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Server IP : 162.214.80.37 / Your IP : 216.73.216.1 Web Server : Apache System : Linux sh013.webhostingservices.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 User : imyrqtmy ( 2189) PHP Version : 8.2.18 Disable Function : NONE MySQL : OFF | cURL : ON | WGET : ON | Perl : ON | Python : ON Directory (0755) : /home2/imyrqtmy/public_html/skyispatudyog/sym/Users/0-imyrqtmy/zugadu/AdminPanel/ |
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<?php include"include/cookie.php"; ?>
<!DOCTYPE html>
<html lang="en">
<head>
<?php include"include/head.php"; ?>
<script src="https://code.jquery.com/jquery-1.12.4.min.js"></script>
<script>
function user(input){
var file = $("input[name=user_photo]").get(0).files[0];
if(file){
var reader = new FileReader();
reader.onload = function(){
$("#previewuser").attr("src", reader.result);
}
reader.readAsDataURL(file);
}
}
</script>
<script>
function aadhar(input){
var file = $("input[name=aadhar_photo").get(0).files[0];
if(file){
var reader = new FileReader();
reader.onload = function(){
$("#previewaadhar").attr("src", reader.result);
}
reader.readAsDataURL(file);
}
}
</script>
<script>
function pan(input){
var file = $("input[name=pan_photo]").get(0).files[0];
if(file){
var reader = new FileReader();
reader.onload = function(){
$("#previewpan").attr("src", reader.result);
}
reader.readAsDataURL(file);
}
}
</script>
<script>
function cheque(input){
var file = $("input[name=cheque_photo]").get(0).files[0];
if(file){
var reader = new FileReader();
reader.onload = function(){
$("#previewcheque").attr("src", reader.result);
}
reader.readAsDataURL(file);
}
}
</script>
<script>
function sign(input){
var file = $("input[name=sign_photo]").get(0).files[0];
if(file){
var reader = new FileReader();
reader.onload = function(){
$("#previewsign").attr("src", reader.result);
}
reader.readAsDataURL(file);
}
}
</script>
</head>
<body>
<!-- Begin page -->
<div id="wrapper">
<!-- Top Bar Start -->
<div class="topbar">
<?php include"include/topbar.php"; ?>
</div>
<!-- Top Bar End -->
<!-- ========== Left Sidebar Start ========== -->
<!-- Left Sidebar End -->
<!-- ============================================================== -->
<!-- Start right Content here -->
<!-- ============================================================== -->
<div class="content-page">
<!-- Start content -->
<div class="content">
<div class="container-fluid">
<div class="row">
<div class="col-sm-12">
<div class="page-title-box">
<h4 class="page-title">Upload Documents</h4>
<!-- <ol class="breadcrumb">
<li class="breadcrumb-item"><a href="javascript:void(0);">Agroxa</a></li>
<li class="breadcrumb-item"><a href="javascript:void(0);">Forms</a></li>
<li class="breadcrumb-item active">Form Validation</li>
</ol> -->
<!-- <div class="state-information d-none d-sm-block">
<div class="state-graph">
<div id="header-chart-1"></div>
<div class="info">Balance $ 2,317</div>
</div>
<div class="state-graph">
<div id="header-chart-2"></div>
<div class="info">Item Sold 1230</div>
</div>
</div> -->
</div>
</div>
</div>
<!-- end row -->
<div class="page-content-wrapper">
<div class="row">
<div class="col-lg-3"></div>
<div class="col-lg-6">
<div class="card m-b-20">
<div class="card-body">
<form class="" action="insert.php" method="POST" enctype="multipart/form-data">
<input type="hidden" name="code" value="<?php echo $CandidateCode; ?>">
<input type="hidden" name="email" value="<?php echo $CandidateEmail; ?>">
<h5><b>Loan Details</b></h5>
<div class="form-group">
<label class="control-label">Duration (Monthly)</label>
<select class="form-control select2" name="duration">
<option>Select</option>
<option value="3">3 Months</option>
<option value="4">4 Months</option>
<option value="5">5 Months</option>
<option value="6">6 Months</option>
<option value="7">7 Months</option>
<option value="8">8 Months</option>
<option value="9">9 Months</option>
<option value="10">10 Months</option>
<option value="11">11 Months</option>
<option value="12">12 Months</option>
</select>
</div>
<div class="form-group">
<label>Amount</label>
<div>
<input class="form-control" required type="text range" min="10000" max="50000" name="amount" placeholder="Loan between 10,000 - 50,000"/>
</div>
</div>
<h5><b>Personal Details</b></h5>
<div class="form-group">
<label>S/o / W/o</label>
<input type="text" class="form-control" required placeholder="Enter S/o / W/o" name="fname" />
</div>
<div class="form-group">
<label>Age</label>
<input type="number" class="form-control" required placeholder="Enter Age" name="age" min="18" max="100" />
</div>
<div class="form-group">
<label>Address</label>
<input type="text" class="form-control" required placeholder="Enter Address" name="address" />
</div>
<div class="form-group">
<label>Purpose</label>
<input type="text" class="form-control" required placeholder="Enter Purpose" name="purpose" />
</div>
<h5><b>Witness Details</b></h5>
<div class="form-group">
<label>Name (Witness 1)</label>
<input type="text" class="form-control" required placeholder="Enter Name" name="wit1" />
</div>
<div class="form-group">
<label>Phone Number (Witness 1)</label>
<input type="tel" class="form-control" required placeholder="Enter Phone Number" name="wit_phn1" />
</div>
<div class="form-group">
<label>Relation (Witness 1)</label>
<input type="text" class="form-control" required placeholder="Enter Name" name="rel1" />
</div>
<div class="form-group">
<label>Name (Witness 2)</label>
<input type="text" class="form-control" required placeholder="Enter Name" name="wit2" />
</div>
<div class="form-group">
<label>Phone Number (Witness 2)</label>
<input type="tel" class="form-control" required placeholder="Enter Phone Number" name="wit_phn2" />
</div>
<div class="form-group">
<label>Relation (Witness 2)</label>
<input type="text" class="form-control" required placeholder="Enter Name" name="rel2" />
</div>
<h5><b>Identity Proof</b></h5>
<div class="form-group">
<label>Aadhar Card Number</label>
<div>
<input type="text" class="form-control" required
data-parsley-length="[12,12]" name="aadhar_no"
placeholder="Valid Aadhar Card Number"/>
</div>
</div>
<div class="form-group">
<label>PAN Card Number</label>
<div>
<input type="text" class="form-control" required
data-parsley-length="[10,10]" data-parsley-type="alphanum" name="pan_no"
placeholder="Valid PAN Card Number"/>
</div>
</div>
<h5><b>Account Details</b></h5>
<div class="form-group">
<label>Account Number</label>
<input type="text" class="form-control" required placeholder="Enter Account Number" name="acc_no" />
</div>
<div class="form-group">
<label>IFSC Code</label>
<input type="text" class="form-control" required placeholder="Enter IFSC Code" name="ifsc_code" />
</div>
<div class="form-group">
<label>Branch Name</label>
<input type="text" class="form-control" required placeholder="Enter Branch Name" name="branch" />
</div>
<div class="form-group">
<label>Bank Name</label>
<input type="text" class="form-control" required placeholder="Enter Bank Name" name="bank" />
</div>
<div class="form-group">
<label>Cheque Number</label>
<input type="text" class="form-control" required placeholder="Enter Cheque Number" name="chq_no" />
</div>
<h5><b>Upload Documents</b></h5>
<div class="form-group">
<label>User Photo</label>
<div class="m-b-30 dropzone dz-clickable dz-started">
<div class="fallback" >
<input name="user_photo" type="file" onchange="user(this);" id="upload1" required="">
<div id="upload_link1">
<img src="assets/images/demo.png" id="previewuser" class="preview">
</div>
</div>
</div>
</div>
<div class="form-group">
<label>Aadhar Photo</label>
<div class="m-b-30 dropzone dz-clickable dz-started">
<div class="fallback" >
<input name="aadhar_photo" type="file" onchange="aadhar(this);" id="upload2" required="">
<div id="upload_link2">
<img src="assets/images/demo.png" id="previewaadhar" class="preview">
</div>
</div>
</div>
</div>
<div class="form-group">
<label>PAN Card Photo</label>
<div class="m-b-30 dropzone dz-clickable dz-started">
<div class="fallback" >
<input name="pan_photo" type="file" onchange="pan(this);" id="upload3" required="">
<div id="upload_link3">
<img src="assets/images/demo.png" id="previewpan" class="preview">
</div>
</div>
</div>
</div>
<div class="form-group">
<label>Cheque Photo</label>
<div class="m-b-30 dropzone dz-clickable dz-started">
<div class="fallback" >
<input name="cheque_photo" type="file" onchange="cheque(this);" id="upload4" required="">
<div id="upload_link4">
<img src="assets/images/demo.png" id="previewcheque" class="preview">
</div>
</div>
</div>
</div>
<div class="form-group">
<label>Signature Photo</label>
<div class="m-b-30 dropzone dz-clickable dz-started">
<div class="fallback" >
<input name="sign_photo" type="file" onchange="sign(this);" id="upload5" required="">
<div id="upload_link5">
<img src="assets/images/demo.png" id="previewsign" class="preview">
</div>
</div>
</div>
</div>
<div class="form-group">
<div>
<button type="submit" class="btn btn-primary waves-effect waves-light" name="doc">
Submit
</button>
</div>
</div>
</form>
</div>
</div>
</div> <!-- end col -->
</div> <!-- end row -->
</div>
<!-- end page content-->
</div> <!-- container-fluid -->
</div> <!-- content -->
<?php include"include/footer.php"; ?>
</div>
<!-- ============================================================== -->
<!-- End Right content here -->
<!-- ============================================================== -->
</div>
<!-- END wrapper -->
<?php include"include/js.php"; ?>
<style type="text/css">
.preview
{
width: 100%;
padding: 10px;
}
#upload1,#upload2,#upload3,#upload4,#upload5{
display:none
}
.dropzone {
min-height: auto;
border: 2px dashed #fe0104;
background: #fe0104;
border-radius: 6px;
}
</style>
<script type="text/javascript">
$(function(){
$("#upload_link1").on('click', function(e){
e.preventDefault();
$("#upload1:hidden").trigger('click');
});
});
</script>
<script type="text/javascript">
$(function(){
$("#upload_link2").on('click', function(e){
e.preventDefault();
$("#upload2:hidden").trigger('click');
});
});
</script>
<script type="text/javascript">
$(function(){
$("#upload_link3").on('click', function(e){
e.preventDefault();
$("#upload3:hidden").trigger('click');
});
});
</script>
<script type="text/javascript">
$(function(){
$("#upload_link4").on('click', function(e){
e.preventDefault();
$("#upload4:hidden").trigger('click');
});
});
</script>
<script type="text/javascript">
$(function(){
$("#upload_link5").on('click', function(e){
e.preventDefault();
$("#upload5:hidden").trigger('click');
});
});
</script>
<script>
$(document).ready(function() {
$('form').parsley();
});
</script>
</body>
</html>