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death_registration.php
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death_registration.php
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<?php
include('services/user/session.php');
?>
<html>
<head>
<title>Death Registration</title>
<link rel="stylesheet" href="./style.css" />
<script src="https://kit.fontawesome.com/a076d05399.js"></script>
<style type = "text/css">
body {
font-family:Arial, Helvetica, sans-serif;
font-size:14px;
}
label {
font-weight:bold;
width:100px;
font-size:14px;
}
.box {
border:#666666 solid 1px;
width:100%;
}
</style>
</head>
<body bgcolor = "#FFFFFF">
<nav>
<div class="menu">
<div class="logo">
<a href="/home.php">Civil Registry</a>
</div>
<ul>
<label hidden style="color: aliceblue;">(Admin)</label>
<li><a href="services/user/logout.php">Logout</a></li>
</ul>
</div>
</nav><br><br><br><br><br>
<div align = "center">
<div style = "width:900px; height: 680px; border: solid 1px #333333; " align = "left">
<div style = "background-color:#333333; color:#FFFFFF; padding:3px;"><b>Death Registration</b></div>
<div style = "width:80%; margin:10%">
<form action = "services/registration/register_death.php" method = "post" enctype="multipart/form-data">
<div style="display: flex;">
<div style="margin-right:25px ;">
<label>User ID :</label><input disabled type = "text" name = "user_id" class = "box"/><br /><br/>
<label>Deceased Name :</label><input type = "text" name = "deceased_name" class = "box" /><br/><br/>
<label>Deceased Sex :<input type="radio" id="male" name="deceased_sex" >
<label for="male">Male</label>
<input type="radio" id="female" name="deceased_sex" >
<label for="female">Female</label>
<input type="radio" id="others" name="deceased_sex" >
<label for="others">Others</label><br><br>
<label>Deceased Age :</label><input type = "number" min="1" max="200" name = "deceased_age" class = "box" /><br/><br/>
<label>Deceased Housename :</label><input type = "text" name = "deceased_housename" class = "box" /><br/><br/>
<label>Deceased City:</label><input type = "text" name = "deceased_city" class = "box" /><br/><br/>
<label>Deceased District:</label><input type = "text" name = "deceased_district" class = "box" /><br/><br/>
<label>Deceased State:</label><input type = "text" name = "deceased_state" class = "box" /><br/><br/><br>
<div align = "center"><input type = "submit" value = " Submit " /></div><br><br>
</div>
<div style="margin-left: 30px;">
<label>Deceased Country:</label><input type = "text" name = "deceased_country" class = "box" /><br/><br/>
<label>Deceased Pin:</label><input type = "text" name = "deceased_pin" class = "box" /><br/><br/>
<label>Father's Name :</label><input type = "text" name = "father_name" class = "box" /><br/><br/>
<label>Mother's Name :</label><input type = "text" name = "mother_name" class = "box" /><br/><br/>
<label>Place of Death :</label><input type = "text" name = "place_of_death" class = "box" /><br/><br/>
<label>Cause Certificate ID :</label><input type = "text" name = "cause_certificate_id" class = "box" /><br/><br/>
<label>Actual Cause :</label><input type = "text" name = "actual_cause" class = "box" /><br/><br/>
<label>Death Document</label><input type="file" name="death_document"><br><br>
<div align = "center"> <button type="reset">Reset</button></div><br><br>
</div>
</div>
</form>
<div style = "font-size:11px; color:#cc0000; margin-top:10px">
</div>
</div>
</div>
</div>
</body>
</html>