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applicantpage1.html
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applicantpage1.html
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<html lang="en">
<head>
<meta charset="utf-8">
<title>Application Form</title>
<link rel="stylesheet" type="text/css" href="style.css" />
</head>
<body>
<div class="container">
<div class="header_app">
<fieldset border=5>
<div class="reg_header">
<legend>
<br><br>
<h1 class="reg_header_title"><b>NOC Application</b></h1><br>
</legend>
<h1 class="reg_header_text">Apply for Petrol Pump<br><br></h1>
</div>
</fieldset>
</div>
<section id="content">
<form action="">
<h1>Application Form</h1>
<div>
Name of oil Company <input type="text" placeholder="Name of oil Company" required="" id="" />
</div>
<div>
Name of applicant
<input type="text" placeholder="Name of applicant" required="" id="" />
</div>
<div>
S/o, W/o, D/o
<input type="text" placeholder="S/o,w/o,d/o" required="" id="" />
</div>
<div>
Permanent address
<input type="text" placeholder="Permanent address" required="" id="" />
</div>
<div>
Mobile Number
<input type="text" placeholder="Mobile Number" required="" id="" />
</div>
<div>
Tehsil
<input type="text" placeholder="Tehsil" required="" id="" />
</div>
<div>
Sub Division
<input type="text" placeholder="Sub Division" required="" id="" />
</div>
<div>
District
<input type="text" placeholder="District" required="" id="" />
</div>
<div>
Address of location where petrol pump is to be installed
<input type="text" placeholder="Address of location where petrol pump is to be installed" required="" id="password" />
</div>
<br>
<div>
attachments-
<br>
affidavit from application
<input type="file" placeholder="upload" required="" id="" />
</div>
<br>
<div>
Site Plan
<input type="file" placeholder="upload" required="" id="" />
</div>
<br>
<div>
Aks Sajra
<input type="file" placeholder="upload" required="" id="" />
</div>
<br>
<div>
letter of entitlement
<input type="file" placeholder="upload" required="" id="" />
</div>
<br>
<div>
Fard/Jamabandi
<input type="file" placeholder="upload" required="" id="" />
</div>
<div id="submit_application">
<input type="submit" value="Submit your application" id="" />
<a href="#"></a>
</div>
</form>
</section>
</div>
<div class="footer">
<div class="footer_text">© 2015 Government of Punjab.    All rights reserved</div>
</div>
</body>
</html>