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21817 kshitij.so 1
<html>
2
<head>
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4
<script type="text/javascript" src="js/jquery-1.10.2.min.js"></script>
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<link rel="stylesheet" href="css/bootstrap.min.css"/>
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<link rel="stylesheet" type="text/css" href="css/main.css"/>
7
<!-- Optional theme -->
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<link rel="stylesheet" href="css/bootstrap-theme.min.css" />
9
 
10
<!-- Latest compiled and minified JavaScript -->
11
<script src="js/bootstrap.min.js" type="script/javascript"></script>
12
<script src="js/bootstrapValidator.js"></script>
13
<script src="js/reg.js"></script>
14
<script src="js/reqformvalidator.js"></script>
15
<script type="text/javascript">
16
 
17
 $(document).ready(function(){
18
    associateValidator();
19
    $("input[name$='bEntity']").click(function() {
20
        var test1 = $(this).val();
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       $(".box").hide();
22
        $("#sale" + test1).show();
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});
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});
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</script>
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27
<script type="text/javascript">
28
$(document).ready(function(){
29
    $("input[name$='bPmpdetail']").click(function() {
30
        var test1 = $(this).val();
31
       $(".pmp").hide();
32
        $("#Pmp" + test1).show();
33
    });
34
});
35
 
36
</script>
37
 
38
<script type="text/javascript">
39
$(document).ready(function(){
40
    $("input[name$='shopstatus']").click(function() {
41
        var test1 = $(this).val();
42
       $(".status").hide();
43
        $("#shop" + test1).show();
44
    });
45
});
46
 
47
</script>
48
<script type="text/javascript">
49
$(document).ready(function(){
50
    $("input[name$='sellingonline']").click(function() {
51
        var test1 = $(this).val();
52
       $(".Names").hide();
53
        $("#selling" + test1).show();
54
    });
55
});
56
 
57
</script>
58
 
59
 
60
<script type="text/javascript">
61
$(document).ready(function(){
62
    $("input[name$='Insurance']").click(function() {
63
        var test1 = $(this).val();
64
       $(".doc").hide();
65
        $("#doc" + test1).show();
66
    });
67
});
68
 
69
</script>
70
 
71
<script type="text/javascript">
72
$(document).ready(function(){
73
    $("input[name$='loan']").click(function() {
74
        var test1 = $(this).val();
75
       $(".document").hide();
76
        $("#document" + test1).show();
77
        $("#showHide").show();
78
    });
79
});
80
 
81
function queryStringToJSON(queryString) {
82
 
83
 
84
  var pairs = queryString.split('&');
85
  var result = {};
86
  pairs.forEach(function(pair) {
87
    pair = pair.split('=');
88
    result[pair[0]] = decodeURIComponent(pair[1] || '');
89
 
90
  });
91
  return result;
92
}
93
 
94
var oResult ={Branchname: "jnkmk",DinNumber: "8327592895",ExperienceinTelecome: "kdnslgrgjemgk",GSTNoDate: "29309238033902",IFSCcode: "kmk",IncomeTaxPanNo: "8384705257029",Insurance: "no",Managementstaff: "9392",MobileNo: "3288702375",North: "",ProprietorAddress: "nsdln",Proprietoremail: "jnefkji",Proprietorowner: "nsja",Proprietorpan: "nsdjak",Proprietorphone: "84u50",ProprietorusineesName: "mnsdvns",RegisteredAddress1: "wz-127 tilak nagar",RegisteredAddress2: "",RegisteredAddress3: "",RegisteredBusinessName: "spice+mobile",accountnumber: "nk",bEntity: "Partnership",bPmpdetail: "Proprietor",bankname: "kmk",businessmodel: "Retailer",city: "delhi",contactemail1: "84300293-92",contactemail2: "",contactname1: "nas+c",contactname2: "",contactno1: "8435092",contactno2: "",descriptionofExistingbusiness: "jsdnkglelr",east: "34",front: "",loan: "yes",location: "shoppingMall",neareststore: "100mtrs",noofemployess: "823u9",ownership: "Rented",partnerAddress1: "",partnerAddress2: "",partnerAddress3: "",partnerAddress4: "",partnerName1: "",partnerName2: "",partnerName3: "",partnerName4: "",partneremail1: "",partneremail2: "",partneremail3: "",partneremail4: "",partnerowner1: "",partnerowner2: "",partnerowner3: "",partnerowner4: "",partnerpan1: "",partnerpan2: "",partnerpan3: "",partnerpan4: "",partnerphone1: "",partnerphone2: "",partnerphone3: "",partnerphone4: "",pincode: "110018",portalName1: "",portalName2: "",portalName3: "",roadsize: "",sellingonline: "no",shareholderAddress1: "",shareholderAddress2: "",shareholderAddress3: "",shareholderAddress4: "",shareholderName1: "",shareholderName2: "",shareholderName3: "",shareholderName4: "",shareholderemail1: "",shareholderemail2: "",shareholderemail3: "",shareholderemail4: "",shareholderowner1: "",shareholderowner2: "",shareholderowner3: "",shareholderowner4: "",shareholderpan1: "",shareholderpan2: "",shareholderpan3: "",shareholderpan4: "",shareholderphone1: "",shareholderphone2: "",shareholderphone3: "",shareholderphone4: "",shopArea: "on",shopAvailbility: "Groundfloor",shopWashroom: "Washroom",shopWater: "Watersupply",shopstatus: "fullfurnished",south: "49",state: "Haryana",storeAddress: "",storename: "",telno: "7597209570",west: "32"}
95
 
96
function jQFormSerializeArrToJson(formSerializeArr){
97
 var jsonObj = {};
98
 jQuery.map( formSerializeArr, function( n, i ) {
99
     jsonObj[n.name] = n.value;
100
 });
101
 
102
 return jsonObj;
103
}
104
 
105
 
106
$(document).ready(function() {
107
 
108
$("#form").submit(function() {
109
 
110
  formData = new FormData($(this)[0]);
111
   for (var pair of formData.entries()) {
112
    console.log(pair[0]+ ', ' + pair[1]);
113
    if(pair[0]=='bEntitydoc') {
114
      console.log("hi");
115
    }
116
   }
117
 
118
   return false;
119
 
120
});
121
});
122
 
123
</script>
124
 
125
 
126
 
127
 
128
</head>
129
 
130
<body>
131
<div class="container">
132
    <div class="row">
133
         <div class ="header">   
134
         <h3 class="header">HOTSPOT PARTNER STORE powered by PROFIT MANDI</h3>
135
         <h4 class="header">(Unit of Spice Group)</h4>
136
         </div>
137
 
138
        <div class="header">
139
            <h5 class="header">APPLICATION FOR REGISTRATION</h5>
140
       </div>  
141
        <hr />
142
 
143
        <div class="row">
144
            <div class="col-sm-8">
145
 
146
                <form role="form" name="myform" id ="form"  enctype="multipart/form-data"  data-toggle="validator" novalidate>
147
             <h4 class="page-header">1. Registered Business Name of HSPS(in Block Letters)</h4>
148
                     <div class="form-group ">
149
 
150
                     <label for=""></label>
151
                     <input type="text" name="RegisteredBusinessName" id="demo" class="bform" placeholder="Business Name"/>
152
 
153
 
154
                     </div>
155
 
156
 
157
             <h4 class="page-header">2. Registered Address (In Block Letters)</h4>
158
 
159
                    <div class="form-group float-label-control">
160
                        <label for="">RegisteredAddress1</label>
161
                        <input type="text" name ="RegisteredAddress1" class="form-control" placeholder="Address 1">
162
                    </div>
163
                     <div class="form-group float-label-control">
164
                        <label for="">Address 2</label>
165
                        <input type="text" name ="RegisteredAddress2"class="form-control" placeholder="Address 2">
166
                    </div>
167
                     <div class="form-group float-label-control">
168
                        <label for="">Address 3</label>
169
                        <input type="text" name="RegisteredAddress3" class="form-control" placeholder="Address 3">
170
                    </div>
171
                     <div class="form-group float-label-control">
172
                        <label for="">City</label>
173
                        <input type="text" name="city" class="form-control" placeholder="City">
174
                    </div>
175
                     <div class="form-group float-label-control">
176
                        <label for="">Pincode</label>
177
                        <input  type="text" name="pincode" maxlength="6" class="form-control" pattern="[0-9]{6}" title="Please enter correct Pin Code"placeholder="Pincode">
178
                      </div>  
179
 
180
                     <div class="form-group float-label-control">
181
 
182
                      <select class="form-control" name = "state" placeholder="State">
183
                       <option value=" ">State</option>
184
                     <option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
185
                            <option value="Andhra Pradesh">Andhra Pradesh</option>
186
                            <option value="Arunachal Pradesh">Arunachal Pradesh</option>
187
                            <option value="Assam">Assam</option>
188
                            <option value="Bihar">Bihar</option>
189
                            <option value="Chandigarh">Chandigarh</option>
190
                            <option value="Chhattisgarh">Chhattisgarh</option>
191
                            <option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
192
                            <option value="Daman and Diu">Daman and Diu</option>
193
                            <option value="Delhi">Delhi</option>
194
                            <option value="Goa">Goa</option>
195
                            <option value="Gujarat">Gujarat</option>
196
                            <option value="Haryana">Haryana</option>
197
                            <option value="Himachal Pradesh">Himachal Pradesh</option>
198
                            <option value="Jammu and Kashmir">Jammu and Kashmir</option>
199
                            <option value="Jharkhand">Jharkhand</option>
200
                            <option value="Karnataka">Karnataka</option>
201
                            <option value="Kerala">Kerala</option>
202
                            <option value="Lakshadweep">Lakshadweep</option>
203
                            <option value="Madhya Pradesh">Madhya Pradesh</option>
204
                            <option value="Maharashtra">Maharashtra</option>
205
                            <option value="Manipur">Manipur</option>
206
                            <option value="Meghalaya">Meghalaya</option>
207
                            <option value="Mizoram">Mizoram</option>
208
                            <option value="Nagaland">Nagaland</option>
209
                            <option value="Orissa">Orissa</option>
210
                            <option value="Pondicherry">Pondicherry</option>
211
                            <option value="Punjab">Punjab</option>
212
                            <option value="Rajasthan">Rajasthan</option>
213
                            <option value="Sikkim">Sikkim</option>
214
                            <option value="Tamil Nadu">Tamil Nadu</option>
215
                            <option value="Tripura">Tripura</option>
216
                            <option value="Telangana">Telangana</option>
217
                            <option value="Uttaranchal">Uttaranchal</option>
218
                            <option value="Uttar Pradesh">Uttar Pradesh</option>
219
                            <option value="West Bengal">West Bengal</option>
220
                                              </select>
221
                    </div>
222
 
223
                      <div class="form-group float-label-control">
224
                        <label for="">Landline</label>
225
                        <input  type="text" class="form-control" name="Landline" maxlength = "10" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Landline">
226
                      </div>  
227
 
228
                       <div class="form-group float-label-control">
229
                        <label for="">Mobile</label>
230
                        <input  type="text" class="form-control" name="Mobile" maxlength = "10" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Mobile">
231
                      </div>    
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.hsps@gmail.com</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
             <h4 class="page-header">3. Type of Business Entity</h4>
246
 
247
                   <div class="funkyradio">
248
 
249
                    <div class="funkyradio-primary">
250
                        <input type="radio" name="bEntity" id="radio1" value="SaleProprietorship" required>
251
                        <label for="radio1">Sale Proprietorship</label>
252
                    </div>
253
                    <div class="funkyradio-primary">
254
                        <input type="radio" name="bEntity" id="radio2" value="Partnership" required>
255
                        <label for="radio2">Partnership</label>
256
                    </div>
257
                    <div class="funkyradio-primary">
258
                        <input type="radio" name="bEntity" id="radio3" value="PrivateLimitedCompany" required>
259
                        <label for="radio3">Private Limited company</label>
260
                    </div>
261
                    <div class="funkyradio-primary">
262
                        <input type="radio" name="bEntity" id="radio4" value="LimitedLiabilityPartnership" required>
263
                        <label for="radio4">Limited Liability Partnership</label>
264
                    </div>
265
                </div>
266
                  <div class ="Entity">
267
                    <div class="SaleProprietorship box" id ="saleSaleProprietorship">Upload <strong>Proprietership proof</strong></div>
268
                     <div class="partnership box" id="salePartnership">Upload <strong>Partnership Deed</strong></div>
269
                     </div>
270
                      <div class="limitedcompany box" id="salePrivateLimitedCompany">
271
        <div class="form-group float-label-control">
272
                        <label for="">DIN Number</label>
273
                        <input type="text" class="form-control" name="DINNumber" placeholder="DIN Number">
274
                    </div>Upload <strong>Incorporation certificate,Memorandum & Article of association</strong>
275
                      </div>
276
 
277
 
278
                      <div class="LimitedLiabilityPartnership box" id="saleLimitedLiabilityPartnership">
279
 
280
 
281
                           <div class="form-group float-label-control">
282
                        <label for="">DIN Number</label>
283
                        <input type="text" class="form-control" name="DINNumber" placeholder="DIN Number">
284
                    </div>Upload <strong>Registration certificate & partnership Deed</strong>
285
                     </div>
286
 
287
                    <div class = "form-group file upload"> 
288
                   <input type="file" accept="application/pdf,image/*" name = "bEntitydoc">
289
                    </div>
290
 
291
 
292
                     <h4 class="page-header">4. Goods And Services Tax Number(GST)</h4>
293
                    <div class="Pmpform">
294
 
295
                        <input type="text" name="GST" class="bform" placeholder="Goods And Services Tax Number"/>
296
                    </div>
297
                     <p>Provide Copy of GST document</p>
298
                    <div class = "file upload"> 
299
                   <input type="file"  accept="application/pdf,image/*" name ="GSTdoc">
300
                    </div>
301
 
302
 
303
                     <h4 class="page-header">5. Permanent Account Number(Pan)</h4>
304
                    <div class="form-group ">
305
 
306
                     <label for=""></label>
307
                     <input type="text" name="pan" class="bform" placeholder="Permanent Account Number"/></div>
308
                     <p>Provide Copy of Pan </p>
309
 
310
                    <div class = "form-group file upload"> 
311
 
312
                   <input type="file" accept="application/pdf,image/*" name="Pandoc">
313
                    </div>
314
 
315
 
316
             <h4 class="page-header">6. Full Details Of BusinessEntity</h4>
317
 
318
                   <div class="funkyradio">
319
                    <div class="funkyradio-primary">
320
                        <input type="radio" name="bPmpdetail" id="business1" value="Proprietor" required>
321
                        <label for="business1">Proprietor</label>
322
                    </div>
323
                    <div class="funkyradio-primary">
324
                        <input type="radio" name="bPmpdetail" id="business2" value="Partners" required>
325
                        <label for="business2">Partners</label>
326
                    </div>
327
                    <div class="funkyradio-primary">
328
                        <input type="radio" name="bPmpdetail" id="business3" value="Directors" required>
329
                        <label for="business3">Directors</label>
330
                    </div>
331
                </div>
332
 
333
                <div class="tablecontainer">
334
   <table class="businessdetail">
335
              <tr> 
336
              <th class ="PMPName">Name</th>
337
              <th  class="PMPAddress">Home Address</th> 
338
              <th class="PMPtelno">Mobile</th>
339
              <th class="PMPpan">Pan</th>
340
              <th class="PMPAdhaar">Adhaar</th>
341
              <th class="PMPemail">Email</th>
342
              <th class="PMPownership">Share %</th>
343
 
344
               </tr>
345
            <tr>
346
 
347
                   <td class="form-group"><input type="text" name="ProprietorbusineesName"size="25"></td>
348
                   <td class="form-group"><textarea row="3" name="ProprietorAddress"></textarea></td>
349
                   <td class="form-group"><input type="text" name="Proprietorphone" maxlength="10" pattern="[0-9]{10}"size="10"></th>
350
                   <td class="form-group"><input type="text" name="Proprietorpan" maxlength="10" title="Please enter correct pan number"size="10"></td>
351
                    <td class="form-group"><input type="text"  name= "Proprietoradhaar" size="15"></td>
352
                   <td class="form-group"><input type="email"  name= "Proprietoremail" size="20"></td>
353
                   <td class="form-group"><input type="text" pattern="[0-9]" name="Proprietorowner" size="10"></td>
354
 
355
                   </tr>
356
 
357
 
358
            </table>
359
 
360
            </div>
361
            <div class="Partners pmp" id= "PmpPartners">
362
            <table class="businessdetail">
363
 
364
             <tr> 
365
              <th class ="PMPName">Name</th>
366
              <th  class="PMPAddress">Home Address</th> 
367
              <th class="PMPtelno">Mobile</th>
368
              <th class="PMPpan">Pan</th>
369
               <th class="PMPAdhaar">Adhaar</th>
370
              <th class="PMPemail">Email </th>
371
              <th class="PMPownership">Share %</th>
372
 
373
               </tr>
374
                <tr>
375
 
376
                   <td class="form-group"><input name="partnerName1"type="text" size="25"></td>
377
                   <td class="form-group"><textarea name="partnerAddress1" type="text" size="60"></textarea></td>
378
                   <td class="form-group"><input name = "partnerphone1" pattern="[0-9]{10}"type="text" size="10"></th>
379
                   <td class="form-group"><input  name ="partnerpan1"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
380
                    <td class="form-group"><input name="partneradhaar1" type="text"  size="15"></td>
381
                   <td class="form-group"><input name="partneremail1" type="email"  size="20"></td>
382
                   <td class="form-group"><input name="partnerowner1" type="text"pattern="[0-9]"size="10"></td>
383
 
384
                   </tr>
385
 
386
 
387
            </table>
388
 
389
                   <table class="businessdetail">
390
 
391
             <tr> 
392
              <th class ="PMPName">Name</th>
393
              <th  class="PMPAddress">Home Address</th> 
394
              <th class="PMPtelno">Mobile</th>
395
              <th class="PMPpan">Pan</th>
396
               <th class="PMPAdhaar">Adhaar</th>
397
              <th class="PMPemail">Email </th>
398
              <th class="PMPownership">Share %</th>
399
 
400
               </tr>
401
              <tr>
402
 
403
                   <td class="form-group"><input name="partnerName2"type="text" size="25"></td>
404
                   <td class="form-group"><textarea name="partnerAddress2" type="text" size="60"></textarea></td>
405
                   <td class="form-group"><input name = "partnerphone2" pattern="[0-9]{10}" type="text" size="10"></th>
406
                   <td class="businesspan"><input  name ="partnerpan2"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
407
                   <td class="form-group"><input name="partneradhaar2" type="text" size="15"></td>
408
                   <td class="form-group"><input name="partneremail2" type="email" size="20"></td>
409
                   <td class="form-group"><input name="partnerowner2" pattern="[0-9]" type="text" size="10"></td>
410
 
411
                   </tr>
412
 
413
            </table>
414
                   <table class="businessdetail">
415
             <tr> 
416
              <th class ="PMPName">Name</th>
417
              <th  class="PMPAddress">Home Address</th> 
418
              <th class="PMPtelno">Mobile</th>
419
              <th class="PMPpan">Pan</th>
420
               <th class="PMPAdhaar">Adhaar</th>
421
              <th class="PMPemail">Email </th>
422
              <th class="PMPownership">Share %</th>
423
 
424
               </tr>
425
                 <tr>
426
 
427
                   <td class="form-group"><input name="partnerName3"type="text" size="25"></td>
428
                   <td class="form-group"><textarea name="partnerAddress3" type="text" size="60"></textarea></td>
429
                   <td class="form-group"><input name = "partnerphone3" type="text"  maxlength = "10" pattern="[0-9]{10}"  size="10"></th>
430
                   <td class="form-group"><input  name ="partnerpan3"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
431
                    <td class="form-groupr"><input name="partneradhaar3" type="text" size="15"></td>
432
                   <td class="form-group"><input name="partneremail3"  type="email" size="20"></td>
433
                   <td class="form-group"><input name="partnerowner3" pattern="[0-9"  type="text" size="10"></td>
434
 
435
                   </tr>
436
 
437
 
438
            </table>
439
 
440
 
441
 
442
           <table class="businessdetail">
443
       <tr> 
444
              <th class ="PMPName">Name</th>
445
              <th  class="PMPAddress">Home Address</th> 
446
              <th class="PMPtelno">Mobile</th>
447
              <th class="PMPpan">Pan</th>
448
               <th class="PMPAdhaar">Adhaar</th>
449
              <th class="PMPemail">Email </th>
450
              <th class="PMPownership">Share %</th>
451
 
452
               </tr>
453
               <tr>
454
 
455
                   <td class="form-group"><input name="partnerName4"type="text" size="25"></td>
456
                   <td class="form-group"><textarea name="partnerAddress4" type="text" size="60"></textarea></td>
457
                   <td class="form-group"><input name = "partnerphone4"  pattern="[0-9]{10}" type="text" size="10"></th>
458
                   <td class="form-group"><input  name ="partnerpan4"type="text" maxlength = "10"title="Please enter correct pan number"size="10"></td>
459
                    <td class="form-group"><input name="partneradhaar4" type="text" size="15"></td>
460
                   <td class="form-group"><input name="partneremail4" type="email" size="20"></td>
461
                   <td class="form-group"><input name="partnerowner4" pattern="[0-9]" type="text" size="10"></td>
462
 
463
                   </tr>
464
 
465
 
466
            </table>
467
 
468
            </div>
469
 
470
 
471
             <div class="Directors pmp" id= "PmpDirectors">
472
            <table class="businessdetail">
473
               <tr> 
474
              <th class ="PMPName">Name</th>
475
              <th  class="PMPAddress">Home Address</th> 
476
              <th class="PMPtelno">Mobile</th>
477
              <th class="PMPpan">Pan</th>
478
               <th class="PMPAdhaar">Adhaar</th>
479
              <th class="PMPemail">Email </th>
480
              <th class="PMPownership">Share %</th>
481
 
482
               </tr>
483
               <tr>
484
                   <td class="form-group"><input name="shareholderName1"type="text" size="25"></td>
485
                   <td class="form-group"><textarea name="shareholderAddress1" type="text" size="60"></textarea></td>
486
                   <td class="form-group"><input name = "shareholderphone1" pattern="[0-9]{10}" type="text" size="10"></th>
487
                   <td class="form-group"><input  name ="shareholderpan1"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
488
                   <td class="form-group"><input name="shareholderadhaar1" type="text" size="15"></td>
489
                   <td class="form-group"><input name="shareholderemail1" type="email" size="20"></td>
490
                   <td class="form-group"><input name="shareholderowner1" pattern="[0-9]" type="text" size="10"></td>
491
 
492
                   </tr>
493
 
494
 
495
            </table>
496
 
497
                   <table class="businessdetail">
498
          <tr> 
499
              <th class ="PMPName">Name</th>
500
              <th  class="PMPAddress">Home Address</th> 
501
              <th class="PMPtelno">Mobile</th>
502
              <th class="PMPpan">Pan</th>
503
               <th class="PMPAdhaar">Adhaar</th>
504
              <th class="PMPemail">Email </th>
505
              <th class="PMPownership">Share %</th>
506
 
507
               </tr>
508
                 <tr>
509
                   <td class="form-group"><input name="shareholderName2"type="text" size="25"></td>
510
                   <td class="form-group"><textarea name="shareholderAddress2" type="text" size="60"></textarea></td>
511
                   <td class="form-group"><input name = "shareholderphone2" pattern="[0-9]{10}" type="text" size="10"></th>
512
                   <td class="form-group"><input  name ="shareholderpan2"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
513
                    <td class="form-group"><input name="shareholderadhaar2" type="text" size="15"></td>
514
                   <td class="form-group"><input name="shareholderemail2"  type="email" size="20"></td>
515
                   <td class="form-group"><input name="shareholderowner2" pattern="[0-9]"  type="text" size="10"></td>
516
 
517
                   </tr>
518
            </table>
519
 
520
                   <table class="businessdetail">
521
              <tr> 
522
              <th class ="PMPName">Name</th>
523
              <th  class="PMPAddress">Home Address</th> 
524
              <th class="PMPtelno">Mobile</th>
525
              <th class="PMPpan">Pan</th>
526
               <th class="PMPAdhaar">Adhaar</th>
527
              <th class="PMPemail">Email </th>
528
              <th class="PMPownership">Share %</th>
529
 
530
               </tr>
531
                   <tr>
532
                   <td class="form-group"><input name="shareholderName3"type="text" size="25"></td>
533
                   <td class="form-group"><textarea name="shareholderAddress3" type="text" size="60"></textarea></td>
534
                   <td class="form-group"><input name = "shareholderphone3" pattern="[0-9]{10}" type="text" size="10"></th>
535
                   <td class="form-group"><input  name ="shareholderpan3" type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
536
                   <td class="form-group"><input name="shareholderadhaar3" type="text" size="15"></td>
537
                   <td class="form-group"><input name="shareholderemail3" type="email" size="20"></td>
538
                   <td class="form-group"><input name="shareholderowner3" pattern="[0-9]" type="text" size="10"></td>
539
 
540
                   </tr>
541
 
542
            </table>
543
 
544
                   <table class="businessdetail">
545
             <tr> 
546
              <th class ="PMPName">Name</th>
547
              <th  class="PMPAddress">Home Address</th> 
548
              <th class="PMPtelno">Mobile</th>
549
              <th class="PMPpan">Pan</th>
550
               <th class="PMPAdhaar">Adhaar</th>
551
              <th class="PMPemail">Email </th>
552
              <th class="PMPownership">Share %</th>
553
 
554
               </tr>
555
                     <tr>
556
                   <td class="form-group"><input name="shareholderName4"type="text" size="25"></td>
557
                   <td class="form-group"><textarea name="shareholderAddress4" type="text" size="60"></textarea></td>
558
                   <td class="form-group"><input name = "shareholderphone4"type="text" pattern="[0-9]{10}" size="10"></th>
559
                   <td class="form-group"><input  name ="shareholderpan4"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
560
                    <td class="form-group"><input name="shareholderadhaar3" type="text" size="15"></td>
561
                   <td class="form-group"><input name="shareholderemail4"  type="email" size="20"></td>
562
                   <td class="form-group"><input name="shareholderowner4" pattern="[0-9]"  type="text" size="10"></td>
563
 
564
                   </tr>
565
 
566
 
567
            </table>
568
 
569
            </div>
570
 
571
         <h4 class="page-header">7. Store Manager Detail</h4>
572
 
573
 
574
                    <div class="form-group">
575
                    <label for="">Name
576
                    <input type="text" name="Managername"placeholder="Name"></label>
577
                    <label for="">Mobile
578
                        <input type="text" name="ManagerNo" pattern="[0-9]{10}" title="Please enter Valid Mobile number" placeholder="Mobile No"> </label>  
579
                    <label for="">Email
580
                        <input type="email" name="Manageremail"size="25px" placeholder="Emailid"> </label>  
581
 
582
                    </div>
583
 
584
 
585
            <h4 class="page-header">8. Manpower Details</h4>
586
 
587
               <div class="form-group">
588
                    <label for="">Number of Employees
589
                    <input type="text"  " pattern="[0-9]" name="noofemployees"placeholder="Number of Employees"></label>
590
                    <label for="">Management Staff
591
                        <input type="text"  " pattern="[0-9]" name="Managementstaff" placeholder="Management Staff"> </label>  
592
 
593
                    </div>
594
 
595
              <h4 class="page-header">9. Experience In Telecom Trade/other Trade (Brand & Product Category)</h4>
596
                <div class="bcontacts">
597
                   <textarea rows="4" name="ExperienceinTelecome"cols="50" placeholder="Describe yourself here..."></textarea> 
598
                </div>
599
 
600
            <h4 class="page-header">10. Description of Existing Business & Annual Turnover</h4>
601
                <div class="bcontacts">
602
                      <textarea rows="4" name="descriptionofExistingbusiness"cols="50" placeholder="Describe yourself here..."></textarea>
603
                </div>
604
                <p>Please Provide ITR of last Two years</p>
605
                <div class = "form-group file upload"> 
606
                   <input type="file" accept="application/pdf,image/*" name ="ITRdoc">
607
                    </div>
608
 
609
 
610
            <h4 class="page-header">11.Business Model</h4>
611
 
612
            <div class="btn-group">
613
                    <label class="btn btn-default">
614
                   <input type="radio" name="businessmodel" value="Retailer" required>
615
                   <span>Retailer</span>
616
                  </label>
617
                <label class="btn btn-default">
618
                    <input type="radio" name="businessmodel" value="Distributor" required>
619
                    <span>Distributor</span>
620
                </label>
621
                <label class="btn btn-default">
622
                    <input type="radio" name="businessmodel" value="Franchises" required>
623
                    <span>Franchises</span>
624
                </label>
625
                  <label class="btn btn-default">
626
                    <input type="radio" name="businessmodel" value="Other" required>
627
                    <span>Other</span>
628
                </label>
629
              </div>
630
 
631
 
632
          <h4 class="page-header">12. Selling Online (if yes, Please Specify Portal Names)</h4>
633
 
634
                    <div class="btn-group">
635
                    <label class="btn btn-default">
636
                   <input type="radio" name="sellingonline" value="yes">
637
                   <span>Yes</span>
638
                  </label>
639
                <label class="btn btn-default">
640
                    <input type="radio" name="sellingonline" value="no">
641
                    <span>No</span>
642
                </label>
643
              </div>
644
                   <div class="form-group portal Names" id = "sellingyes">
645
                   <label>Portal Names</label>
646
                       <input type="text" name="portalName1" size="25">
647
                       <input type="text" name="portalName2" size="25">
648
                       <input type="text" name="portalName3" size="25">
649
                  </div>
650
            <h4 class="page-header">13. Area of Shop(in sq Feet)</h4>
651
              <div>
652
                 <div class="form-group">
653
                    <label>
654
 
655
                    <input type="number" name="east"  placeholder="East(Sq Feet)">
656
                    <input type="number" name="west"  placeholder="West(Sq Feet)">
657
                    <input type="number" name="North" placeholder="North(Sq Feet)"> 
658
                    </label>
659
                </div>
660
                    <br>
661
                      <div class="form-group">
662
                    <label>
663
 
664
                    <input type="number" name="south" placeholder="South(Sq Feet)">
665
                    <input type="number" name="front" placeholder="Front(Sq Feet)">
666
                    <input type="number" name="roadsize" placeholder="Road Size in Front(Sq Feet)">
667
 
668
                    </label>
669
                </div>
670
 
671
                  </div>  
672
                  <div class="shopArea">
673
                   <div class="btn-group">
674
                    <label class="btn btn-default">
675
                   <input type="radio" name="shopArea" value="Singleside">
676
                   <span>Single Side</span>
677
                  </label>
678
                <label class="btn btn-default">
679
                    <input type="radio" name="shopArea" value"Twoside">
680
                    <span>Two Side</span>
681
                </label>
682
                  <label class="btn btn-default">
683
                    <input type="radio" name="shopArea" value="Corner">
684
                    <span>Corner</span>
685
                </label>
686
              </div>
687
              </div>
688
 
689
 
690
              <h4 class="page-header">14. Status of Shop</h4>
691
 
692
                 <div class="btn-group">
693
                    <label class="btn btn-default">
694
                   <input type="radio" name="shopstatus" value="semifurnished">
695
                   <span>Semi Furnished</span>
696
                  </label>
697
                <label class="btn btn-default">
698
                    <input type="radio" name="shopstatus" value="fullfurnished">
699
                    <span>Full Furnished</span>
700
                </label>
701
                </div>
702
 
703
                 <div class="checkboxes status" id ="shopsemifurnished">
704
                 <div class="btn btn-default">
705
   <label for="success" class="btn btn-success">Flooring<input type="checkbox" name="flooring" 
706
          value ="flooring" id="success" class="badgebox"><span class="badge">&check;</span></label>
707
        <label for="warning" class="btn btn-success">Cieling<input type="checkbox" name="cieling" value="Pantry" id="warning" class="badgebox"><span class="badge">&check;</span></label>
708
              </div>
709
            </div>
710
 
711
<div class ="checkboxes status"  id ="shopfullfurnished">
712
          <div class="row text-center">
713
    <label for="default" class="btn btn-success">Store <input type="checkbox" name="shopStore" value="Store" id="default" class="badgebox"><span class="badge">&check;</span></label>
714
        <label for="primary" class="btn btn-success">Washroom <input type="checkbox" name="shopWashroom" value="Washroom"id="primary" class="badgebox"><span class="badge">&check;</span></label>
715
        <label for="info" class="btn btn-success">Water Supply<input type="checkbox" name="shopWater" value="Watersupply"id="info" class="badgebox"><span class="badge">&check;</span></label>
716
        <label for="success" class="btn btn-success">Electricity<input type="checkbox" name="shopElectricity" 
717
          value ="Electricity" id="success" class="badgebox"><span class="badge">&check;</span></label>
718
        <label for="warning" class="btn btn-success">Pantry<input type="checkbox" name="shopPantry" value="Pantry" id="warning" class="badgebox"><span class="badge">&check;</span></label>
719
  </div>
720
    </div>
721
 
722
 
723
              <h4 class="page-header">15. Shop Available At</h4>
724
 
725
                     <div class="btn-group">
726
                    <label class="btn btn-default">
727
                   <input type="radio" name="shopAvailbility" value="Basement">
728
                   <span>Basement</span>
729
                  </label>
730
                <label class="btn btn-default">
731
                    <input type="radio" name="shopAvailbility" value="Groundfloor">
732
                    <span>Ground Floor</span>
733
                </label>
734
                  <label class="btn btn-default">
735
                    <input type="radio" name="shopAvailbility" value="firstfloor">
736
                    <span>First Floor</span>
737
                </label>
738
 
739
                  <label class="btn btn-default">
740
                    <input type="radio" name="shopAvailbility" value="secondfloor">
741
                    <span>Second Floor</span>
742
                </label>
743
 
744
                 <label class="btn btn-default">
745
                    <input type="radio" name="shopAvailbility" value="thirdfloor">
746
                    <span>Third Floor</span>
747
                </label>
748
                </div>
749
 
750
                <div class="form-group bdetail">
751
                   <p>Provide Pictures of the Shop From 3 different Angles and cieling and floorig</p>
752
                      <input type="file" name="angledoc1" accept="application/pdf,image/*" >
753
                      <input type="file" name="angledoc2" accept="application/pdf,image/*" >
754
                     <input type="file" name="angledoc3"  accept="application/pdf,image/*" >
755
                            <input type="file" name="angledoc4"  accept="application/pdf,image/*" >
756
                                   <input type="file" name="angledoc5" accept="application/pdf,image/*">
757
                  </div>
758
 
759
         <h4 class="page-header">16. Location of Shop</h4>
760
                        <div class="btn-group">
761
                    <label class="btn btn-default">
762
                   <input type="radio" name="location" value="shoppingMall">
763
                   <span>Shopping Mall</span>
764
                  </label>
765
                <label class="btn btn-default">
766
                    <input type="radio" name="location" value="MainMobileMarket">
767
                    <span>Main Mobile Market</span>
768
                </label>
769
                  <label class="btn btn-default">
770
                    <input type="radio" name="location" value="LocalMarket">
771
                    <span>Local Market</span>
772
                </label>
773
 
774
                </div>
775
 
776
 
777
 
778
             <h4 class="page-header">17.Nearest Mobile Store</h4>
779
                           <div class="btn-group">
780
                    <label class="btn btn-default">
781
                   <input type="radio" name="neareststore" value="100mtrs">
782
                   <span>100Mtrs</span>
783
                  </label>
784
                <label class="btn btn-default">
785
                    <input type="radio" name="neareststore" value="200mtrs">
786
                    <span>200Mtrs</span>
787
                </label>
788
                  <label class="btn btn-default">
789
                    <input type="radio" name="neareststore" value="500mtrs">
790
                    <span>500Mtrs</span>
791
                </label>
792
 
793
                </div>
794
 
795
                 <div class="form-group location">
796
                   <label>Name of the Shop</label>
797
                       <input type="text" size ="35" name="storename">
798
                       <br>
799
                       <br>
800
                        <label>Address of the Shop</label>
801
                       <input type="text" size ="65" name="storeAddress">
802
                  </div>
803
 
804
 
805
 
806
            <h4 class="page-header">18. Ownership of shop</h4>
807
 
808
                    <div class="btn-group">
809
                    <label class="btn btn-default">
810
                   <input type="radio" name="ownership" value="Selfowned">
811
                   <span>Self Owned</span>
812
                  </label>
813
                <label class="btn btn-default">
814
                    <input type="radio" name="ownership" value="Rented">
815
                    <span>Rented</span>
816
                </label>
817
                  <label class="btn btn-default">
818
                    <input type="radio" name="ownership" value="lease">
819
                    <span>Lease</span>
820
                </label>
821
                  </label>
822
                  <label class="btn btn-default">
823
                    <input type="radio" name="ownership" value="collaboration">
824
                    <span>Collaboration</span>
825
                </label>
826
 
827
                </div>
828
 
829
                 <div class="form-group bdetail">
830
                   <p>Provide relevant documents (Electricity bill/Rent Agreement/Lease Deed)to prove the status of ownership</p>
831
                     <input type="file" accept="application/pdf,image/*" name="ownershipdoc">
832
                   </div>
833
 
834
 
835
           <h4 class="page-header">19. Insurance of Shop (if yes,Please provide the copy of the same)</h4>
836
 
837
 
838
                    <div class="btn-group">
839
                    <label class="btn btn-default">
840
                   <input type="radio" name="Insurance" value="yes">
841
                   <span>Yes</span>
842
                  </label>
843
                <label class="btn btn-default">
844
                    <input type="radio" name="Insurance" value="no">
845
                    <span>No</span>
846
                </label>
847
              </div>
848
 
849
                 <div class="form-group insurance doc"  id= "docyes">
850
                  <p>Please provide copy of insurance document</p>
851
                     <input type="file" accept="application/pdf,image/*" name="insurancedoc">
852
                   </div>
853
 
854
 
855
         <h4 class="page-header">20. Loan on shop (LAP/BL/CC/others)</h4>
856
 
857
                     <div class="btn-group">
858
                    <label class="btn btn-default">
859
                   <input type="radio" name="loan" value="yes">
860
                   <span>Yes</span>
861
                  </label>
862
                <label class="btn btn-default">
863
                    <input type="radio" name="loan" value="no">
864
                    <span>No</span>
865
                </label>
866
              </div>
867
 
868
                 <div class="form-group loan document" id ="documentyes">
869
                  <p>Please provide current statement Letter</p>
870
                     <input type="file" accept="application/pdf,image/*" name="loandoc">
871
 
872
                      <p>Please provide current sanction Letter</p>
873
                     <input type="file" accept="application/pdf,image/*" name="sanctiondoc">
874
                   </div>
875
 
876
 
877
            <h4 class="page-header">21. Bank Name & Address</h4>
878
 
879
                  <div class="form-group float-label-control">
880
                        <label for="">Account Number</label>
881
                        <input type="text" name="accountnumber"class="form-control" placeholder="Account Number">
882
                    </div>
883
                     <div class="form-group float-label-control">
884
                        <label for="">Bank Name</label>
885
                        <input type="text" name="bankname"class="form-control" placeholder="Bank Name">
886
                    </div>
887
                     <div class="form-group float-label-control">
888
                        <label for="">IFSC Code</label>
889
                        <input type="text" name="IFSCcode"class="form-control" placeholder="IFSC Code">
890
                    </div>
891
                     <div class="form-group float-label-control">
892
                        <label for="">Branch Name</label>
893
                        <input type="text" name="Branchname" class="form-control" placeholder="Branch Name">
894
                    </div>
895
                     <div >
896
                  <p>Please Attach the copy of cancelled cheques</p>
897
                      <div class="form-group">
898
                     <input type="file" name="chequecopy" accept="application/pdf,image/*">
899
                   </div>
900
 
901
 
902
                  <h4 class="page-header">22. Advance Payment Amount</h4> 
903
 
904
 
905
                      <div class ="Account">
906
                         <h5>Account Detail:-</h5>
907
                       <label>Account Name: New Spice Solutions Pvt Ltd</label><br>
908
                       <label>Bank Name: Indusind Bank Ltd.</label><br>
909
                        <label>Account No.:201000488351</label><br>
910
                        <label>Branch:M-56, Greater Kailash-II, Main Market New Delhi-110048</label><br>
911
                         <label>IFSC:INDB0000012</label><br>
912
                        </div>
913
                  <p>Please deposit amount of <strong> Rs 1 Lac </strong>as advance payment in following account through NEFT/RTGS and submit the UTR No
914
                    <div class="form-group float-label-control">
915
                        <label for="">UTR Number</label>
916
                        <input type="text" name="utr" class="form-control" placeholder="UTR No">
917
                    </div>
918
                    <p><b>Note:</b> Advance amount deposited shall be adjustable in the first billing. This amount is 100% refundable in case of failed verification/withdrawl of application.</p>
919
 
920
 
921
 
922
                <div class="submit">
923
              		<button type="submit" class="btn btn-success btn-lg">Submit</button>
924
             	</div>
925
 
926
             	<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>
927
 
928
 
929
 
930
 
931
 <!--             <fieldset hidden disabled="disabled">
932
              <h4 class="page-header">PMP STORE REGISTRATION APPROVAL</h4>
933
                 <p>(FOR OFFICE USE ONLY)</P>
934
 
935
                <div class=breg>
936
                 <div class=bApproval>
937
 
938
                  <label>Recommended by</label>
939
                  <input type="text" name = "recommended"class="reg-control" size="50">
940
 
941
                  </div>
942
                  <br>
943
 
944
                    <div class=bApproval>
945
                  <label>Business Manager</label>
946
                  <input type="text" name=" bManager" class="reg-control" size="50">
947
                </div>
948
                      <br>
949
                        <div class=bApproval>
950
                    <label>Operations Manager</label>
951
                  <input type="text"name="operation"class="reg-control"  size="50">
952
                </div>
953
                  <br>
954
               <div class=bApproval>
955
                     <label>BusinessHeadCategoryHead</label>
956
                  <input type="text" name="bhead"class="reg-control" size="50">
957
                </div>
958
 
959
 
960
                 </div>
961
               </fieldset> -->
962
 
963
                      </form>
964
                    </div>
965
          </div>
966
   <div class="col-sm-4">
967
                <div class="panel panel-default">
968
 
969
                    <div class="panel-body">
970
 
971
 
972
                       <label>Email:care@profitmandi.com</label><br>
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                       <label>Contact:8588842949 </label><br>
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                       <label>Address:Spice knowledge park,Sector 125, Noida, Uttar Pradesh</label>
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