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index.html
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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet">
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js"></script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.css"/>
<!-- <link rel="stylesheet" href="../style.css"> -->
<title>Register</title>
</head>
<style>
.card-default {
color: #333;
background: linear-gradient(#fff,#ebebeb) repeat scroll 0 0 transparent;
font-weight: 600;
border-radius: 6px;
}
</style>
<body>
<div class="container">
<div id="accordion">
<div class="row">
<div class="col-lg-12">
<div class="text-center pt-5">
<h3>National ID Registration Form</h3>
</div>
</div>
</div>
<div class="card card-default shadow-lg mb-5 bg-body rounded">
<div class="card-header">
<h4 class="card-title">
<a data-toggle="collapse" data-parent="#accordion" href="#collapse1">
<i class="glyphicon glyphicon-search text-gold"></i>
<b>TO BE COMPLETED BY APPLICANT</b>
</a>
</h4>
</div>
<div id="collapse1" class="collapse show pb-4">
<div class="card-body">
<div class="row">
<div class="col-md-3 col-lg-4">
<div class="form-group">
<label class="control-label">Last Name</label>
<input type="text" id="lastname" class="form-control" />
</div>
</div>
<div class="col-md-1 col-lg-4">
<div class="form-group">
<label class="control-label">First Name</label>
<input type="text" id="firstname" class="form-control" />
</div>
</div>
<div class="col-md-1 col-lg-2">
<div class="form-group">
<label class="control-label">Middle Name</label>
<input class="form-control" id="midname" type="text" />
</div>
</div>
<div class="col-md-2 col-lg-2">
<div class="form-group">
<label class="control-label">Date Of Birth</label>
<div class="input-group date">
<input class="form-control" id="birthdate" type="date"/>
</span>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4 col-lg-4">
<div class="form-group">
<label class="control-label">Mailing Address</label>
<input type="email" id="mailadd" class="form-control"/>
</div>
</div>
<div class="col-md-1 col-lg-2">
<div class="form-group">
<label class="control-label">Region</label>
<input type="text" id="region" class="form-control"/>
</div>
</div>
<div class="col-md-1 col-lg-3">
<div class="form-group">
<label class="control-label">City</label>
<input type="text" id="city" class="form-control"/>
</div>
</div>
<div class="col-md-3 col-lg-3">
<div class="form-group">
<label class="control-label">Municipality</label>
<input type="text" id="municipality" class="form-control"/>
</div>
</div>
<div class="col-md-3 col-lg-2">
<div class="form-group">
<label class="control-label">Zip Code</label>
<input type="text" id="zipcode" inputmode="numeric" min="4" max="10" class="form-control"/>
</div>
</div>
<div class="col-md-3 col-lg-2">
<div class="form-group">
<label class="control-label">Street Name</label>
<input type="text" id="streetname" class="form-control"/>
</div>
</div>
<div class="col-md-3 col-lg-2">
<div class="form-group">
<label class="control-label">Contact Number</label>
<input type="tel" id="contact" class="form-control"/>
</div>
</div>
<div class="col-md-3 col-lg-2">
<div class="form-group">
<label class="control-label">Father's Name</label>
<input type="text" id="fathername" class="form-control"/>
</div>
</div>
<div class="col-md-3 col-lg-2">
<div class="form-group">
<label class="control-label">Mother's Name</label>
<input type="text" id="mothername" class="form-control"/>
</div>
</div>
<div class="col-sm-1 col-sm-1">
<div class="form-group">
<label class="control-label">Gender</label>
<select name="gender" id="gender" class="form-control">
<option value="0">Sex..</option>
<option value="female">Female</option>
<option value="male">Male</option>
<option value="other">Other</option>
</select>
</div>
</div>
<div class="col-md-1 col-lg-1">
<div class="form-group">
<label class="control-label">Age</label>
<input type="text" inputmode="numeric" id="age" class="form-control"/>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="container">
<div class="form-group">
<div class="text-center">
<input type="button" class="btn btn-outline-secondary text-dark px-5 shadow-lg mb-1 bg-body rounded" id="btn-submit" value="Submit">
</div>
<div class="text-center">
<a href="./public/idcard.html" class="text-decoration-underline" id="request">Requests</a>
</div>
</div>
</div>
</body>
<script src="public/jquery.js"></script>
<script src="public/register.js"></script>
</html>