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<h1 align="center">AFWC<br>MANAGEMENT INFORMATION & LENDING SYSTEM</h1>

<table id="btable" cellpadding="8" width="100%">
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		<td id="d"; align="left">MEMBER'S INFORMATION</td>
		<td id="t";>DATE: Thursday, January 11,2018<br>TIME: 1:57:25 PM</td>
	</tr>
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	<div class="tbl1" >
		<table id="b2table"; cellpadding="4"; width="50%"	>


				<tr>
					<td colspan="3"; align="right"><p><a href = "http://www.google.com">Quick Search</a></td>
				</tr>

					<tr>
						<td id="em">*Employee ID:
						</td>
						<td><input type="text" name="custId" id="custId" required="required"/>
						</td>
						<td align="center"; >    <select name="prodlist" id="prodlist"> <option value="prod1">	     </option> 	<option value="prod1">286196</option>
								   <option value="prod1">615987</option>	</select>
						</td>
					</tr>

				<tr>   <td align="right">*Last Name:</td>
					<td colspan="2"><input type="text" name="lname" id="lname" required="required"/></td>
				</tr>

				<tr>   <td align="right">*First Name:</td>
				<td colspan="2"><input type="text" name="fname" id="fname" required="required"/></td>
				</tr>


				<tr> <td align="right">*Middle Initial:</td>
				<td colspan="2"><input type="text" name="Mname" id="fname" required="required"/></td>
				</tr>

				<tr> <td align="right">Gender:</td>
				<td align="left"; colspan="2"> <select name="prodlist" id="prodlist"> <option value="prod1">Male</option>
				<option value="prod1">Female</option>	</select>   </td>
				</tr>

				<tr>   <td align="right">Civil Status:</td>
					<td align="left"; colspan="2" >
						<select name="prodlist" id="prodlist">
						<option value="prod1"></option>
						<option value="prod1">Single</option>
						<option value="prod1">Married</option>
						<option value="prod1">Separated</option>
						<option value="prod1">Divorced</option>
						<option value="prod1">Widowed</option>
						</select>
					</td>
				</tr>

				<tr> <td align="right">Birth Place:</td>
							<td colspan="2"><input type="text" name="bplace" id="fname" required="required"/></td>
				</tr>

				<tr>
				 <td align="right">*Date Of Birth:</td>
				 <td ><input type="date" name="custId" id="custId" required="required"/></td>
				 <td ><input type="date" name="custId" id="custId" required="required"/></td>
				</tr>

				 <tr> <td align="right">Age:</td>
				 <td align="left"; colspan="2" ><input type="text" name="bplace" id="fname" required="required"/></td>
				 </tr>

				 <tr> <td align="right">Other Source of <br> Income:</td>
				 <td align="left"; colspan="2" ><input type="text" name="bplace" id="fname" required="required"/></td>
				 </tr>

				 <tr> <td align="right">Nearest Relative:</td>
				 <td align="left"; colspan="2" ><input type="text" name="bplace" id="fname" required="required"/></td>
				 </tr>

				 <tr> <td align="right">Relationship:</td>
				 <td align="left"; colspan="2" ><input type="text" name="bplace" id="fname" required="required"/></td>
				 </tr>

				 <tr> <td align="right">*# of Dependents</td>
				 <td align="left" ><input type="text" name="bplace" id="fname" required="required"/></td>
				 </tr>


		</table>
	</div>

	<div class="tbl2">
		<table cellpadding="4" border="1" >

			<tr>
				<td>Address:</td>
				<td><input type="text" id="add"/></td>
			</tr

			<tr>
				<td>HPhone:</td>
				<td><input type="text"/></td>
			</tr>

			<tr>
				<td>Mobile:</td>
				<td><input type="text"/></td>
			</tr>

			<tr>
				<td> e-mail ID:</td>
				<td> <input type="text"></td>
			</tr>

	</table>
	</div>

	<div class="tbl3">
		<table cellpadding="4" border="1" >
		<tr>
			<td>PLDT Branch: </td>
			<td><input type="text"/></td>

			<td>Date of Join: </td>
			<td><input type="date" name="custId" id="custId" required="required"/></td>
			<td><input type="date" name="custId" id="custId" required="required"/></td>

		</tr>


		<tr>
			<td>Officer/Employer: </td>
			<td><input type="text"/></td>

			<td>COOP Cap<br>
			Share: </td>
			<td><input type="text"/></td>
		</tr>


		<tr>
			<td>Division: </td>
			<td><input type="text"/></td>

			<td>Salary: </td>
			<td><input type="text"/></td>
		</tr>

		<tr>
			<td>Position: </td>
			<td><input type="text"/></td>
		</tr>

		<tr>
			<td>Office Phone: </td>
			<td><input type="text"/></td>

			<td>Notes: </td>
			<td><input type="text"/></td>
		</table>
	</div>


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