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certificate.php
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certificate.php
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<?php
session_start();
?>
<!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" maximum-scale=1.0, user-scalable=0">
<meta property="og:title" content="Taluka Panchayat - GOVERNMENT OF GUJARAT" />
<meta property="og:description" content=A Taluka Panchayat is a local government body in India that is responsible for the administration of a taluka, which is a sub-district level administrative unit." />
<meta property="og:image" content="https://i.ibb.co/FwbCBHF/fotor-2023-1-29-10-51-0.png" />
<title>Non-Creamy layer Certificate -Taluka Panchayat</title>
<!-- Favicon -->
<link rel="shortcut icon" type="image/x-icon" href="https://i.ibb.co/FwbCBHF/fotor-2023-1-29-10-51-0.png">
<link rel="stylesheet" href="certificate-style.css">
<!-- google font link -->
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Mulish:wght@600;700;900&family=Quicksand:wght@400;500;600;700&display=swap" rel="stylesheet">
<link rel="preconnect" href="https://fonts.googleapis.com"><link rel="preconnect" href="https://fonts.gstatic.com" crossorigin><link href="https://fonts.googleapis.com/css2?family=Poppins:ital,wght@0,300;0,400;0,500;0,600;0,700;0,800;1,300;1,400;1,500;1,600;1,700;1,800&family=Roboto:wght@300;400&display=swap" rel="stylesheet">
<link rel="stylesheet" href="https://unicons.iconscout.com/release/v4.0.0/css/line.css">
</head>
<body>
<header class="header" data-header>
<div class="container-div">
<a href="../../index.php" class="logo">
<img src="https://i.ibb.co/Lhyd2kg/menu-logo.png" alt="Taluka Panchayat logo" width="250px" class="nav-logo">
</a>
<button class="menu-toggle-btn" data-nav-toggle-btn>
<ion-icon name="menu-outline"></ion-icon>
</button>
<nav class="navbar">
<ul class="navbar-list">
<li>
<a href="index.php" class="navbar-link">Home</a>
</li>
<li>
<a href="index.php#hero" class="navbar-link">About</a>
</li>
<li>
<a href="index.php#services" class="navbar-link">Services</a>
</li>
<li>
<a href="index.php#features" class="navbar-link">Notice</a>
</li>
<li>
<a href="index.php#blog" class="navbar-link">Blog</a>
</li>
<li>
<div class="google_translate">
<a href="#" class="disclaimer" data-toggle="tooltip" data-placement="top">
<i class="icon icon-information2"></i>
</a>
<div id="google_translate_element"></div>
</div>
</li>
</ul>
</nav>
</div>
</header>
<div class="container">
<header>Non-Creamy layer Certificate For Gujarat Government</header>
<form action="code.php" method="POST">
<div class="form first">
<div class="details personal">
<span class="title">Personal Details</span>
<div class="fields">
<div class="input-field">
<label>Full Name</label>
<input type="text" placeholder="Enter your name" id="name" name="fullname" required>
</div>
<div class="input-field">
<label>Date of Birth</label>
<input type="date" placeholder="Enter birth date" name="dob" required >
</div>
<div class="input-field">
<label>Email</label>
<input type="text" placeholder="Enter your email" name="email" required >
</div>
<div class="input-field">
<label>Mobile Number</label>
<input type="number" placeholder="Enter mobile number" name="mobile" required pattern="/^-?\d+\.?\d*$/" onKeyPress="if(this.value.length==10) return false;" >
</div>
<div class="input-field">
<label>Gender</label>
<select required name="gender">
<option disabled selected>Select gender</option>
<option>Male</option>
<option>Female</option>
<option>Others</option>
</select>
</div>
<div class="input-field">
<label>Aadhar Card Number</label>
<input type="number" placeholder="Enter your Aadhar card Number" name="aadhar" required pattern="/^-?\d+\.?\d*$/" onKeyPress="if(this.value.length==12) return false;" >
</div>
<div class="input-field">
<label>Father name</label>
<input type="text" placeholder="Enter Father name" name="fathername" required >
</div>
<div class="input-field">
<label>Relation</label>
<select name="relation" required>
<option disabled selected>Select</option>
<option>દીકરો/પુત્ર</option>
<option>પુત્રી</option>
</select>
</div>
<div class="input-field">
<label>Caste</label>
<select name="caste">
<option disabled selected required>Select</option>
<option>Bhathi Rajput/ભાથી રાજપૂત</option>
<option>Charan gadhvi/ચારણ ગઢવી</option>
<option>Chaudhary/ચૌધરી</option>
<option>Prajapati/પ્રજાપતિ</option>
</select>
</div>
</div>
<div class="details ID">
<span class="title">Address Details</span>
<div class="fields">
<div class="input-field">
<label>District</label>
<select required name="district" required>
<option disabled selected>Select District</option>
<option>Banaskantha </option>
</select>
</div>
<div class="input-field">
<label>Taluka</label>
<select required name="taluka" required>
<option disabled selected>Select Taluka</option>
<option>Vav</option>
<option>Tharad</option>
<option>Dhanera</option>
<option>Dantiwada</option>
<option>Vadgam</option>
<option>Palanpur</option>
<option>Deesa</option>
<option>Deodar</option>
<option>Bhabhar</option>
<option>Kankrej</option>
</select>
</div>
<div class="input-field">
<label>Village</label>
<select required name="village" required>
<option disabled selected >Select Village</option>
<option>Pasvadal</option>
<option>Malosana</option>
<option>Majadar</option>
<option>Teniwada</option>
<option>Basu</option>
<option>Bharkawada</option>
</select>
</div>
<div class="input-field">
<label>Upload Income Proof </label>
<input type="file" style="padding-top: 10px;" name="IncomeProof" required>
</div>
<div class="input-field">
<label>Annual Income</label>
<input type="number" placeholder="Enter Annual Income" id="income-id" required name="annualincome">
</div>
<div class="input-field">
<label>Issue date </label>
<input type="date" name="issuedate" required >
</div>
<div class="input-field">
<label>Upload Caste Certificate</label>
<input type="file" style="padding-top: 10px;" required name="CasteCertificate">
</div>
<div class="input-field">
<label>Certificate number</label>
<input type="number" placeholder="Enter Certificate number" required name="Certificatenumber" >
</div>
<div class="input-field">
<label>Photo</label>
<input type="file" accept="image/*" capture="user" required style="padding-top: 10px;" name="Photo">
</div>
<div class="input-field" style="display:none;">
<label>Remark</label>
<textarea name="remark" cols="30" rows="10"></textarea>
</div>
<div class="input-field" style="display:none;">
<label>Status</label>
<select name="fstatus">
<option selected>Pending</option>
<option>Approved</option>
<option>Cancelled</option>
</select>
</div>
<button class="sumbit" name="sumbit">
<span class="btnText">Submit</span>
<i class="uil uil-navigator"></i>
</button>
</div>
</div>
</div></div></form></div>
<script>
'use strict';
// navbar variables
const navToggleBtn = document.querySelector("[data-nav-toggle-btn]");
const header = document.querySelector("[data-header]");
navToggleBtn.addEventListener("click", function () {
header.classList.toggle("active");
});
</script>
<script type="text/javascript">
function googleTranslateElementInit()
{
new google.translate.TranslateElement({pageLanguage: 'en', includedLanguages: 'gu,hi,en', layout: google.translate.TranslateElement.InlineLayout.SIMPLE}, 'google_translate_element');
}
</script>
<script type="text/javascript" src="//translate.google.com/translate_a/element.js?cb=googleTranslateElementInit"></script>
<!-- - ionicon link -->
<script type="module" src="https://unpkg.com/ionicons@5.5.2/dist/ionicons/ionicons.esm.js"></script>
<script nomodule src="https://unpkg.com/ionicons@5.5.2/dist/ionicons/ionicons.js"></script>
</body>
</html>