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tejus.loha |
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<section class="wrapper">
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<div class="row">
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<div class="col-lg-12">
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<h3 class="page-header" style="text-align: center ;color:#d3181f">LOI Update Form</h3>
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<ol class="breadcrumb">
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<li><i class="fa fa-home"></i><a href="${rc.contextPath}/dashboard">#springMessage(
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"reportdailycollection.home")</a></li>
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<li><i class="icon_document_alt"></i>LOI Update Form</li>
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</ol>
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</div>
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</div>
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<div>
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<form name="LoiUpdate" id="LoiUpdate" method="post" style="margin-top:40px;">
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<div>
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<h4>Personal Details</h4>
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</div>
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<div class="row">
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<div class="col-md-4">
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<!-- Owner Name -->
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<div class="form-group">
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<label>First Name </label><span
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style="color:red ;font-size: 140%">*</span>
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<input type="text" class="form-control" required name="firstName"
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placeholder="Enter first name" value="$loiForm.getFirstName()">
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</div>
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</div>
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<div class="col-md-4">
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<!-- Owner Name -->
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<div class="form-group">
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<label>Last Name </label><span
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style="color:red ;font-size: 140%">*</span>
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<input type="text" class="form-control" required name="lastName"
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placeholder="Enter last name" value="$loiForm.getLastName()">
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</div>
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</div>
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<div class="col-md-4">
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<!-- Mobile No -->
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<div class="form-group">
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<label>Mobile No. </label><span
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style="color:red ;font-size: 140%">*</span>
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<input type="tel" class="form-control" required name="mobile"
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placeholder="10-digit Mobile"
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maxlength="10"
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minlength="10"
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value=$loiForm.getMobile()>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-4">
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<!-- Landline No -->
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<div class="form-group">
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<label>Alternative Mobile No.</label>
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<input type="tel" class="form-control" name="landline"
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maxlength="10"
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minlength="10"
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placeholder="Enter Alternative mobile"
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value="$loiForm.getLandline()">
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</div>
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</div>
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<div class="col-lg-4"><!-- Email ID -->
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<div class="form-group">
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<label>Email ID </label>
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<span
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style="color:red ;font-size: 140%">*</span>
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<input type="email" class="form-control" required name="email" placeholder="Enter Email"
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value="$loiForm.getEmail()">
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</div>
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</div>
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<div class="col-lg-4"> <!-- DOB -->
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<div class="form-group">
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<label>DOB </label>
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<span
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style="color:red ;font-size: 140%">*</span>
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<input type="date" class="form-control" required name="dob" placeholder="Enter DOB"
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value="$loiForm.getDob()">
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-lg-4"> <!-- PAN No-->
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<div class="form-group">
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<label>PAN No</label><span
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style="color:red ;font-size: 140%">*</span>
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<input type="text" class="form-control" required name="panNo" placeholder="enter Pan No"
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minlength="10"
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maxlength="10"
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value="$loiForm.getPanNo()"
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>
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</div>
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</div>
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<div class="col-lg-4"> <!-- Aadhar No-->
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<div class="form-group">
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<label>Aadhar No</label><span
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style="color:red ;font-size: 140%">*</span>
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<input type="tel" class="form-control" required name="adharNo"
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value="$loiForm.getAdharNo()"
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placeholder="Adhar Number"
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maxlength="12"
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minlength="12"
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pattern="[0-9]{12}">
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</div>
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</div>
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</div>
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<div class="form-group" style="text-align: center; margin-bottom:2px;">
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<button type="button"
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class="btn btn-primary text-white font-semibold py-1 px-4 rounded background-red updateLoiFormDataButton"
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style="box-shadow:none;margin-bottom:2px;" data-loiid="$loiForm.getId()">
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<span>Update</span>
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</button>
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</div>
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</form>
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</div>
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</section>
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