bnmbertsurhetertertertertertertertpdf'tdfg

hjkhghopjkertteerterterterertertrtoirh bnmbertsurhetertertertertertertertpdf'tdfg

<?php include "includes/db.php"; ?>
<!DOCTYPE html>
<html dir="ltr" lang="en">

<head>

<meta name="viewport" content="width=device-width,initial-scale=1.0"/>
<meta http-equiv="content-type" content="text/html; charset=UTF-8"/>
<meta name="description" content="#" />
<meta name="author" content="Paramedical"/>

<title>Correction Form</title>

<link href="images/favicon.png" rel="shortcut icon" type="image/png">
<link href="images/apple-touch-icon.png" rel="apple-touch-icon">
<link href="images/apple-touch-icon-72x72.png" rel="apple-touch-icon" sizes="72x72">
<link href="images/apple-touch-icon-114x114.png" rel="apple-touch-icon" sizes="114x114">
<link href="images/apple-touch-icon-144x144.png" rel="apple-touch-icon" sizes="144x144">

<link href="css/bootstrap.min.css" rel="stylesheet" type="text/css">
<link href="css/jquery-ui.min.css" rel="stylesheet" type="text/css">
<link href="css/animate.css" rel="stylesheet" type="text/css">
<link href="css/css-plugin-collections.css" rel="stylesheet"/>

<link id="menuzord-menu-skins" href="css/menuzord-skins/menuzord-boxed.css" rel="stylesheet"/>

<link href="css/style-main.css" rel="stylesheet" type="text/css">

<link href="css/preloader.css" rel="stylesheet" type="text/css">

<link href="css/custom-bootstrap-margin-padding.css" rel="stylesheet" type="text/css">

<link href="css/responsive.css" rel="stylesheet" type="text/css">

<link  href="js/revolution-slider/css/settings.css" rel="stylesheet" type="text/css"/>
<link  href="js/revolution-slider/css/layers.css" rel="stylesheet" type="text/css"/>
<link  href="js/revolution-slider/css/navigation.css" rel="stylesheet" type="text/css"/>

<link href="css/colors/theme-skin-orange.css" rel="stylesheet" type="text/css">

<script src="js/jquery-2.2.0.min.js"></script>
<script src="js/jquery-ui.min.js"></script>
<script src="js/bootstrap.min.js"></script>

<script src="js/jquery-plugin-collection.js"></script>

<script src="js/revolution-slider/js/jquery.themepunch.tools.min.js"></script>
<script src="js/revolution-slider/js/jquery.themepunch.revolution.min.js"></script>

<script async src="https://www.googletagmanager.com/gtag/js?id=UA-147079398-1"></script>
<script>
  window.dataLayer = window.dataLayer || [];
  function gtag(){dataLayer.push(arguments);}
  gtag('js', new Date());

gtag('config', 'UA-147079398-1');
</script>
</head>
<body class="has-side-panel side-panel-right fullwidth-page side-push-panel">
<div class="body-overlay"></div>
<div id="wrapper" class="clearfix">

<?php include "includes/header.php"; ?>
  
  
   
  <div class="main-content">
    
    <section class="inner-header divider layer-overlay overlay-deep" data-bg-img="images/bg/bg5.jpg">
      <div class="container pt-90 pb-50">
        
        <div class="section-content">
          <div class="row"> 
            <div class="col-md-12 xs-text-center">
              <h3 class="font-28">Correction Form</h3>
            </div>
          </div>
        </div>
      </div>
    </section>

<section>
      <div class="container">
        <div class="row">
	<div class="col-sm-12">
            <div class="sidebar sidebar-right mt-sm-30 mb-sm-30">
			    <div class="sidebar-widget p-15 pt-10">
                    <div class="border-2px border-theme-colored p-15">
                  <h4 class="m-0 mb-30"> <i class="fa fa-envelope text-theme-colored"></i> Correction Form ( All the fields are mandatory. ) </h4>
				
                  
				  <div id="appointment_form_at_home" name="appointment_form_at_home" >
                        <div class="row">
						    <div class="col-sm-6">
                                 <div class="form-group">
                                     <label for="form_name">Name of Candidate<small>*</small></label>
                                     <input id="center" name="centername" class="form-control" type="text"  placeholder="Enter center name..." aria-required="true" required="">
                                 </div>
                            </div>
    						<div class="col-sm-6">
                                <div class="form-group">
                                    <label for="form_name">Registration No./ Enrollment No.<small>*</small></label>
                                    <input id="ngo" name="ngoname" class="form-control" type="text"  placeholder="Registration No./ Enrollment No" aria-required="true" required="">
                                </div>
                            </div>
                            <div class="col-sm-6">
                                <div class="form-group">
                                    <label for="form_name">Father's/Husband's Name<small>*</small></label>
                                    <input id="phone" name="ngoname" class="form-control" type="text"  placeholder="Father's/Husband's Name" aria-required="true" required="">
                                </div>
                            </div>
                            <div class="col-sm-6">
                                <div class="form-group mb-10">
                                    <label for="form_phone">Contact Number <small>*</small></label>
                                    <input id="contact" name="contact" class="form-control" type="text" oninput="this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..?)\../g, '$1');" maxlength="10" placeholder="Enter contact..." aria-required="true" required="">
                                </div>
                            </div>
						    <div class="col-sm-12">
					            <div class="form-group mb-10">
                                    <label for="form_message">Address <small>*</small></label>
                                    <textarea id="address" name="postaladdress" class="form-control required"  placeholder="Enter postal address..." rows="5" aria-required="true" required=""></textarea>
                                </div>
					        </div>
					        <div class="col-sm-12">
					            <div class="form-group mb-10">
                                    <label for="form_message">Correction <small>*</small></label>
                                    <textarea id="correction" name="postaladdress" class="form-control required"  placeholder="Correction..." rows="5" aria-required="true" required=""></textarea>
                                </div>
					        </div>
					        
    						<div class="col-sm-12">
    					        <div class="form-group mb-10">
        						    <h5> (Registration Certificate, Degree/Diploma/Certificate, Photo, Aadhar card, Character certificate, Domicile certificate, Pan card,) in one PDF</h5>
                                    <label for="form_attachment"> Upload Docs: </label>
                                    <input type="file" class="file" id="formFile" name="formFile" multiple="" required>
        						    
                                </div>
                            </div>
        					<div class="col-sm-12">
                                <div class="form-group mb-0 mt-10">
                                    <input id="form_botcheck" name="form_botcheck" class="form-control" type="hidden" value="">
                                    <button type="submit" name="cvubmit" id="myform" class="btn btn-dark btn-theme-colored" data-loading-text="Please wait...">Submit</button>
                                </div>
        					</div>
					   </div>
                  </div>
    
                  
                </div>
                </div>
	  </div>
      </div>
	  </div>
	  
	       
	  </div>
    </section>

</div>

<?php include "includes/footer.php"; ?>
  <script src="https://cdn.jsdelivr.net/npm/sweetalert2@11"></script>
    <script>
        $(document).ready(function(){
            $("#myform").click(function(){
                
                var center = $("#center").val();
                var ngo = $("#ngo").val();
                var address = $("#address").val();
                var contact = $("#contact").val();
                var phone = $("#phone").val();
                var correction = $("#correction").val();
                var corr = 'corr';
			    var email = 'paramedicalcouncilup@gmail.com';
			    
			    if(center == ""){
			        return false;
			    }
			   
			    var fd = new FormData();
			    fd.append("center", center);
			    fd.append("ngo", ngo);
			    fd.append("address", address);
			    fd.append("contact", contact);
			    fd.append("phone", phone);
			    fd.append("correction", correction);
			    
                
                $.ajax({
                    url : 'ajax/correctio-ajax.php',
                    type:  'POST',
                    data: fd,
                    contentType: false,
                    processData: false,
                    success: function (data) {
                       if(data == 1){
                            Swal.fire("Make Payment!").then((result) => {
                                  if (result.isConfirmed) {
                                    window.location.href = "easebuzz.php?name=" + center + "&mobile=" + contact + "&email=" + email + "&type=" + corr;
                                  }
                                })
                       }else if(data == 2){
                           alert("Institute Already Taken Addmission!, check Your Registration");
                        //   window.location.href="reg-check.php";
                       }
                    }
                });
            });
        });
	
	</script>