. <meta charset="utf-8">
  8. <meta name="viewport" content="width=device-width, initial-scale=1">
  9. <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
  10. <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script>
  11. <script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
  12.  
  13. </head>
  14.  
  15. <body>
  16.  
  17.  
  18. <section id="form1">
  19. <div class="container">
  20.  
  21. <!-- heading part-->
  22. <div class="col-sm-12">
  23.  
  24.  
  25. <h1>Passport Application -Stage 1</h1>
  26. <p>Before filling up the online application form read the <a> guidelines </a>carefully </p>
  27. <p>fields mark with * are mandatory.
  28. </p>
  29.  
  30.  
  31. </div>
  32.  
  33. <hr>
  34.  
  35.  
  36. <!-- left form part -->
  37. <form class="form-horizontal" action="#">
  38.  
  39. <div class="col-sm-6">
  40.  
  41.  
  42. <div class="col-sm-12">
  43. <h3>Passport Application Information </h3>
  44. <!-- apply in -->
  45. <div class="col-sm-4"><label for="sel1">Applying in:</label></div>
  46. <div class="col-sm-8">
  47.  
  48. <select class="form-control" id="sel1">
  49. <?php
  50. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  51. foreach ( $countries as $value)
  52. {
  53. echo '<option>'.$value.'</option>';
  54. }
  55.  
  56.  
  57. ?>
  58. </select>
  59. </div>
  60. </div>
  61. <br>
  62. <div class="col-sm-12">
  63. <!-- application type -->
  64. <div class="col-sm-4"><h4>Application Type:</h4></div>
  65. <div class="col-sm-8"> <h5> New Application</h5></div>
  66. </div>
  67.  
  68. <!-- passport type-->
  69. <div class="col-sm-12">
  70. <div class="col-sm-4"><h4> Passport type</h4></div>
  71. <div class="col-sm-8">
  72.  
  73. <select class="form-control" id="sel1">
  74. <?php
  75. $type = array('1st class','2nd class');
  76. foreach ( $type as $value)
  77. {
  78. echo '<option>'.$value.'</option>';
  79. }
  80.  
  81.  
  82. ?>
  83. </select>
  84.  
  85.  
  86.  
  87. </div>
  88. </div>
  89.  
  90. <!-- deliver type -->
  91.  
  92. <div class="col-sm-12">
  93. <div class="col-sm-4"><h4>Delivery type</h4></div>
  94. <div class="col-sm-8 ">
  95.  
  96. <div class="radio">
  97. <label><input type="radio" name="optradio">Regular</label>
  98. </div>
  99. <div class="radio">
  100. <label><input type="radio" name="optradio">Express</label>
  101. </div>
  102.  
  103.  
  104. </div>
  105. </div>
  106.  
  107.  
  108. <!--personal info -->
  109. <div class="col-sm-12">
  110. <h3> Personal Information</h3>
  111. </div>
  112.  
  113.  
  114. <div class="col-sm-12">
  115. <div class="col-sm-4"> <h4> Name of the applicant: </h4></div>
  116. <div class="col-sm-8 form-group">
  117.  
  118. <input class="form-control" type=text value="applicantName" placeholder="name">
  119.  
  120. </div>
  121. </div>
  122.  
  123.  
  124. <div class="col-sm-12">
  125. <div class="col-sm-4"> <h4>First part(Given Name): </h4></div>
  126. <div class="col-sm-8 form-group">
  127.  
  128. <input class="form-control" type=text value="firstName" placeholder="name">
  129.  
  130. </div>
  131. </div>
  132.  
  133.  
  134. <div class="col-sm-12">
  135. <div class="col-sm-4"> <h4> Second part(Surname): </h4></div>
  136. <div class="col-sm-8 form-group">
  137.  
  138. <input class="form-control" type=text value="Surname" placeholder="name">
  139.  
  140. </div>
  141. </div>
  142.  
  143.  
  144.  
  145.  
  146.  
  147. <div class="col-sm-12">
  148. <div class="col-sm-4">
  149. <h4> Gurdian :</h4>
  150.  
  151. </div>
  152. <div class="col-sm-8">
  153. <label class="checkbox-inline"><input type="checkbox" value="">*Tick* only Applicant is legally adopted</label>
  154.  
  155.  
  156. </div>
  157. </div>
  158.  
  159.  
  160.  
  161. <div class="col-sm-12">
  162. <div class="col-sm-4"> <h4> Father's Name: </h4></div>
  163. <div class="col-sm-8 form-group">
  164.  
  165. <input class="form-control" type=text value="FatherName" placeholder="name">
  166.  
  167. </div>
  168. </div>
  169.  
  170.  
  171. <div class="col-sm-12">
  172.  
  173.  
  174. <div class="col-sm-4"><h4> Father's Nationality :</h4></div>
  175. <div class="col-sm-8">
  176.  
  177. <select class="form-control" id="sel1">
  178. <?php
  179. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  180. foreach ( $countries as $value)
  181. {
  182. echo '<option>'.$value.'</option>';
  183. }
  184.  
  185.  
  186. ?>
  187. </select>
  188. </div>
  189. </div>
  190.  
  191. <div class="col-sm-12">
  192. <div class="col-sm-4"><h4> Father's Profession:</h4></div>
  193. <div class="col-sm-8">
  194.  
  195. <select class="form-control" id="sel1">
  196. <?php
  197. $countries = array('Doctor','engineer','service holder','teacher','bussinessman');
  198. foreach ( $countries as $value)
  199. {
  200. echo '<option>'.$value.'</option>';
  201. }
  202.  
  203.  
  204. ?>
  205. </select>
  206. </div>
  207. </div>
  208.  
  209. <div class="col-sm-12">
  210. <div class="col-sm-4"> <h4> Mother's Name: </h4></div>
  211. <div class="col-sm-8 form-group">
  212.  
  213. <input class="form-control" type=text value="MotherName" placeholder="name">
  214.  
  215. </div>
  216. </div>
  217.  
  218.  
  219. <div class="col-sm-12">
  220.  
  221.  
  222. <div class="col-sm-4"><h4> Mother's Nationality :</h4></div>
  223. <div class="col-sm-8">
  224.  
  225. <select class="form-control" id="sel1">
  226. <?php
  227. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  228. foreach ( $countries as $value)
  229. {
  230. echo '<option>'.$value.'</option>';
  231. }
  232.  
  233.  
  234. ?>
  235. </select>
  236. </div>
  237. </div>
  238.  
  239. <div class="col-sm-12">
  240. <div class="col-sm-4"><h4> Mother's Profession:</h4></div>
  241. <div class="col-sm-8">
  242.  
  243. <select class="form-control" id="sel1">
  244. <?php
  245. $countries = array('Doctor','engineer','service holder','teacher','bussinessman');
  246. foreach ( $countries as $value)
  247. {
  248. echo '<option>'.$value.'</option>';
  249. }
  250.  
  251.  
  252. ?>
  253. </select>
  254. </div>
  255. </div>
  256.  
  257.  
  258.  
  259.  
  260.  
  261.  
  262. <div class="col-sm-12">
  263. <div class="col-sm-4"> <h4> Spouse's Name: </h4></div>
  264. <div class="col-sm-8 form-group">
  265.  
  266. <input class="form-control" type=text value="SpouseName" placeholder="name">
  267.  
  268. </div>
  269. </div>
  270.  
  271.  
  272. <div class="col-sm-12">
  273.  
  274.  
  275. <div class="col-sm-4"><h4> Spouse's Nationality :</h4></div>
  276. <div class="col-sm-8">
  277.  
  278. <select class="form-control" id="sel1">
  279. <?php
  280. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  281. foreach ( $countries as $value)
  282. {
  283. echo '<option>'.$value.'</option>';
  284. }
  285.  
  286.  
  287. ?>
  288. </select>
  289. </div>
  290. </div>
  291.  
  292. <div class="col-sm-12">
  293. <div class="col-sm-4"><h4> Spouse's Profession:</h4></div>
  294. <div class="col-sm-8">
  295.  
  296. <select class="form-control" id="sel1">
  297. <?php
  298. $countries = array('Doctor','engineer','service holder','teacher','bussinessman');
  299. foreach ( $countries as $value)
  300. {
  301. echo '<option>'.$value.'</option>';
  302. }
  303.  
  304.  
  305. ?>
  306. </select>
  307. </div>
  308. </div>
  309.  
  310.  
  311. <div class="col-sm-12">
  312. <div class="col-sm-4"><h4>Matrital Status:</h4></div>
  313. <div class="col-sm-8">
  314.  
  315. <select class="form-control" id="sel1">
  316. <?php
  317. $countries = array('married','single','divorce');
  318. foreach ( $countries as $value)
  319. {
  320. echo '<option>'.$value.'</option>';
  321. }
  322.  
  323.  
  324. ?>
  325. </select>
  326. </div>
  327. </div>
  328.  
  329.  
  330. <div class="col-sm-12">
  331. <div class="col-sm-4"><h4> Applicant's Profession:</h4></div>
  332. <div class="col-sm-8">
  333.  
  334. <select class="form-control" id="sel1">
  335. <?php
  336. $countries = array('Doctor','engineer','service holder','teacher','bussinessman');
  337. foreach ( $countries as $value)
  338. {
  339. echo '<option>'.$value.'</option>';
  340. }
  341.  
  342.  
  343. ?>
  344. </select>
  345. </div>
  346. </div>
  347.  
  348. <div class="col-sm-12">
  349.  
  350.  
  351. <div class="col-sm-4"><h4> Country of Birth :</h4></div>
  352. <div class="col-sm-8">
  353.  
  354. <select class="form-control" id="sel1">
  355. <?php
  356. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  357. foreach ( $countries as $value)
  358. {
  359. echo '<option>'.$value.'</option>';
  360. }
  361.  
  362.  
  363. ?>
  364. </select>
  365. </div>
  366. </div>
  367.  
  368. <div class="col-sm-12">
  369.  
  370.  
  371. <div class="col-sm-4"><h4> Birth District :</h4></div>
  372. <div class="col-sm-8">
  373.  
  374. <select class="form-control" id="sel1">
  375. <?php
  376. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  377. foreach ( $countries as $value)
  378. {
  379. echo '<option>'.$value.'</option>';
  380. }
  381.  
  382.  
  383. ?>
  384. </select>
  385. </div>
  386. </div>
  387.  
  388.  
  389.  
  390.  
  391.  
  392. </div>
  393.  
  394.  
  395.  
  396. <!--right form part-->
  397.  
  398. <div class="col-sm-6">
  399.  
  400.  
  401. <div class="col-sm-12">
  402. <div class="col-sm-4"><h4>Date of Birth :</h4></div>
  403. <div class="col-sm-8">
  404.  
  405. <input class="form-control" type="date" name="bday">
  406. </div>
  407. </div>
  408.  
  409.  
  410.  
  411.  
  412. <div class="col-sm-12">
  413. <div class="col-sm-4"><h4>Gender</h4></div>
  414. <div class="col-sm-8 ">
  415.  
  416. <div class="radio">
  417. <label><input type="radio" name="optradio">Male</label>
  418. </div>
  419. <div class="radio">
  420. <label><input type="radio" name="optradio">Female</label>
  421. </div>
  422. <div class="radio">
  423. <label><input type="radio" name="optradio">Others</label>
  424. </div>
  425.  
  426. </div>
  427. </div>
  428.  
  429.  
  430. <div class="col-sm-12">
  431. <div class="col-sm-4"> <h4> Birth ID no: </h4></div>
  432. <div class="col-sm-8 form-group">
  433.  
  434. <input class="form-control" type=text value="BId" placeholder="name">
  435.  
  436. </div>
  437. </div>
  438.  
  439.  
  440.  
  441.  
  442. <div class="col-sm-12">
  443. <div class="col-sm-4"> <h4> National ID no: </h4></div>
  444. <div class="col-sm-8 form-group">
  445.  
  446. <input class="form-control" type=text value="" placeholder="name">
  447.  
  448. </div>
  449. </div>
  450.  
  451.  
  452.  
  453. <div class="col-sm-12">
  454. <div class="col-sm-4"> <h4> Tax ID no: </h4></div>
  455. <div class="col-sm-8 form-group">
  456.  
  457. <input class="form-control" type=text value="" placeholder="">
  458.  
  459. </div>
  460. </div>
  461.  
  462.  
  463.  
  464.  
  465.  
  466. <div class="col-sm-12">
  467. <div class="col-sm-4"> <h4> height: </h4></div>
  468. <div class="col-sm-8 form-group">
  469. <div class="col-sm-6">
  470. <input class="form-control" type=text value="" placeholder="cm">
  471. </div>
  472. <div class="col-sm-6">
  473. <input class="form-control" type=text value="" placeholder="Inch">
  474. </div>
  475. </div>
  476. </div>
  477.  
  478.  
  479.  
  480.  
  481. <div class="col-sm-12">
  482.  
  483.  
  484. <div class="col-sm-4"><h4> Religion :</h4></div>
  485. <div class="col-sm-8">
  486.  
  487. <select class="form-control" id="sel1">
  488. <?php
  489. $countries = array('hindu','muslim','cristian','buddha','jews','non religion');
  490. foreach ( $countries as $value)
  491. {
  492. echo '<option>'.$value.'</option>';
  493. }
  494.  
  495.  
  496. ?>
  497. </select>
  498. </div>
  499. </div>
  500.  
  501. <div class="col-sm-12">
  502. <div class="col-sm-4"> <h4> Email: </h4></div>
  503. <div class="col-sm-8 form-group">
  504.  
  505. <input class="form-control" type=text value="" placeholder="">
  506.  
  507. </div>
  508. </div>
  509.  
  510.  
  511. <div class="col-sm-12">
  512.  
  513.  
  514. <h3>Citizenship Information</h3>
  515. <div class="col-sm-4"><h4> Nationality :</h4></div>
  516. <div class="col-sm-8">
  517.  
  518. <select class="form-control" id="sel1">
  519. <?php
  520. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  521. foreach ( $countries as $value)
  522. {
  523. echo '<option>'.$value.'</option>';
  524. }
  525.  
  526.  
  527. ?>
  528. </select>
  529. </div>
  530. </div>
  531.  
  532.  
  533. <div class="col-sm-12">
  534.  
  535.  
  536.  
  537. <div class="col-sm-4"><h4> Citizenship status :</h4></div>
  538. <div class="col-sm-8">
  539.  
  540. <select class="form-control" id="sel1">
  541. <?php
  542. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  543. foreach ( $countries as $value)
  544. {
  545. echo '<option>'.$value.'</option>';
  546. }
  547.  
  548.  
  549. ?>
  550. </select>
  551. </div>
  552. </div>
  553.  
  554.  
  555.  
  556.  
  557. <div class="col-sm-12">
  558. <div class="col-sm-4"><h4>Dual Citizenship</h4></div>
  559. <div class="col-sm-8 ">
  560.  
  561. <div class="radio">
  562. <label><input type="radio" name="optradio">Yes</label>
  563. </div>
  564. <div class="radio">
  565. <label><input type="radio" name="optradio">No</label>
  566. </div>
  567.  
  568.  
  569. </div>
  570. </div>
  571.  
  572. <div class="col-sm-12">
  573. <h3> Present Address :</h3>
  574. <div class="col-sm-4"> <h4> village/house </h4></div>
  575. <div class="col-sm-8 form-group">
  576.  
  577. <input class="form-control" type=text value="" placeholder="">
  578.  
  579. </div>
  580. </div>
  581.  
  582.  
  583.  
  584.  
  585. <div class="col-sm-12">
  586.  
  587. <div class="col-sm-4"> <h4> Road/block/sector: </h4></div>
  588. <div class="col-sm-8 form-group">
  589.  
  590. <input class="form-control" type=text value="" placeholder="">
  591.  
  592. </div>
  593. </div>
  594.  
  595.  
  596.  
  597. <div class="col-sm-12">
  598.  
  599.  
  600.  
  601. <div class="col-sm-4"><h4> District:</h4></div>
  602. <div class="col-sm-8">
  603.  
  604. <select class="form-control" id="sel1">
  605. <?php
  606. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  607. foreach ( $countries as $value)
  608. {
  609. echo '<option>'.$value.'</option>';
  610. }
  611.  
  612.  
  613. ?>
  614. </select>
  615. </div>
  616. </div>
  617.  
  618.  
  619.  
  620. <div class="col-sm-12">
  621.  
  622. <div class="col-sm-4"> <h4> Police Sation: </h4></div>
  623. <div class="col-sm-8 form-group">
  624.  
  625. <input class="form-control" type=text value="" placeholder="">
  626.  
  627. </div>
  628. </div>
  629.  
  630. <div class="col-sm-12">
  631.  
  632. <div class="col-sm-4"> <h4> Post Office: </h4></div>
  633. <div class="col-sm-8 form-group">
  634.  
  635. <input class="form-control" type=text value="" placeholder="">
  636.  
  637. </div>
  638. </div>
  639.  
  640.  
  641.  
  642.  
  643.  
  644.  
  645.  
  646.  
  647.  
  648. <div class="col-sm-12">
  649.  
  650.  
  651. <h3> Parmanent Address :</h3>
  652.  
  653. <div ><label class="checkbox-inline"><input type="checkbox" value="">Same as above</label>
  654. </div>
  655.  
  656. <div class="col-sm-4"> <h4> village/house </h4></div>
  657. <div class="col-sm-8 form-group">
  658.  
  659. <input class="form-control" type=text value="" placeholder="">
  660.  
  661. </div>
  662. </div>
  663.  
  664.  
  665.  
  666.  
  667. <div class="col-sm-12">
  668.  
  669. <div class="col-sm-4"> <h4> Road/block/sector: </h4></div>
  670. <div class="col-sm-8 form-group">
  671.  
  672. <input class="form-control" type=text value="" placeholder="">
  673.  
  674. </div>
  675. </div>
  676.  
  677.  
  678.  
  679. <div class="col-sm-12">
  680.  
  681.  
  682.  
  683. <div class="col-sm-4"><h4> District:</h4></div>
  684. <div class="col-sm-8">
  685.  
  686. <select class="form-control" id="sel1">
  687. <?php
  688. $countries = array('Algeria', 'BAngladesh', 'India', 'Butan', 'Pakistan','Srilanka','Canada','United kingdom','Nigeria','Zimbabewe');
  689. foreach ( $countries as $value)
  690. {
  691. echo '<option>'.$value.'</option>';
  692. }
  693.  
  694.  
  695. ?>
  696. </select>
  697. </div>
  698. </div>
  699.  
  700.  
  701.  
  702. <div class="col-sm-12">
  703.  
  704. <div class="col-sm-4"> <h4> Police Sation: </h4></div>
  705. <div class="col-sm-8 form-group">
  706.  
  707. <input class="form-control" type=text value="" placeholder="">
  708.  
  709. </div>
  710. </div>
  711.  
  712. <div class="col-sm-12">
  713.  
  714. <div class="col-sm-4"> <h4> Post Office: </h4></div>
  715. <div class="col-sm-8 form-group">
  716.  
  717. <input class="form-control" type=text value="" placeholder="">
  718.  
  719. </div>
  720. </div>
  721.  
  722.  
  723.  
  724. </div>
  725.  
  726. <!-- button part-->
  727.  
  728.  
  729. <div class=col-sm-12>
  730.  
  731. <div class="col-sm-6"></div>
  732.  
  733. <div class="col-sm-6">
  734.  
  735. <div class="col-sm-8">
  736.  
  737. <input class="btn-success" type="submit" value="Save now & Continue for Future ">
  738.  
  739. </div>
  740. <div class="col-sm-4"></div>
  741. <input class="btn-success"type="submit" value=" save & Next ">
  742. </div>
  743.  
  744.  
  745.  
  746. </div>
  747.  
  748. <div class="col-sm-12"></div>
  749.  
  750. </form>
  751. </div>
  752. </section>
  753.  
  754.  
  755.  
  756. </body>
  757.  
  758. </html>
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