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Rev Author Line No. Line
21920 rajender 1
<html>
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<head>
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<script type="text/javascript" src="$action.getContextPath()/js/jquery-1.10.2.min.js"></script>
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<link rel="stylesheet" href="$action.getContextPath()/css/bootstrap.min.css"/>
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<link rel="stylesheet" type="text/css" href="$action.getContextPath()/css/main.css"/>
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<!-- Optional theme -->
8
<link rel="stylesheet" href="$action.getContextPath()/css/bootstrap-theme.min.css" />
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<!-- Latest compiled and minified JavaScript -->
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<script src="$action.getContextPath()/js/bootstrap.min.js" type="script/javascript"></script>
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<script src="$action.getContextPath()/js/bootstrapValidator.js"></script>
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<script src="$action.getContextPath()/js/reg.js"></script>
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<script src="$action.getContextPath()/js/reqformvalidator.js"></script>
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<script src="$action.getContextPath()/js/fofoedit.js"></script>
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<script type="text/javascript">
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var jsonObj=$action.fofoFormJson();
18
console.log(JSON.stringify(jsonObj));
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$(document).ready(function(){
20
readForm();
21
    $("input[name$='bEntity']").click(function() {
22
        var test1 = $(this).val();
23
       $(".box").hide();
24
       $('input[name=dinNumber]').each(function(){
25
         $(this).prop('disabled', true);
26
      });
27
 
28
       var dinNumberInput = $("#sale"+test1+ " input[name=dinNumber]");
29
       if (dinNumberInput.prop('disabled') == true){
30
            dinNumberInput.prop('disabled', false);
31
       } 
32
        $("#sale" + test1).show();
33
});
34
});
35
</script>
36
 
37
<script type="text/javascript">
38
$(document).ready(function(){
39
    $("input[name$='bPmpDetail']").click(function() {
40
        var test1 = $(this).val();
41
       $(".pmp").hide();
42
        $("#Pmp" + test1).show();
43
    });
44
});
45
 
46
</script>
47
 
48
<script type="text/javascript">
49
$(document).ready(function(){
50
    $("input[name$='shopStatus']").click(function() {
51
        var test1 = $(this).val();
52
          $("#shopsemifurnished, #shopfullfurnished").find("input[type=checkbox]").each(function(){
53
         $(this).prop('disabled', true);
54
    });
55
 
56
       $(".status").hide();
57
       $("#shop" + test1).show();
58
       $("#shop" + test1).find("input[type=checkbox]").prop('disabled', false);
59
 
60
    });
61
});
62
 
63
</script>
64
<script type="text/javascript">
65
$(document).ready(function(){
66
    $("input[name$='sellingOnline']").click(function() {
67
        var test1 = $(this).val();
68
       $(".Names").hide();
69
        $("#selling" + test1).show();
70
    });
71
});
72
 
73
</script>
74
 
75
 
76
<script type="text/javascript">
77
$(document).ready(function(){
78
    associateValidator();
79
    $("input[name$='insurance']").click(function() {
80
        var test1 = $(this).val();
81
       $(".doc").hide();
82
        $("#doc" + test1).show();
83
    });
84
});
85
 
86
</script>
87
 
88
<script type="text/javascript">
89
$(document).ready(function(){
90
    $("input[name$='loan']").click(function() {
91
        var test1 = $(this).val();
92
       $(".document").hide();
93
        $("#document" + test1).show();
94
        $("#showHide").show();
95
    });
96
});
97
 
98
function queryStringToJSON(queryString) {
99
  var pairs = queryString.split('&');
100
  var result = {};
101
  pairs.forEach(function(pair) {
102
    pair = pair.split('=');
103
    result[pair[0]] = decodeURIComponent(pair[1] || '');
104
 
105
  });
106
  return result;
107
}
108
 
109
 
110
function jQFormSerializeArrToJson(formSerializeArr){
111
 var jsonObj = {};
112
 jQuery.map( formSerializeArr, function( n, i ) {
113
     jsonObj[n.name] = n.value;
114
 });
115
 return jsonObj;
116
}
117
 
118
</script>
119
 
120
<style>
121
.loading-image {
122
position: fixed;
123
top: 50%;
124
left: 50%;
125
margin-top: -50px;
126
margin-left: -100px;
127
z-index: 100;
128
}
129
</style>
130
 
131
</head>
132
 
133
<body>
134
<div class="container">
135
    <div class="row">
136
         <div class ="header">   
137
		 <h3 class="header">HOTSPOT PARTNER STORE</h3>
138
         <h4 class="header">Powered by Profit Mandi (A Unit of Spice Group)</h4>
139
         </div>
140
 
141
        <div class="header">
142
            <h5 class="header">APPLICATION FOR REGISTRATION</h5>
143
       </div>  
144
        <hr />
145
 
146
        <div class="row">
147
            <div class="col-sm-8">
148
 
149
                <form role="form" name="myform" id ="form"  enctype="multipart/form-data"  data-toggle="validator" novalidate>
150
             <h4 class="page-header">1. Registered Business Name of HSPS (in Block Letters)</h4>
151
                     <div class="form-group ">
152
 
153
                     <label for=""></label>
154
                     <input type="text" name="registeredBusinessName" id="demo" class="bform" placeholder="Business Name"/>
155
 
156
 
157
                     </div>
158
 
159
 
160
             <h4 class="page-header">2. Registered Address (In Block Letters)</h4>
161
 
162
                    <div class="form-group float-label-control">
163
                        <label for="">Line 1</label>
164
                        <input type="text" name ="line1" class="form-control" placeholder="Line 1">
165
                    </div>
166
 
167
                     <div class="form-group float-label-control">
168
                      <label for="">Line 2</label>
169
                        <input type="text" name ="line2" class="form-control" placeholder="Line 2">
170
                    </div>
171
                     <div class="form-group float-label-control">
172
                        <label for="">Line 3</label>
173
                        <input type="text" name="line3" class="form-control" placeholder="Line 3">
174
                    </div>
175
                     <div class="form-group float-label-control">
176
                        <label for="">City</label>
177
                        <input type="text" name="city" class="form-control" placeholder="City">
178
                    </div>
179
                      <div class="form-group float-label-control">
180
                        <label for="">District</label>
181
                        <input type="text" name="district" class="form-control" placeholder="District">
182
                    </div>
183
                     <div class="form-group float-label-control">
184
                        <label for="">Pincode</label>
185
                        <input  type="text" name="pincode" maxlength="6" class="form-control" pattern="[0-9]{6}" title="Please enter correct Pin Code"placeholder="Pincode">
186
                      </div>  
187
 
188
                     <div class="form-group float-label-control">
189
 
190
                      <select class="form-control" name = "state" placeholder="State">
191
                       <option value=" ">State</option>
192
                     <option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
193
                            <option value="Andhra Pradesh">Andhra Pradesh</option>
194
                            <option value="Arunachal Pradesh">Arunachal Pradesh</option>
195
                            <option value="Assam">Assam</option>
196
                            <option value="Bihar">Bihar</option>
197
                            <option value="Chandigarh">Chandigarh</option>
198
                            <option value="Chhattisgarh">Chhattisgarh</option>
199
                            <option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
200
                            <option value="Daman and Diu">Daman and Diu</option>
201
                            <option value="Delhi">Delhi</option>
202
                            <option value="Goa">Goa</option>
203
                            <option value="Gujarat">Gujarat</option>
204
                            <option value="Haryana">Haryana</option>
205
                            <option value="Himachal Pradesh">Himachal Pradesh</option>
206
                            <option value="Jammu and Kashmir">Jammu and Kashmir</option>
207
                            <option value="Jharkhand">Jharkhand</option>
208
                            <option value="Karnataka">Karnataka</option>
209
                            <option value="Kerala">Kerala</option>
210
                            <option value="Lakshadweep">Lakshadweep</option>
211
                            <option value="Madhya Pradesh">Madhya Pradesh</option>
212
                            <option value="Maharashtra">Maharashtra</option>
213
                            <option value="Manipur">Manipur</option>
214
                            <option value="Meghalaya">Meghalaya</option>
215
                            <option value="Mizoram">Mizoram</option>
216
                            <option value="Nagaland">Nagaland</option>
217
                            <option value="Orissa">Orissa</option>
218
                            <option value="Pondicherry">Pondicherry</option>
219
                            <option value="Punjab">Punjab</option>
220
                            <option value="Rajasthan">Rajasthan</option>
221
                            <option value="Sikkim">Sikkim</option>
222
                            <option value="Tamil Nadu">Tamil Nadu</option>
223
                            <option value="Tripura">Tripura</option>
224
                            <option value="Telangana">Telangana</option>
225
                            <option value="Uttaranchal">Uttaranchal</option>
226
                            <option value="Uttar Pradesh">Uttar Pradesh</option>
227
                            <option value="West Bengal">West Bengal</option>
228
                                              </select>
229
                    </div>
230
 
231
 
232
                      <div class="form-group float-label-control">
233
                        <label for="">Email1</label>
234
                        <input type="email" class="form-control" name="registeredEmail1" placeholder="Email1">
235
                      </div>  
236
                         <p>Example:- xyz<strong>.hsps@gmail.com</strong></p>
237
 
238
 
239
 
240
                        <div class="form-group float-label-control">
241
                        <label for="">Email2</label>
242
                        <input type="email" class="form-control" name="registeredEmail2" placeholder="Email2">
243
                      </div> 
244
 
245
 
246
                       <div class="form-group float-label-control">
247
                        <label for="">Mobile</label>
248
                        <input  type="text" class="form-control" name="mobile" maxlength = "10" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Mobile">
249
                      </div>  
250
 
251
                    <label>Landline</label>
252
                      <div class="form-group Pmpform">
253
                      <input type="text" name="stdcode" maxlength = "5" pattern="[0-9]*" title="Please enter valid Phone number" placeholder="STDcode"/> 
254
 
255
 
256
                      <input type="text" name="telephone" maxlength = "10" pattern="[0-9]*" title="Please enter valid Phone number" placeholder="Telephone"/>
257
                      </div>
258
 
259
 
260
 
261
             <h4 class="page-header">3. Type of Business Entity</h4>
262
                   <div class="funkyradio">
263
 
264
                    <div class="funkyradio-primary">
265
                        <input type="radio" name="bEntity" id="radio1" value="SaleProprietorship" required>
266
                        <label for="radio1">Proprietor</label>
267
                    </div>
268
                    <div class="funkyradio-primary">
269
                        <input type="radio" name="bEntity" id="radio2" value="Partnership" required>
270
                        <label for="radio2">Partnership</label>
271
                    </div>
272
                    <div class="funkyradio-primary">
273
                        <input type="radio" name="bEntity" id="radio3" value="PrivateLimitedCompany" required>
274
                        <label for="radio3">Private Limited company</label>
275
                    </div>
276
                    <div class="funkyradio-primary">
277
                        <input type="radio" name="bEntity" id="radio4" value="LimitedLiabilityPartnership" required>
278
                        <label for="radio4">Limited Liability Partnership</label>
279
                    </div>
280
                </div>
281
                  <div class ="Entity">
282
                    <div class="SaleProprietorship box" id ="saleSaleProprietorship">Upload <strong>Proprietership proof</strong></div>
283
                     <div class="partnership box" id="salePartnership">Upload <strong>Partnership Deed</strong></div>
284
                     </div>
285
                      <div class="limitedcompany box" id="salePrivateLimitedCompany">
286
                      <div class="form-group float-label-control">
287
                        <label for="">DIN Number</label>
288
                        <input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number">
289
                    </div>Upload <strong>Incorporation certificate,Memorandum & Article of association</strong>
290
                      </div>
291
 
292
 
293
                      <div class="LimitedLiabilityPartnership box" id="saleLimitedLiabilityPartnership">
294
 
295
 
296
                           <div class="form-group float-label-control">
297
                        <label for="">DIN Number</label>
298
                        <input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number">
299
                    </div>Upload <strong>Registration certificate & partnership Deed</strong>
300
                     </div>
301
 
302
                    <div class = "form-group file upload"> 
303
                   <input type="file" accept="application/pdf,image/*" name = "bEntityDoc"  />
304
 
305
                  <a href="somelink" id="link-bEntityDoc" style="display:none">View bEntity Document</a>
306
 
307
                    </div>
308
 
309
 
310
                     <h4 class="page-header">4. Goods And Services Tax Number(GST)</h4>
311
                    <div class="Pmpform">
312
 
313
                        <input type="text" name="gst" class="bform" placeholder="Goods And Services Tax Number"/>
314
                    </div>
315
                     <p>Provide Copy of GST document</p>
316
                    <div class = "file upload"> 
317
                   <input type="file"  accept="application/pdf,image/*" name ="gstDoc">
318
                     <a href="somelink" id="link-gstDoc" style="display:none">View GST Document</a>
319
                    </div>
320
 
321
 
322
                     <h4 class="page-header">5. Permanent Account Number(PAN)</h4>
323
                    <div class="form-group ">
324
 
325
                     <label for=""></label>
326
                     <input type="text" name="pan" maxlength="10" class="bform" placeholder="Permanent Account Number"/></div>
327
                     <p>Provide Copy of PAN </p>
328
 
329
                    <div class = "form-group file upload"> 
330
 
331
                   <input type="file" accept="application/pdf,image/*" id ="panDoc"  name="panDoc">
332
                   <a href="somelink" id="link-panDoc" style="display:none">View Pan Document</a>
333
                    </div>
334
 
335
 
336
             <h4 class="page-header">6. Full Details Of Business Entity</h4>
337
 
338
                   <div class="funkyradio">
339
                    <div class="funkyradio-primary">
340
                        <input type="radio" name="bPmpDetail" id="business1" value="Proprietor" required>
341
                        <label for="business1">Proprietor</label>
342
                    </div>
343
                    <div class="funkyradio-primary">
344
                        <input type="radio" name="bPmpDetail" id="business2" value="Partners" required>
345
                        <label for="business2">Partners</label>
346
                    </div>
347
                    <div class="funkyradio-primary">
348
                        <input type="radio" name="bPmpDetail" id="business3" value="Directors" required>
349
                        <label for="business3">Directors</label>
350
                    </div>
351
                </div>
352
 
353
                <div class="tablecontainer">
354
   <table class="businessdetail">
355
              <tr> 
356
              <th class ="PMPName">Name</th>
357
              <th  class="PMPAddress">Address</th> 
358
              <th class="PMPtelno">Mobile</th>
359
              <th class="PMPpan">PAN</th>
360
              <th class="PMPAdhaar">Aadhaar Number</th>
361
              <th class="PMPemail">Email</th>
362
              <th class="PMPownership">Share %</th>
363
 
364
               </tr>
365
            <tr>
366
 
367
                   <td class="form-group"><input type="text" name="proprietorBusineesName"size="25"></td>
368
                   <td class="form-group"><textarea row="3" name="proprietorAddress"></textarea></td>
369
                   <td class="form-group"><input type="text" name="proprietorPhone" maxlength="10" pattern="[0-9]{10}"size="10"></th>
370
                   <td class="form-group"><input type="text" name="proprietorPan" maxlength="10" title="Please enter correct pan number"size="10"></td>
371
                    <td class="form-group"><input type="text"  name= "proprietorAdhaar" size="15"></td>
372
                   <td class="form-group"><input type="email"  name= "proprietorEmail" size="20"></td>
373
                   <td class="form-group"><input type="text" pattern="[0-9]" name="proprietorOwner" size="10"></td>
374
 
375
                   </tr>
376
 
377
 
378
            </table>
379
 
380
            </div>
381
            <div class="Partners pmp" id= "PmpPartners">
382
            <table class="businessdetail">
383
 
384
             <tr> 
385
              <th class ="PMPName">Name</th>
386
              <th  class="PMPAddress">Address</th> 
387
              <th class="PMPtelno">Mobile</th>
388
              <th class="PMPpan">PAN</th>
389
              <th class="PMPAdhaar">Aadhaar Number</th>
390
              <th class="PMPemail">Email</th>
391
              <th class="PMPownership">Share %</th>
392
 
393
               </tr>
394
                <tr>
395
 
396
                   <td class="form-group"><input name="partnerName1"type="text" size="25"></td>
397
                   <td class="form-group"><textarea name="partnerAddress1" type="text" size="60"></textarea></td>
398
                   <td class="form-group"><input name = "partnerPhone1" pattern="[0-9]{10}"type="text" size="10"></th>
399
                   <td class="form-group"><input  name ="partnerPan1"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
400
                    <td class="form-group"><input name="partnerAdhaar1" type="text"  size="15"></td>
401
                   <td class="form-group"><input name="partnerEmail1" type="email"  size="20"></td>
402
                   <td class="form-group"><input name="partnerOwner1" type="text"pattern="[0-9]"size="10"></td>
403
 
404
                   </tr>
405
 
406
 
407
            </table>
408
 
409
                   <table class="businessdetail">
410
 
411
             <tr> 
412
              <th class ="PMPName">Name</th>
413
              <th  class="PMPAddress">Address</th> 
414
              <th class="PMPtelno">Mobile</th>
415
              <th class="PMPpan">PAN</th>
416
              <th class="PMPAdhaar">Aadhaar Number</th>
417
              <th class="PMPemail">Email</th>
418
              <th class="PMPownership">Share %</th>
419
 
420
               </tr>
421
              <tr>
422
 
423
                   <td class="form-group"><input name="partnerName2"type="text" size="25"></td>
424
                   <td class="form-group"><textarea name="partnerAddress2" type="text" size="60"></textarea></td>
425
                   <td class="form-group"><input name = "partnerPhone2" pattern="[0-9]{10}" type="text" size="10"></th>
426
                   <td class="businesspan"><input  name ="partnerPan2"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
427
                   <td class="form-group"><input name="partnerAdhaar2" type="text" size="15"></td>
428
                   <td class="form-group"><input name="partnerEmail2" type="email" size="20"></td>
429
                   <td class="form-group"><input name="partnerOwner2" pattern="[0-9]" type="text" size="10"></td>
430
 
431
                   </tr>
432
 
433
            </table>
434
                   <table class="businessdetail">
435
             <tr> 
436
            <th class ="PMPName">Name</th>
437
              <th  class="PMPAddress">Address</th> 
438
              <th class="PMPtelno">Mobile</th>
439
              <th class="PMPpan">PAN</th>
440
              <th class="PMPAdhaar">Aadhaar Number</th>
441
              <th class="PMPemail">Email</th>
442
              <th class="PMPownership">Share %</th>
443
 
444
               </tr>
445
                 <tr>
446
 
447
                   <td class="form-group"><input name="partnerName3"type="text" size="25"></td>
448
                   <td class="form-group"><textarea name="partnerAddress3" type="text" size="60"></textarea></td>
449
                   <td class="form-group"><input name = "partnerPhone3" type="text"  maxlength = "10" pattern="[0-9]{10}"  size="10"></th>
450
                   <td class="form-group"><input  name ="partnerPan3"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
451
                    <td class="form-groupr"><input name="partnerAdhaar3" type="text" size="15"></td>
452
                   <td class="form-group"><input name="partnerEmail3"  type="email" size="20"></td>
453
                   <td class="form-group"><input name="partnerOwner3" pattern="[0-9"  type="text" size="10"></td>
454
 
455
                   </tr>
456
 
457
 
458
            </table>
459
 
460
 
461
 
462
           <table class="businessdetail">
463
       <tr> 
464
                <th class ="PMPName">Name</th>
465
              <th  class="PMPAddress">Address</th> 
466
              <th class="PMPtelno">Mobile</th>
467
              <th class="PMPpan">PAN</th>
468
              <th class="PMPAdhaar">Aadhaar Number</th>
469
              <th class="PMPemail">Email</th>
470
              <th class="PMPownership">Share %</th>
471
               </tr>
472
               <tr>
473
 
474
                   <td class="form-group"><input name="partnerName4"type="text" size="25"></td>
475
                   <td class="form-group"><textarea name="partnerAddress4" type="text" size="60"></textarea></td>
476
                   <td class="form-group"><input name = "partnerPhone4"  pattern="[0-9]{10}" type="text" size="10"></th>
477
                   <td class="form-group"><input  name ="partnerPan4"type="text" maxlength = "10"title="Please enter correct pan number"size="10"></td>
478
                    <td class="form-group"><input name="partnerAdhaar4" type="text" size="15"></td>
479
                   <td class="form-group"><input name="partnerEmail4" type="email" size="20"></td>
480
                   <td class="form-group"><input name="partnerOwner4" pattern="[0-9]" type="text" size="10"></td>
481
 
482
                   </tr>
483
 
484
 
485
            </table>
486
 
487
            </div>
488
 
489
 
490
             <div class="Directors pmp" id= "PmpDirectors">
491
            <table class="businessdetail">
492
               <tr> 
493
               <th class ="PMPName">Name</th>
494
              <th  class="PMPAddress">Address</th> 
495
              <th class="PMPtelno">Mobile</th>
496
              <th class="PMPpan">PAN</th>
497
              <th class="PMPAdhaar">Aadhaar Number</th>
498
              <th class="PMPemail">Email</th>
499
              <th class="PMPownership">Share %</th>
500
 
501
               </tr>
502
               <tr>
503
                   <td class="form-group"><input name="shareholderName1"type="text" size="25"></td>
504
                   <td class="form-group"><textarea name="shareholderAddress1" type="text" size="60"></textarea></td>
505
                   <td class="form-group"><input name = "shareholderPhone1" pattern="[0-9]{10}" type="text" size="10"></th>
506
                   <td class="form-group"><input  name ="shareholderPan1"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
507
                   <td class="form-group"><input name="shareholderAdhaar1" type="text" size="15"></td>
508
                   <td class="form-group"><input name="shareholderEmail1" type="email" size="20"></td>
509
                   <td class="form-group"><input name="shareholderOwner1" pattern="[0-9]" type="text" size="10"></td>
510
 
511
                   </tr>
512
 
513
 
514
            </table>
515
 
516
                   <table class="businessdetail">
517
          <tr> 
518
                <th class ="PMPName">Name</th>
519
              <th  class="PMPAddress">Address</th> 
520
              <th class="PMPtelno">Mobile</th>
521
              <th class="PMPpan">PAN</th>
522
              <th class="PMPAdhaar">Aadhaar Number</th>
523
              <th class="PMPemail">Email</th>
524
              <th class="PMPownership">Share %</th>
525
               </tr>
526
                 <tr>
527
                   <td class="form-group"><input name="shareholderName2"type="text" size="25"></td>
528
                   <td class="form-group"><textarea name="shareholderAddress2" type="text" size="60"></textarea></td>
529
                   <td class="form-group"><input name = "shareholderPhone2" pattern="[0-9]{10}" type="text" size="10"></th>
530
                   <td class="form-group"><input  name ="shareholderPan2"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
531
                    <td class="form-group"><input name="shareholderAdhaar2" type="text" size="15"></td>
532
                   <td class="form-group"><input name="shareholderEmail2"  type="email" size="20"></td>
533
                   <td class="form-group"><input name="shareholderOwner2" pattern="[0-9]"  type="text" size="10"></td>
534
 
535
                   </tr>
536
            </table>
537
 
538
                   <table class="businessdetail">
539
              <tr> 
540
                <th class ="PMPName">Name</th>
541
              <th  class="PMPAddress">Address</th> 
542
              <th class="PMPtelno">Mobile</th>
543
              <th class="PMPpan">PAN</th>
544
              <th class="PMPAdhaar">Aadhaar Number</th>
545
              <th class="PMPemail">Email</th>
546
              <th class="PMPownership">Share %</th>
547
 
548
               </tr>
549
                   <tr>
550
                   <td class="form-group"><input name="shareholderName3"type="text" size="25"></td>
551
                   <td class="form-group"><textarea name="shareholderAddress3" type="text" size="60"></textarea></td>
552
                   <td class="form-group"><input name = "shareholderPhone3" pattern="[0-9]{10}" type="text" size="10"></th>
553
                   <td class="form-group"><input  name ="shareholderPan3" type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
554
                   <td class="form-group"><input name="shareholderAdhaar3" type="text" size="15"></td>
555
                   <td class="form-group"><input name="shareholderEmail3" type="email" size="20"></td>
556
                   <td class="form-group"><input name="shareholderOwner3" pattern="[0-9]" type="text" size="10"></td>
557
 
558
                   </tr>
559
 
560
            </table>
561
 
562
                   <table class="businessdetail">
563
             <tr> 
564
                <th class ="PMPName">Name</th>
565
              <th  class="PMPAddress">Address</th> 
566
              <th class="PMPtelno">Mobile</th>
567
              <th class="PMPpan">PAN</th>
568
              <th class="PMPAdhaar">Aadhaar Number</th>
569
              <th class="PMPemail">Email</th>
570
              <th class="PMPownership">Share %</th>
571
               </tr>
572
                     <tr>
573
                   <td class="form-group"><input name="shareholderName4" type="text" size="25"></td>
574
                   <td class="form-group"><textarea name="shareholderAddress4" type="text" size="60"></textarea></td>
575
                   <td class="form-group"><input name = "shareholderPhone4" type="text" pattern="[0-9]{10}" size="10"></th>
576
                   <td class="form-group"><input  name ="shareholderPan4" type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
577
                    <td class="form-group"><input name="shareholderAdhaar4" type="text" size="15"></td>
578
                   <td class="form-group"><input name="shareholderEmail4"  type="email" size="20"></td>
579
                   <td class="form-group"><input name="shareholderOwner4" pattern="[0-9]"  type="text" size="10"></td>
580
 
581
                   </tr>
582
 
583
 
584
            </table>
585
 
586
            </div>
587
 
588
         <h4 class="page-header">7. Store Manager Details</h4>
589
 
590
 
591
                    <div class="form-group">
592
                    <label for="">Name
593
                    <input type="text" name="managerName"placeholder="Name"></label>
594
                    <label for="">Mobile
595
                        <input type="text" name="managerNo" pattern="[0-9]{10}" title="Please enter Valid Mobile number" placeholder="Mobile No"> </label>  
596
                    <label for="">Email
597
                        <input type="email" name="managerEmail"size="25px" placeholder="Emailid"> </label>  
598
 
599
                    </div>
600
 
601
 
602
            <h4 class="page-header">8. Manpower Details</h4>
603
 
604
               <div class="form-group">
605
                    <label for="">Number of Employees
606
                    <input type="text" pattern="[0-9]" name="noOfEmployees"placeholder="Number of Employees"></label>
607
                    <label for="">Number of Management Staff
608
                        <input type="text" pattern="[0-9]" name="managementStaff" placeholder="Management Staff"> </label>  
609
 
610
                    </div>
611
 
612
              <h4 class="page-header">9. Experience In Telecom Trade/other Trade (Brand & Product Category)</h4>
613
                <div class="bcontacts">
614
                   <textarea rows="4" name="experienceinTelecome"cols="50" placeholder="Describe yourself here..."></textarea> 
615
                </div>
616
 
617
            <h4 class="page-header">10. Description of Existing Business & Annual Turnover</h4>
618
                <div class="bcontacts">
619
                      <textarea rows="4" name="descriptionofExistingBusiness"cols="50" placeholder="Describe yourself here..."></textarea>
620
                </div>
621
                <p>Please Provide ITR of last Two years</p>
622
                <div class = "form-group file upload"> 
623
                   <input type="file" accept="application/pdf,image/*" name ="itrDoc">
624
                <a href="somelink" id="link-itrDoc" style="display:none">View ITR Document</a>
625
                    </div>
626
 
627
 
628
            <h4 class="page-header">11.Business Model</h4>
629
 
630
            <div class="btn-group">
631
                    <label class="btn btn-default">
632
                   <input type="radio" name="businessModel" value="Retailer" required>
633
                   <span>Retailer</span>
634
                  </label>
635
                <label class="btn btn-default">
636
                    <input type="radio" name="businessModel" value="Distributor" required>
637
                    <span>Distributor</span>
638
                </label>
639
                <label class="btn btn-default">
640
                    <input type="radio" name="businessModel" value="Franchises" required>
641
                    <span>Franchise</span>
642
                </label>
643
                  <label class="btn btn-default">
644
                    <input type="radio" name="businessModel" value="Other" required>
645
                    <span>Other</span>
646
                </label>
647
              </div>
648
 
649
 
650
          <h4 class="page-header">12. Selling Online (if yes, please specify Portal Names)</h4>
651
 
652
                    <div class="btn-group">
653
                    <label class="btn btn-default">
654
                   <input type="radio" name="sellingOnline" value="yes">
655
                   <span>Yes</span>
656
                  </label>
657
                <label class="btn btn-default">
658
                    <input type="radio" name="sellingOnline" value="no">
659
                    <span>No</span>
660
                </label>
661
              </div>
662
                   <div class="form-group portal Names" id = "sellingyes">
663
                   <label>Portal Names</label>
664
                       <input type="text" name="portalName1" size="25">
665
                       <input type="text" name="portalName2" size="25">
666
                       <input type="text" name="portalName3" size="25">
667
                  </div>
668
            <h4 class="page-header">13. Area of Shop(in Sq Feet)</h4>
669
              <div>
670
                 <div class="form-group">
671
                    <label>
672
 
673
                    <input type="number" name="east"  placeholder="East(Sq Feet)">
674
                    <input type="number" name="west"  placeholder="West(Sq Feet)">
675
                    <input type="number" name="north" placeholder="North(Sq Feet)"> 
676
                    </label>
677
                </div>
678
                    <br>
679
                      <div class="form-group">
680
                    <label>
681
 
682
                    <input type="number" name="south" placeholder="South(Sq Feet)">
683
                    <input type="number" name="front" placeholder="Front(Sq Feet)">
684
                    <input type="number" name="roadSize" placeholder="Road Size in Front(Sq Feet)">
685
 
686
                    </label>
687
                </div>
688
 
689
                  </div>  
690
                  <div class="shopArea">
691
                   <div class="btn-group">
692
                    <label class="btn btn-default">
693
                   <input type="radio" name="shopArea" value="Singleside">
694
                   <span>Single Side</span>
695
                  </label>
696
                <label class="btn btn-default">
697
                    <input type="radio" name="shopArea" value"Twoside">
698
                    <span>Two Side</span>
699
                </label>
700
                  <label class="btn btn-default">
701
                    <input type="radio" name="shopArea" value="Corner">
702
                    <span>Corner</span>
703
                </label>
704
              </div>
705
              </div>
706
 
707
 
708
              <h4 class="page-header">14. Status of Shop</h4>
709
 
710
                 <div class="btn-group">
711
                    <label class="btn btn-default">
712
                   <input type="radio" name="shopStatus" value="semifurnished">
713
                   <span>Semi Furnished</span>
714
                  </label>
715
                <label class="btn btn-default">
716
                    <input type="radio" name="shopStatus" value="fullfurnished">
717
                    <span>Fully Furnished</span>
718
                </label>
719
                </div>
720
 
721
                 <div class="checkboxes status" id ="shopsemifurnished">
722
                 <div class="btn btn-default">
723
   <label for="success1" class="btn btn-success">Flooring<input type="checkbox" name="flooring" 
724
          value ="flooring" id="success1" class="badgebox"><span class="badge">&check;</span></label>
725
        <label for="warning1" class="btn btn-success">Ceiling<input type="checkbox" name="cieling" value="ceiling" id="warning1" class="badgebox"><span class="badge">&check;</span></label>
726
 
727
 
728
              </div>
729
            </div>
730
 
731
<div class ="checkboxes status"  id ="shopfullfurnished">
732
          <div class="row text-center">
733
    <label for="default" class="btn btn-success">Store <input type="checkbox" name="store" value="yes" id="default" class="badgebox"><span class="badge">&check;</span></label>
734
        <label for="primary" class="btn btn-success">Washroom <input type="checkbox" name="washroom" value="yes" id="primary" class="badgebox"><span class="badge">&check;</span></label>
735
        <label for="info" class="btn btn-success">Water Supply<input type="checkbox" name="waterSupply" value="yes" id="info" class="badgebox"><span class="badge">&check;</span></label>
736
        <label for="success" class="btn btn-success">Electricity<input type="checkbox" name="electricity" 
737
          value ="yes" id="success" class="badgebox"><span class="badge">&check;</span></label>
738
        <label for="warning" class="btn btn-success">Pantry<input type="checkbox" name="pantry" value="yes" id="warning" class="badgebox"><span class="badge">&check;</span></label>
739
  </div>
740
    </div>
741
 
742
 
743
              <h4 class="page-header">15. Shop Available At</h4>
744
 
745
                     <div class="btn-group">
746
                    <label class="btn btn-default">
747
                   <input type="radio" name="shopAvailbility" value="Basement">
748
                   <span>Basement</span>
749
                  </label>
750
                <label class="btn btn-default">
751
                    <input type="radio" name="shopAvailbility" value="Groundfloor">
752
                    <span>Ground Floor</span>
753
                </label>
754
                  <label class="btn btn-default">
755
                    <input type="radio" name="shopAvailbility" value="firstfloor">
756
                    <span>First Floor</span>
757
                </label>
758
 
759
                  <label class="btn btn-default">
760
                    <input type="radio" name="shopAvailbility" value="secondfloor">
761
                    <span>Second Floor</span>
762
                </label>
763
 
764
                 <label class="btn btn-default">
765
                    <input type="radio" name="shopAvailbility" value="thirdfloor">
766
                    <span>Third Floor</span>
767
                </label>
768
                </div>
769
 
770
                <div class="form-group bdetail">
771
                   <p>Provide pictures of the shop from 3 different angles, ceiling and flooring</p>
772
                      <input type="file" name="angleDoc1" accept="application/pdf,image/*" >   
773
                      <a href="somelink" id="link-angleDoc1" style="display:none">View angleDoc1 Document</a>
774
                      <input type="file" name="angleDoc2" accept="application/pdf,image/*" > 
775
                        <a href="somelink" id="link-angleDoc2" style="display:none">View angleDoc2 Document</a>   
776
                     <input type="file" name="angleDoc3"  accept="application/pdf,image/*" >  
777
                      <a href="somelink" id="link-angleDoc3" style="display:none">View angleDoc3 Document</a>    
778
                            <input type="file" name="angleDoc4"  accept="application/pdf,image/*" >   
779
                      <a href="somelink" id="link-angleDoc4" style="display:none">View angleDoc4 Document</a>    
780
                    <input type="file" name="angleDoc5" accept="application/pdf,image/*"> 
781
                <a href="somelink" id="link-angleDoc5" style="display:none">View angleDoc5Document</a>         
782
                  </div>
783
 
784
         <h4 class="page-header">16. Location of Shop</h4>
785
                        <div class="btn-group">
786
                    <label class="btn btn-default">
787
                   <input type="radio" name="location" value="shoppingMall">
788
                   <span>Shopping Mall</span>
789
                  </label>
790
                <label class="btn btn-default">
791
                    <input type="radio" name="location" value="MainMobileMarket">
792
                    <span>Main Mobile Market</span>
793
                </label>
794
                  <label class="btn btn-default">
795
                    <input type="radio" name="location" value="LocalMarket">
796
                    <span>Local Market</span>
797
                </label>
798
 
799
                </div>
800
 
801
 
802
 
803
             <h4 class="page-header">17.Nearest Mobile Store</h4>
804
                           <div class="btn-group">
805
                    <label class="btn btn-default">
806
                   <input type="radio" name="nearestStore" value="100mtrs">
807
                   <span>100Mtrs</span>
808
                  </label>
809
                <label class="btn btn-default">
810
                    <input type="radio" name="nearestStore" value="200mtrs">
811
                    <span>200Mtrs</span>
812
                </label>
813
                  <label class="btn btn-default">
814
                    <input type="radio" name="nearestStore" value="500mtrs">
815
                    <span>500Mtrs</span>
816
                </label>
817
 
818
                </div>
819
 
820
                 <div class="form-group location">
821
                   <label>Name of the Shop</label>
822
                       <input type="text" size ="35" name="storeName">
823
                       <br>
824
                       <br>
825
                        <label>Address of the Shop</label>
826
                       <input type="text" size ="65" name="storeAddress">
827
                  </div>
828
 
829
 
830
 
831
            <h4 class="page-header">18. Ownership of Shop</h4>
832
 
833
                    <div class="btn-group">
834
                    <label class="btn btn-default">
835
                   <input type="radio" name="ownership" value="Selfowned">
836
                   <span>Self Owned</span>
837
                  </label>
838
                <label class="btn btn-default">
839
                    <input type="radio" name="ownership" value="Rented">
840
                    <span>Rented</span>
841
                </label>
842
                  <label class="btn btn-default">
843
                    <input type="radio" name="ownership" value="lease">
844
                    <span>Lease</span>
845
                </label>
846
                  </label>
847
                  <label class="btn btn-default">
848
                    <input type="radio" name="ownership" value="collaboration">
849
                    <span>Collaboration</span>
850
                </label>
851
 
852
                </div>
853
 
854
                 <div class="form-group bdetail">
855
                   <p>Provide relevant documents (Electricity bill/Rent Agreement/Lease Deed)to prove the status of ownership</p>
856
                     <input type="file" accept="application/pdf,image/*" name="ownershipDoc">
857
                         <a href=""></a>
858
                   </div>
859
 
860
 
861
           <h4 class="page-header">19. Insurance of Shop (if yes, please provide the copy of the same)</h4>
862
 
863
 
864
                    <div class="btn-group">
865
                    <label class="btn btn-default">
866
                   <input type="radio" name="insurance" value="yes">
867
                   <span>Yes</span>
868
                  </label>
869
                <label class="btn btn-default">
870
                    <input type="radio" name="insurance" value="no">
871
                    <span>No</span>
872
                </label>
873
              </div>
874
 
875
                 <div class="form-group insurance doc"  id= "docyes">
876
                  <p>Please provide copy of insurance document</p>
877
                     <input type="file" accept="application/pdf,image/*" name="insuranceDoc">
878
    <a href="somelink" id="link-insuranceDoc" style="display:none">View InsuranceDoc Document</a>    
879
                   </div>
880
 
881
 
882
         <h4 class="page-header">20. Loan on Shop (LAP/BL/CC/others)</h4>
883
 
884
                     <div class="btn-group">
885
                    <label class="btn btn-default">
886
                   <input type="radio" name="loan" value="yes">
887
                   <span>Yes</span>
888
                  </label>
889
                <label class="btn btn-default">
890
                    <input type="radio" name="loan" value="no">
891
                    <span>No</span>
892
                </label>
893
              </div>
894
 
895
                 <div class="form-group loan document" id ="documentyes">
896
                  <p>Please provide current statement Letter</p>
897
                     <input type="file" accept="application/pdf,image/*" name="loanDoc">
898
                     <a href="somelink" id="link-loanDoc" style="display:none">View loanDoc Document</a>  
899
 
900
                      <p>Please provide current sanction Letter</p>
901
                     <input type="file" accept="application/pdf,image/*" name="sanctionDoc">
902
                        <a href="somelink" id="link-sanctionDoc" style="display:none">View sanctionDoc Document</a>  
903
 
904
                   </div>
905
 
906
 
907
            <h4 class="page-header">21. Bank Name & Address</h4>
908
 
909
                  <div class="form-group float-label-control">
910
                        <label for="">Account Number</label>
911
                        <input type="text" name="accountNumber"class="form-control" placeholder="Account Number">
912
                    </div>
913
                     <div class="form-group float-label-control">
914
                        <label for="">Bank Name</label>
915
                        <input type="text" name="bankName"class="form-control" placeholder="Bank Name">
916
                    </div>
917
                     <div class="form-group float-label-control">
918
                        <label for="">IFSC Code</label>
919
                        <input type="text" name="ifscCode"class="form-control" placeholder="IFSC Code">
920
                    </div>
921
                     <div class="form-group float-label-control">
922
                        <label for="">Branch Name</label>
923
                        <input type="text" name="branchName" class="form-control" placeholder="Branch Name">
924
                    </div>
925
                     <div >
926
                  <p>Please attach the copy of cancelled cheque</p>
927
                      <div class="form-group">
928
                     <input type="file" name="chequeCopy" accept="application/pdf,image/*">
929
              <a href="somelink" id="link-chequeCopy" style="display:none">View chequeCopy Document</a>  
930
 
931
                   </div>
932
 
933
 
934
                  <h4 class="page-header">22. HSPS Bank Account Detail</h4> 
935
 
936
                  <p>Please deposit amount of <strong> Rs 1 Lac </strong>as advance payment in following account through NEFT and submit the UTR No.</p>
937
                    <div class="form-group float-label-control">
938
                        <label for="">UTR Number</label>
939
                        <input type="text" name="utr" class="form-control" placeholder="UTR No">
940
                    </div>
941
                    <p><b>Note:</b> Advance amount deposited shall be adjustable in the first billing. This amount is 100% refundable in case of withdrawal of application by applicant.</p>
942
 
943
 
944
 
945
                      <div class ="Account">
946
                      <label>Account Name: New Spice Solutions Pvt Ltd</label><br>
947
                       <label>Bank Name: IndusInd Bank Ltd.</label><br>
948
                        <label>Account No.:201000488351</label><br>
949
                        <label>Branch:M-56, Greater Kailash-II, Main Market New Delhi-110048</label><br>
950
                         <label>IFSC:INDB0000012</label><br>
951
                        </div>
952
 
953
                <div class="submit">
954
                    <button type="submit" class="btn btn-success btn-lg">Submit</button>
955
                </div>
956
 
957
                <div class="alert alert-success" role="alert" id="success_message">Success <i class="glyphicon glyphicon-thumbs-up"></i> Thanks for contacting us, we will get back to you shortly.</div>
958
 
959
 
960
 
961
 
962
 <!--             <fieldset hidden disabled="disabled">
963
              <h4 class="page-header">PMP STORE REGISTRATION APPROVAL</h4>
964
                 <p>(FOR OFFICE USE ONLY)</P>
965
 
966
                <div class=breg>
967
                 <div class=bApproval>
968
 
969
                  <label>Recommended by</label>
970
                  <input type="text" name = "recommended"class="reg-control" size="50">
971
 
972
                  </div>
973
                  <br>
974
 
975
                    <div class=bApproval>
976
                  <label>Business Manager</label>
977
                  <input type="text" name=" bManager" class="reg-control" size="50">
978
                </div>
979
                      <br>
980
                        <div class=bApproval>
981
                    <label>Operations Manager</label>
982
                  <input type="text"name="operation"class="reg-control"  size="50">
983
                </div>
984
                  <br>
985
               <div class=bApproval>
986
                     <label>BusinessHeadCategoryHead</label>
987
                  <input type="text" name="bhead"class="reg-control" size="50">
988
                </div>
989
 
990
 
991
                 </div>
992
               </fieldset> -->
993
 
994
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                   <label>Spice Global Knowledge Park - 6th Floor, Plot No.19A & 19B, Sector 125, Noida, UP - 201301</label>
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                    <label>Email - care@profitmandi.com</<label>
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                    <br> 
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                    <label>Contact - 8588842949 </label>
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