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21817 kshitij.so 1
<html>
2
<head>
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<script type="text/javascript" src="js/jquery-1.10.2.min.js"></script>
5
<link rel="stylesheet" href="css/bootstrap.min.css"/>
6
<link rel="stylesheet" type="text/css" href="css/main.css"/>
7
<!-- Optional theme -->
8
<link rel="stylesheet" href="css/bootstrap-theme.min.css" />
9
 
10
<!-- Latest compiled and minified JavaScript -->
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<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(){
21825 kshitij.so 18
 
21817 kshitij.so 19
    $("input[name$='bEntity']").click(function() {
20
        var test1 = $(this).val();
21
       $(".box").hide();
21826 kshitij.so 22
       $('input[name=dinNumber]').each(function(){
23
    	 $(this).prop('disabled', true);
24
	  });
25
 
26
       var dinNumberInput = $("#sale"+test1+ " input[name=dinNumber]");
27
	   if (dinNumberInput.prop('disabled') == true){
28
	   		dinNumberInput.prop('disabled', false);
29
	   } 
21817 kshitij.so 30
        $("#sale" + test1).show();
31
});
32
});
33
</script>
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35
<script type="text/javascript">
36
$(document).ready(function(){
21822 rajender 37
    $("input[name$='bPmpDetail']").click(function() {
21817 kshitij.so 38
        var test1 = $(this).val();
39
       $(".pmp").hide();
40
        $("#Pmp" + test1).show();
41
    });
42
});
43
 
44
</script>
45
 
46
<script type="text/javascript">
47
$(document).ready(function(){
21822 rajender 48
    $("input[name$='shopStatus']").click(function() {
21817 kshitij.so 49
        var test1 = $(this).val();
50
       $(".status").hide();
51
        $("#shop" + test1).show();
52
    });
53
});
54
 
55
</script>
56
<script type="text/javascript">
57
$(document).ready(function(){
21822 rajender 58
    $("input[name$='sellingOnline']").click(function() {
21817 kshitij.so 59
        var test1 = $(this).val();
60
       $(".Names").hide();
61
        $("#selling" + test1).show();
62
    });
63
});
64
 
65
</script>
66
 
67
 
68
<script type="text/javascript">
69
$(document).ready(function(){
21826 kshitij.so 70
	associateValidator();
21822 rajender 71
    $("input[name$='insurance']").click(function() {
21817 kshitij.so 72
        var test1 = $(this).val();
73
       $(".doc").hide();
74
        $("#doc" + test1).show();
75
    });
76
});
77
 
78
</script>
79
 
80
<script type="text/javascript">
81
$(document).ready(function(){
82
    $("input[name$='loan']").click(function() {
83
        var test1 = $(this).val();
84
       $(".document").hide();
85
        $("#document" + test1).show();
86
        $("#showHide").show();
87
    });
88
});
89
 
90
function queryStringToJSON(queryString) {
91
 
92
 
93
  var pairs = queryString.split('&');
94
  var result = {};
95
  pairs.forEach(function(pair) {
96
    pair = pair.split('=');
97
    result[pair[0]] = decodeURIComponent(pair[1] || '');
98
 
99
  });
100
  return result;
101
}
102
 
103
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"}
104
 
105
function jQFormSerializeArrToJson(formSerializeArr){
106
 var jsonObj = {};
107
 jQuery.map( formSerializeArr, function( n, i ) {
108
     jsonObj[n.name] = n.value;
109
 });
110
 return jsonObj;
111
}
112
 
113
</script>
114
 
21826 kshitij.so 115
<style>
116
.loading-image {
117
position: fixed;
118
top: 50%;
119
left: 50%;
120
margin-top: -50px;
121
margin-left: -100px;
122
z-index: 100;
123
}
124
</style>
125
 
21817 kshitij.so 126
</head>
127
 
128
<body>
129
<div class="container">
130
    <div class="row">
131
         <div class ="header">   
132
         <h3 class="header">HOTSPOT PARTNER STORE powered by PROFIT MANDI</h3>
133
         <h4 class="header">(Unit of Spice Group)</h4>
134
         </div>
135
 
136
        <div class="header">
137
            <h5 class="header">APPLICATION FOR REGISTRATION</h5>
138
       </div>  
139
        <hr />
140
 
141
        <div class="row">
142
            <div class="col-sm-8">
143
 
144
                <form role="form" name="myform" id ="form"  enctype="multipart/form-data"  data-toggle="validator" novalidate>
145
             <h4 class="page-header">1. Registered Business Name of HSPS(in Block Letters)</h4>
146
                     <div class="form-group ">
147
 
148
                     <label for=""></label>
21822 rajender 149
                     <input type="text" name="registeredBusinessName" id="demo" class="bform" placeholder="Business Name"/>
21817 kshitij.so 150
 
151
 
152
                     </div>
153
 
154
 
155
             <h4 class="page-header">2. Registered Address (In Block Letters)</h4>
156
 
157
                    <div class="form-group float-label-control">
158
                        <label for="">RegisteredAddress1</label>
21822 rajender 159
                        <input type="text" name ="registeredAddress1" class="form-control" placeholder="Address 1">
21817 kshitij.so 160
                    </div>
161
                     <div class="form-group float-label-control">
162
                        <label for="">Address 2</label>
21822 rajender 163
                        <input type="text" name ="registeredAddress2"class="form-control" placeholder="Address 2">
21817 kshitij.so 164
                    </div>
165
                     <div class="form-group float-label-control">
166
                        <label for="">Address 3</label>
21822 rajender 167
                        <input type="text" name="registeredAddress3" class="form-control" placeholder="Address 3">
21817 kshitij.so 168
                    </div>
169
                     <div class="form-group float-label-control">
170
                        <label for="">City</label>
171
                        <input type="text" name="city" class="form-control" placeholder="City">
172
                    </div>
173
                     <div class="form-group float-label-control">
174
                        <label for="">Pincode</label>
175
                        <input  type="text" name="pincode" maxlength="6" class="form-control" pattern="[0-9]{6}" title="Please enter correct Pin Code"placeholder="Pincode">
176
                      </div>  
177
 
178
                     <div class="form-group float-label-control">
179
 
180
                      <select class="form-control" name = "state" placeholder="State">
181
                       <option value=" ">State</option>
182
                     <option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
183
                            <option value="Andhra Pradesh">Andhra Pradesh</option>
184
                            <option value="Arunachal Pradesh">Arunachal Pradesh</option>
185
                            <option value="Assam">Assam</option>
186
                            <option value="Bihar">Bihar</option>
187
                            <option value="Chandigarh">Chandigarh</option>
188
                            <option value="Chhattisgarh">Chhattisgarh</option>
189
                            <option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
190
                            <option value="Daman and Diu">Daman and Diu</option>
191
                            <option value="Delhi">Delhi</option>
192
                            <option value="Goa">Goa</option>
193
                            <option value="Gujarat">Gujarat</option>
194
                            <option value="Haryana">Haryana</option>
195
                            <option value="Himachal Pradesh">Himachal Pradesh</option>
196
                            <option value="Jammu and Kashmir">Jammu and Kashmir</option>
197
                            <option value="Jharkhand">Jharkhand</option>
198
                            <option value="Karnataka">Karnataka</option>
199
                            <option value="Kerala">Kerala</option>
200
                            <option value="Lakshadweep">Lakshadweep</option>
201
                            <option value="Madhya Pradesh">Madhya Pradesh</option>
202
                            <option value="Maharashtra">Maharashtra</option>
203
                            <option value="Manipur">Manipur</option>
204
                            <option value="Meghalaya">Meghalaya</option>
205
                            <option value="Mizoram">Mizoram</option>
206
                            <option value="Nagaland">Nagaland</option>
207
                            <option value="Orissa">Orissa</option>
208
                            <option value="Pondicherry">Pondicherry</option>
209
                            <option value="Punjab">Punjab</option>
210
                            <option value="Rajasthan">Rajasthan</option>
211
                            <option value="Sikkim">Sikkim</option>
212
                            <option value="Tamil Nadu">Tamil Nadu</option>
213
                            <option value="Tripura">Tripura</option>
214
                            <option value="Telangana">Telangana</option>
215
                            <option value="Uttaranchal">Uttaranchal</option>
216
                            <option value="Uttar Pradesh">Uttar Pradesh</option>
217
                            <option value="West Bengal">West Bengal</option>
218
                                              </select>
219
                    </div>
220
 
221
                      <div class="form-group float-label-control">
21825 kshitij.so 222
                        <label for="landline">Landline</label>
21826 kshitij.so 223
                        <input  type="text" class="form-control" name="landline" maxlength = "12" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Landline">
21817 kshitij.so 224
                      </div>  
225
 
226
                       <div class="form-group float-label-control">
227
                        <label for="">Mobile</label>
21822 rajender 228
                        <input  type="text" class="form-control" name="mobile" maxlength = "10" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Mobile">
21817 kshitij.so 229
                      </div>    
230
                      <div class="form-group float-label-control">
231
                        <label for="">Email1</label>
21822 rajender 232
                        <input type="email" class="form-control" name="registeredEmail1" placeholder="Email1">
21817 kshitij.so 233
                      </div>  
234
                         <p>Example:- xyz.hsps@gmail.com</p>
235
 
236
 
237
 
238
                        <div class="form-group float-label-control">
239
                        <label for="">Email2</label>
21822 rajender 240
                        <input type="email" class="form-control" name="registeredEmail2" placeholder="Email2">
21817 kshitij.so 241
                      </div>   
242
 
243
             <h4 class="page-header">3. Type of Business Entity</h4>
244
 
245
                   <div class="funkyradio">
246
 
247
                    <div class="funkyradio-primary">
248
                        <input type="radio" name="bEntity" id="radio1" value="SaleProprietorship" required>
249
                        <label for="radio1">Sale Proprietorship</label>
250
                    </div>
251
                    <div class="funkyradio-primary">
252
                        <input type="radio" name="bEntity" id="radio2" value="Partnership" required>
253
                        <label for="radio2">Partnership</label>
254
                    </div>
255
                    <div class="funkyradio-primary">
256
                        <input type="radio" name="bEntity" id="radio3" value="PrivateLimitedCompany" required>
257
                        <label for="radio3">Private Limited company</label>
258
                    </div>
259
                    <div class="funkyradio-primary">
260
                        <input type="radio" name="bEntity" id="radio4" value="LimitedLiabilityPartnership" required>
261
                        <label for="radio4">Limited Liability Partnership</label>
262
                    </div>
263
                </div>
264
                  <div class ="Entity">
265
                    <div class="SaleProprietorship box" id ="saleSaleProprietorship">Upload <strong>Proprietership proof</strong></div>
266
                     <div class="partnership box" id="salePartnership">Upload <strong>Partnership Deed</strong></div>
267
                     </div>
268
                      <div class="limitedcompany box" id="salePrivateLimitedCompany">
21825 kshitij.so 269
                      <div class="form-group float-label-control">
21817 kshitij.so 270
                        <label for="">DIN Number</label>
21826 kshitij.so 271
                        <input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number">
21817 kshitij.so 272
                    </div>Upload <strong>Incorporation certificate,Memorandum & Article of association</strong>
273
                      </div>
274
 
275
 
276
                      <div class="LimitedLiabilityPartnership box" id="saleLimitedLiabilityPartnership">
277
 
278
 
279
                           <div class="form-group float-label-control">
280
                        <label for="">DIN Number</label>
21826 kshitij.so 281
                        <input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number">
21817 kshitij.so 282
                    </div>Upload <strong>Registration certificate & partnership Deed</strong>
283
                     </div>
284
 
285
                    <div class = "form-group file upload"> 
21822 rajender 286
                   <input type="file" accept="application/pdf,image/*" name = "bEntityDoc">
21817 kshitij.so 287
                    </div>
288
 
289
 
290
                     <h4 class="page-header">4. Goods And Services Tax Number(GST)</h4>
291
                    <div class="Pmpform">
292
 
21822 rajender 293
                        <input type="text" name="gst" class="bform" placeholder="Goods And Services Tax Number"/>
21817 kshitij.so 294
                    </div>
295
                     <p>Provide Copy of GST document</p>
296
                    <div class = "file upload"> 
21822 rajender 297
                   <input type="file"  accept="application/pdf,image/*" name ="gstDoc">
21817 kshitij.so 298
                    </div>
299
 
300
 
301
                     <h4 class="page-header">5. Permanent Account Number(Pan)</h4>
302
                    <div class="form-group ">
303
 
304
                     <label for=""></label>
21822 rajender 305
                     <input type="text" name="pan" maxlength="10" class="bform" placeholder="Permanent Account Number"/></div>
21817 kshitij.so 306
                     <p>Provide Copy of Pan </p>
307
 
308
                    <div class = "form-group file upload"> 
309
 
21822 rajender 310
                   <input type="file" accept="application/pdf,image/*" name="panDoc">
21817 kshitij.so 311
                    </div>
312
 
313
 
314
             <h4 class="page-header">6. Full Details Of BusinessEntity</h4>
315
 
316
                   <div class="funkyradio">
317
                    <div class="funkyradio-primary">
21822 rajender 318
                        <input type="radio" name="bPmpDetail" id="business1" value="Proprietor" required>
21817 kshitij.so 319
                        <label for="business1">Proprietor</label>
320
                    </div>
321
                    <div class="funkyradio-primary">
21822 rajender 322
                        <input type="radio" name="bPmpDetail" id="business2" value="Partners" required>
21817 kshitij.so 323
                        <label for="business2">Partners</label>
324
                    </div>
325
                    <div class="funkyradio-primary">
21822 rajender 326
                        <input type="radio" name="bPmpDetail" id="business3" value="Directors" required>
21817 kshitij.so 327
                        <label for="business3">Directors</label>
328
                    </div>
329
                </div>
330
 
331
                <div class="tablecontainer">
332
   <table class="businessdetail">
333
              <tr> 
334
              <th class ="PMPName">Name</th>
335
              <th  class="PMPAddress">Home Address</th> 
336
              <th class="PMPtelno">Mobile</th>
337
              <th class="PMPpan">Pan</th>
338
              <th class="PMPAdhaar">Adhaar</th>
339
              <th class="PMPemail">Email</th>
340
              <th class="PMPownership">Share %</th>
341
 
342
               </tr>
343
            <tr>
344
 
21822 rajender 345
                   <td class="form-group"><input type="text" name="proprietorBusineesName"size="25"></td>
346
                   <td class="form-group"><textarea row="3" name="proprietorAddress"></textarea></td>
347
                   <td class="form-group"><input type="text" name="proprietorPhone" maxlength="10" pattern="[0-9]{10}"size="10"></th>
348
                   <td class="form-group"><input type="text" name="proprietorPan" maxlength="10" title="Please enter correct pan number"size="10"></td>
349
                    <td class="form-group"><input type="text"  name= "proprietorAdhaar" size="15"></td>
350
                   <td class="form-group"><input type="email"  name= "proprietorEmail" size="20"></td>
351
                   <td class="form-group"><input type="text" pattern="[0-9]" name="proprietorOwner" size="10"></td>
21817 kshitij.so 352
 
353
                   </tr>
354
 
355
 
356
            </table>
357
 
358
            </div>
359
            <div class="Partners pmp" id= "PmpPartners">
360
            <table class="businessdetail">
361
 
362
             <tr> 
363
              <th class ="PMPName">Name</th>
364
              <th  class="PMPAddress">Home Address</th> 
365
              <th class="PMPtelno">Mobile</th>
366
              <th class="PMPpan">Pan</th>
367
               <th class="PMPAdhaar">Adhaar</th>
368
              <th class="PMPemail">Email </th>
369
              <th class="PMPownership">Share %</th>
370
 
371
               </tr>
372
                <tr>
373
 
374
                   <td class="form-group"><input name="partnerName1"type="text" size="25"></td>
375
                   <td class="form-group"><textarea name="partnerAddress1" type="text" size="60"></textarea></td>
21822 rajender 376
                   <td class="form-group"><input name = "partnerPhone1" pattern="[0-9]{10}"type="text" size="10"></th>
377
                   <td class="form-group"><input  name ="partnerPan1"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
378
                    <td class="form-group"><input name="partnerAdhaar1" type="text"  size="15"></td>
379
                   <td class="form-group"><input name="partnerEmail1" type="email"  size="20"></td>
380
                   <td class="form-group"><input name="partnerOwner1" type="text"pattern="[0-9]"size="10"></td>
21817 kshitij.so 381
 
382
                   </tr>
383
 
384
 
385
            </table>
386
 
387
                   <table class="businessdetail">
388
 
389
             <tr> 
390
              <th class ="PMPName">Name</th>
391
              <th  class="PMPAddress">Home Address</th> 
392
              <th class="PMPtelno">Mobile</th>
393
              <th class="PMPpan">Pan</th>
394
               <th class="PMPAdhaar">Adhaar</th>
395
              <th class="PMPemail">Email </th>
396
              <th class="PMPownership">Share %</th>
397
 
398
               </tr>
399
              <tr>
400
 
401
                   <td class="form-group"><input name="partnerName2"type="text" size="25"></td>
402
                   <td class="form-group"><textarea name="partnerAddress2" type="text" size="60"></textarea></td>
21822 rajender 403
                   <td class="form-group"><input name = "partnerPhone2" pattern="[0-9]{10}" type="text" size="10"></th>
404
                   <td class="businesspan"><input  name ="partnerPan2"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
405
                   <td class="form-group"><input name="partnerAdhaar2" type="text" size="15"></td>
406
                   <td class="form-group"><input name="partnerEmail2" type="email" size="20"></td>
407
                   <td class="form-group"><input name="partnerOwner2" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 408
 
409
                   </tr>
410
 
411
            </table>
412
                   <table class="businessdetail">
413
             <tr> 
414
              <th class ="PMPName">Name</th>
415
              <th  class="PMPAddress">Home Address</th> 
416
              <th class="PMPtelno">Mobile</th>
417
              <th class="PMPpan">Pan</th>
418
               <th class="PMPAdhaar">Adhaar</th>
419
              <th class="PMPemail">Email </th>
420
              <th class="PMPownership">Share %</th>
421
 
422
               </tr>
423
                 <tr>
424
 
425
                   <td class="form-group"><input name="partnerName3"type="text" size="25"></td>
426
                   <td class="form-group"><textarea name="partnerAddress3" type="text" size="60"></textarea></td>
21822 rajender 427
                   <td class="form-group"><input name = "partnerPhone3" type="text"  maxlength = "10" pattern="[0-9]{10}"  size="10"></th>
428
                   <td class="form-group"><input  name ="partnerPan3"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
429
                    <td class="form-groupr"><input name="partnerAdhaar3" type="text" size="15"></td>
430
                   <td class="form-group"><input name="partnerEmail3"  type="email" size="20"></td>
431
                   <td class="form-group"><input name="partnerOwner3" pattern="[0-9"  type="text" size="10"></td>
21817 kshitij.so 432
 
433
                   </tr>
434
 
435
 
436
            </table>
437
 
438
 
439
 
440
           <table class="businessdetail">
441
       <tr> 
442
              <th class ="PMPName">Name</th>
443
              <th  class="PMPAddress">Home Address</th> 
444
              <th class="PMPtelno">Mobile</th>
445
              <th class="PMPpan">Pan</th>
446
               <th class="PMPAdhaar">Adhaar</th>
447
              <th class="PMPemail">Email </th>
448
              <th class="PMPownership">Share %</th>
449
 
450
               </tr>
451
               <tr>
452
 
453
                   <td class="form-group"><input name="partnerName4"type="text" size="25"></td>
454
                   <td class="form-group"><textarea name="partnerAddress4" type="text" size="60"></textarea></td>
21822 rajender 455
                   <td class="form-group"><input name = "partnerPhone4"  pattern="[0-9]{10}" type="text" size="10"></th>
456
                   <td class="form-group"><input  name ="partnerPan4"type="text" maxlength = "10"title="Please enter correct pan number"size="10"></td>
457
                    <td class="form-group"><input name="partnerAdhaar4" type="text" size="15"></td>
458
                   <td class="form-group"><input name="partnerEmail4" type="email" size="20"></td>
459
                   <td class="form-group"><input name="partnerOwner4" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 460
 
461
                   </tr>
462
 
463
 
464
            </table>
465
 
466
            </div>
467
 
468
 
469
             <div class="Directors pmp" id= "PmpDirectors">
470
            <table class="businessdetail">
471
               <tr> 
472
              <th class ="PMPName">Name</th>
473
              <th  class="PMPAddress">Home Address</th> 
474
              <th class="PMPtelno">Mobile</th>
475
              <th class="PMPpan">Pan</th>
476
               <th class="PMPAdhaar">Adhaar</th>
477
              <th class="PMPemail">Email </th>
478
              <th class="PMPownership">Share %</th>
479
 
480
               </tr>
481
               <tr>
482
                   <td class="form-group"><input name="shareholderName1"type="text" size="25"></td>
483
                   <td class="form-group"><textarea name="shareholderAddress1" type="text" size="60"></textarea></td>
21822 rajender 484
                   <td class="form-group"><input name = "shareholderPhone1" pattern="[0-9]{10}" type="text" size="10"></th>
485
                   <td class="form-group"><input  name ="shareholderPan1"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
486
                   <td class="form-group"><input name="shareholderAdhaar1" type="text" size="15"></td>
487
                   <td class="form-group"><input name="shareholderEmail1" type="email" size="20"></td>
488
                   <td class="form-group"><input name="shareholderOwner1" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 489
 
490
                   </tr>
491
 
492
 
493
            </table>
494
 
495
                   <table class="businessdetail">
496
          <tr> 
497
              <th class ="PMPName">Name</th>
498
              <th  class="PMPAddress">Home Address</th> 
499
              <th class="PMPtelno">Mobile</th>
500
              <th class="PMPpan">Pan</th>
501
               <th class="PMPAdhaar">Adhaar</th>
502
              <th class="PMPemail">Email </th>
503
              <th class="PMPownership">Share %</th>
504
 
505
               </tr>
506
                 <tr>
507
                   <td class="form-group"><input name="shareholderName2"type="text" size="25"></td>
508
                   <td class="form-group"><textarea name="shareholderAddress2" type="text" size="60"></textarea></td>
21822 rajender 509
                   <td class="form-group"><input name = "shareholderPhone2" pattern="[0-9]{10}" type="text" size="10"></th>
510
                   <td class="form-group"><input  name ="shareholderPan2"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
511
                    <td class="form-group"><input name="shareholderAdhaar2" type="text" size="15"></td>
512
                   <td class="form-group"><input name="shareholderEmail2"  type="email" size="20"></td>
513
                   <td class="form-group"><input name="shareholderOwner2" pattern="[0-9]"  type="text" size="10"></td>
21817 kshitij.so 514
 
515
                   </tr>
516
            </table>
517
 
518
                   <table class="businessdetail">
519
              <tr> 
520
              <th class ="PMPName">Name</th>
521
              <th  class="PMPAddress">Home Address</th> 
522
              <th class="PMPtelno">Mobile</th>
523
              <th class="PMPpan">Pan</th>
524
               <th class="PMPAdhaar">Adhaar</th>
525
              <th class="PMPemail">Email </th>
526
              <th class="PMPownership">Share %</th>
527
 
528
               </tr>
529
                   <tr>
530
                   <td class="form-group"><input name="shareholderName3"type="text" size="25"></td>
531
                   <td class="form-group"><textarea name="shareholderAddress3" type="text" size="60"></textarea></td>
21822 rajender 532
                   <td class="form-group"><input name = "shareholderPhone3" pattern="[0-9]{10}" type="text" size="10"></th>
533
                   <td class="form-group"><input  name ="shareholderPan3" type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
534
                   <td class="form-group"><input name="shareholderAdhaar3" type="text" size="15"></td>
535
                   <td class="form-group"><input name="shareholderEmail3" type="email" size="20"></td>
536
                   <td class="form-group"><input name="shareholderOwner3" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 537
 
538
                   </tr>
539
 
540
            </table>
541
 
542
                   <table class="businessdetail">
543
             <tr> 
544
              <th class ="PMPName">Name</th>
545
              <th  class="PMPAddress">Home Address</th> 
546
              <th class="PMPtelno">Mobile</th>
547
              <th class="PMPpan">Pan</th>
548
               <th class="PMPAdhaar">Adhaar</th>
549
              <th class="PMPemail">Email </th>
550
              <th class="PMPownership">Share %</th>
551
 
552
               </tr>
553
                     <tr>
21825 kshitij.so 554
                   <td class="form-group"><input name="shareholderName4" type="text" size="25"></td>
21817 kshitij.so 555
                   <td class="form-group"><textarea name="shareholderAddress4" type="text" size="60"></textarea></td>
21825 kshitij.so 556
                   <td class="form-group"><input name = "shareholderPhone4" type="text" pattern="[0-9]{10}" size="10"></th>
557
                   <td class="form-group"><input  name ="shareholderPan4" type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
558
                    <td class="form-group"><input name="shareholderAdhaar4" type="text" size="15"></td>
21822 rajender 559
                   <td class="form-group"><input name="shareholderEmail4"  type="email" size="20"></td>
560
                   <td class="form-group"><input name="shareholderOwner4" pattern="[0-9]"  type="text" size="10"></td>
21817 kshitij.so 561
 
562
                   </tr>
563
 
564
 
565
            </table>
566
 
567
            </div>
568
 
569
         <h4 class="page-header">7. Store Manager Detail</h4>
570
 
571
 
572
                    <div class="form-group">
573
                    <label for="">Name
21822 rajender 574
                    <input type="text" name="managerName"placeholder="Name"></label>
21817 kshitij.so 575
                    <label for="">Mobile
21822 rajender 576
                        <input type="text" name="managerNo" pattern="[0-9]{10}" title="Please enter Valid Mobile number" placeholder="Mobile No"> </label>  
21817 kshitij.so 577
                    <label for="">Email
21822 rajender 578
                        <input type="email" name="managerEmail"size="25px" placeholder="Emailid"> </label>  
21817 kshitij.so 579
 
580
                    </div>
581
 
582
 
583
            <h4 class="page-header">8. Manpower Details</h4>
584
 
585
               <div class="form-group">
586
                    <label for="">Number of Employees
21822 rajender 587
                    <input type="text"  " pattern="[0-9]" name="noOfEmployees"placeholder="Number of Employees"></label>
21817 kshitij.so 588
                    <label for="">Management Staff
21822 rajender 589
                        <input type="text"  " pattern="[0-9]" name="managementStaff" placeholder="Management Staff"> </label>  
21817 kshitij.so 590
 
591
                    </div>
592
 
593
              <h4 class="page-header">9. Experience In Telecom Trade/other Trade (Brand & Product Category)</h4>
594
                <div class="bcontacts">
21822 rajender 595
                   <textarea rows="4" name="experienceinTelecome"cols="50" placeholder="Describe yourself here..."></textarea> 
21817 kshitij.so 596
                </div>
597
 
598
            <h4 class="page-header">10. Description of Existing Business & Annual Turnover</h4>
599
                <div class="bcontacts">
21822 rajender 600
                      <textarea rows="4" name="descriptionofExistingBusiness"cols="50" placeholder="Describe yourself here..."></textarea>
21817 kshitij.so 601
                </div>
602
                <p>Please Provide ITR of last Two years</p>
603
                <div class = "form-group file upload"> 
21822 rajender 604
                   <input type="file" accept="application/pdf,image/*" name ="itrDoc">
21817 kshitij.so 605
                    </div>
606
 
607
 
608
            <h4 class="page-header">11.Business Model</h4>
609
 
610
            <div class="btn-group">
611
                    <label class="btn btn-default">
21822 rajender 612
                   <input type="radio" name="businessModel" value="Retailer" required>
21817 kshitij.so 613
                   <span>Retailer</span>
614
                  </label>
615
                <label class="btn btn-default">
21822 rajender 616
                    <input type="radio" name="businessModel" value="Distributor" required>
21817 kshitij.so 617
                    <span>Distributor</span>
618
                </label>
619
                <label class="btn btn-default">
21822 rajender 620
                    <input type="radio" name="businessModel" value="Franchises" required>
21817 kshitij.so 621
                    <span>Franchises</span>
622
                </label>
623
                  <label class="btn btn-default">
21822 rajender 624
                    <input type="radio" name="businessModel" value="Other" required>
21817 kshitij.so 625
                    <span>Other</span>
626
                </label>
627
              </div>
628
 
629
 
630
          <h4 class="page-header">12. Selling Online (if yes, Please Specify Portal Names)</h4>
631
 
632
                    <div class="btn-group">
633
                    <label class="btn btn-default">
21822 rajender 634
                   <input type="radio" name="sellingOnline" value="yes">
21817 kshitij.so 635
                   <span>Yes</span>
636
                  </label>
637
                <label class="btn btn-default">
21822 rajender 638
                    <input type="radio" name="sellingOnline" value="no">
21817 kshitij.so 639
                    <span>No</span>
640
                </label>
641
              </div>
642
                   <div class="form-group portal Names" id = "sellingyes">
643
                   <label>Portal Names</label>
644
                       <input type="text" name="portalName1" size="25">
645
                       <input type="text" name="portalName2" size="25">
646
                       <input type="text" name="portalName3" size="25">
647
                  </div>
648
            <h4 class="page-header">13. Area of Shop(in sq Feet)</h4>
649
              <div>
650
                 <div class="form-group">
651
                    <label>
652
 
653
                    <input type="number" name="east"  placeholder="East(Sq Feet)">
654
                    <input type="number" name="west"  placeholder="West(Sq Feet)">
21822 rajender 655
                    <input type="number" name="north" placeholder="North(Sq Feet)"> 
21817 kshitij.so 656
                    </label>
657
                </div>
658
                    <br>
659
                      <div class="form-group">
660
                    <label>
661
 
662
                    <input type="number" name="south" placeholder="South(Sq Feet)">
663
                    <input type="number" name="front" placeholder="Front(Sq Feet)">
21822 rajender 664
                    <input type="number" name="roadSize" placeholder="Road Size in Front(Sq Feet)">
21817 kshitij.so 665
 
666
                    </label>
667
                </div>
668
 
669
                  </div>  
670
                  <div class="shopArea">
671
                   <div class="btn-group">
672
                    <label class="btn btn-default">
673
                   <input type="radio" name="shopArea" value="Singleside">
674
                   <span>Single Side</span>
675
                  </label>
676
                <label class="btn btn-default">
677
                    <input type="radio" name="shopArea" value"Twoside">
678
                    <span>Two Side</span>
679
                </label>
680
                  <label class="btn btn-default">
681
                    <input type="radio" name="shopArea" value="Corner">
682
                    <span>Corner</span>
683
                </label>
684
              </div>
685
              </div>
686
 
687
 
688
              <h4 class="page-header">14. Status of Shop</h4>
689
 
690
                 <div class="btn-group">
691
                    <label class="btn btn-default">
21822 rajender 692
                   <input type="radio" name="shopStatus" value="semifurnished">
21817 kshitij.so 693
                   <span>Semi Furnished</span>
694
                  </label>
695
                <label class="btn btn-default">
21822 rajender 696
                    <input type="radio" name="shopStatus" value="fullfurnished">
21828 kshitij.so 697
                    <span>Fully Furnished</span>
21817 kshitij.so 698
                </label>
699
                </div>
700
 
701
                 <div class="checkboxes status" id ="shopsemifurnished">
702
                 <div class="btn btn-default">
21828 kshitij.so 703
   <label for="success1" class="btn btn-success">Flooring<input type="checkbox" name="flooring" 
704
          value ="yes" id="success1" class="badgebox"><span class="badge">&check;</span></label>
705
        <label for="warning1" class="btn btn-success">Cieling<input type="checkbox" name="cieling" value="yes" id="warning1" class="badgebox"><span class="badge">&check;</span></label>
21817 kshitij.so 706
              </div>
707
            </div>
708
 
709
<div class ="checkboxes status"  id ="shopfullfurnished">
710
          <div class="row text-center">
21826 kshitij.so 711
    <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>
712
        <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>
713
        <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>
714
        <label for="success" class="btn btn-success">Electricity<input type="checkbox" name="electricity" 
715
          value ="yes" id="success" class="badgebox"><span class="badge">&check;</span></label>
716
        <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>
21817 kshitij.so 717
  </div>
718
    </div>
719
 
720
 
721
              <h4 class="page-header">15. Shop Available At</h4>
722
 
723
                     <div class="btn-group">
724
                    <label class="btn btn-default">
725
                   <input type="radio" name="shopAvailbility" value="Basement">
726
                   <span>Basement</span>
727
                  </label>
728
                <label class="btn btn-default">
729
                    <input type="radio" name="shopAvailbility" value="Groundfloor">
730
                    <span>Ground Floor</span>
731
                </label>
732
                  <label class="btn btn-default">
733
                    <input type="radio" name="shopAvailbility" value="firstfloor">
734
                    <span>First Floor</span>
735
                </label>
736
 
737
                  <label class="btn btn-default">
738
                    <input type="radio" name="shopAvailbility" value="secondfloor">
739
                    <span>Second Floor</span>
740
                </label>
741
 
742
                 <label class="btn btn-default">
743
                    <input type="radio" name="shopAvailbility" value="thirdfloor">
744
                    <span>Third Floor</span>
745
                </label>
746
                </div>
747
 
748
                <div class="form-group bdetail">
749
                   <p>Provide Pictures of the Shop From 3 different Angles and cieling and floorig</p>
21822 rajender 750
                      <input type="file" name="angleDoc1" accept="application/pdf,image/*" >
751
                      <input type="file" name="angleDoc2" accept="application/pdf,image/*" >
752
                     <input type="file" name="angleDoc3"  accept="application/pdf,image/*" >
753
                            <input type="file" name="angleDoc4"  accept="application/pdf,image/*" >
754
                                   <input type="file" name="angleDoc5" accept="application/pdf,image/*">
21817 kshitij.so 755
                  </div>
756
 
757
         <h4 class="page-header">16. Location of Shop</h4>
758
                        <div class="btn-group">
759
                    <label class="btn btn-default">
760
                   <input type="radio" name="location" value="shoppingMall">
761
                   <span>Shopping Mall</span>
762
                  </label>
763
                <label class="btn btn-default">
764
                    <input type="radio" name="location" value="MainMobileMarket">
765
                    <span>Main Mobile Market</span>
766
                </label>
767
                  <label class="btn btn-default">
768
                    <input type="radio" name="location" value="LocalMarket">
769
                    <span>Local Market</span>
770
                </label>
771
 
772
                </div>
773
 
774
 
775
 
776
             <h4 class="page-header">17.Nearest Mobile Store</h4>
777
                           <div class="btn-group">
778
                    <label class="btn btn-default">
21822 rajender 779
                   <input type="radio" name="nearestStore" value="100mtrs">
21817 kshitij.so 780
                   <span>100Mtrs</span>
781
                  </label>
782
                <label class="btn btn-default">
21822 rajender 783
                    <input type="radio" name="nearestStore" value="200mtrs">
21817 kshitij.so 784
                    <span>200Mtrs</span>
785
                </label>
786
                  <label class="btn btn-default">
21822 rajender 787
                    <input type="radio" name="nearestStore" value="500mtrs">
21817 kshitij.so 788
                    <span>500Mtrs</span>
789
                </label>
790
 
791
                </div>
792
 
793
                 <div class="form-group location">
794
                   <label>Name of the Shop</label>
21822 rajender 795
                       <input type="text" size ="35" name="storeName">
21817 kshitij.so 796
                       <br>
797
                       <br>
798
                        <label>Address of the Shop</label>
799
                       <input type="text" size ="65" name="storeAddress">
800
                  </div>
801
 
802
 
803
 
804
            <h4 class="page-header">18. Ownership of shop</h4>
805
 
806
                    <div class="btn-group">
807
                    <label class="btn btn-default">
808
                   <input type="radio" name="ownership" value="Selfowned">
809
                   <span>Self Owned</span>
810
                  </label>
811
                <label class="btn btn-default">
812
                    <input type="radio" name="ownership" value="Rented">
813
                    <span>Rented</span>
814
                </label>
815
                  <label class="btn btn-default">
816
                    <input type="radio" name="ownership" value="lease">
817
                    <span>Lease</span>
818
                </label>
819
                  </label>
820
                  <label class="btn btn-default">
821
                    <input type="radio" name="ownership" value="collaboration">
822
                    <span>Collaboration</span>
823
                </label>
824
 
825
                </div>
826
 
827
                 <div class="form-group bdetail">
828
                   <p>Provide relevant documents (Electricity bill/Rent Agreement/Lease Deed)to prove the status of ownership</p>
21822 rajender 829
                     <input type="file" accept="application/pdf,image/*" name="ownershipDoc">
21817 kshitij.so 830
                   </div>
831
 
832
 
833
           <h4 class="page-header">19. Insurance of Shop (if yes,Please provide the copy of the same)</h4>
834
 
835
 
836
                    <div class="btn-group">
837
                    <label class="btn btn-default">
21822 rajender 838
                   <input type="radio" name="insurance" value="yes">
21817 kshitij.so 839
                   <span>Yes</span>
840
                  </label>
841
                <label class="btn btn-default">
21822 rajender 842
                    <input type="radio" name="insurance" value="no">
21817 kshitij.so 843
                    <span>No</span>
844
                </label>
845
              </div>
846
 
847
                 <div class="form-group insurance doc"  id= "docyes">
848
                  <p>Please provide copy of insurance document</p>
21822 rajender 849
                     <input type="file" accept="application/pdf,image/*" name="insuranceDoc">
21817 kshitij.so 850
                   </div>
851
 
852
 
853
         <h4 class="page-header">20. Loan on shop (LAP/BL/CC/others)</h4>
854
 
855
                     <div class="btn-group">
856
                    <label class="btn btn-default">
857
                   <input type="radio" name="loan" value="yes">
858
                   <span>Yes</span>
859
                  </label>
860
                <label class="btn btn-default">
861
                    <input type="radio" name="loan" value="no">
862
                    <span>No</span>
863
                </label>
864
              </div>
865
 
866
                 <div class="form-group loan document" id ="documentyes">
867
                  <p>Please provide current statement Letter</p>
21822 rajender 868
                     <input type="file" accept="application/pdf,image/*" name="loanDoc">
21817 kshitij.so 869
 
870
                      <p>Please provide current sanction Letter</p>
21822 rajender 871
                     <input type="file" accept="application/pdf,image/*" name="sanctionDoc">
21817 kshitij.so 872
                   </div>
873
 
874
 
875
            <h4 class="page-header">21. Bank Name & Address</h4>
876
 
877
                  <div class="form-group float-label-control">
878
                        <label for="">Account Number</label>
21822 rajender 879
                        <input type="text" name="accountNumber"class="form-control" placeholder="Account Number">
21817 kshitij.so 880
                    </div>
881
                     <div class="form-group float-label-control">
882
                        <label for="">Bank Name</label>
21822 rajender 883
                        <input type="text" name="bankName"class="form-control" placeholder="Bank Name">
21817 kshitij.so 884
                    </div>
885
                     <div class="form-group float-label-control">
886
                        <label for="">IFSC Code</label>
21822 rajender 887
                        <input type="text" name="ifscCode"class="form-control" placeholder="IFSC Code">
21817 kshitij.so 888
                    </div>
889
                     <div class="form-group float-label-control">
890
                        <label for="">Branch Name</label>
21822 rajender 891
                        <input type="text" name="branchName" class="form-control" placeholder="Branch Name">
21817 kshitij.so 892
                    </div>
893
                     <div >
894
                  <p>Please Attach the copy of cancelled cheques</p>
895
                      <div class="form-group">
21822 rajender 896
                     <input type="file" name="chequeCopy" accept="application/pdf,image/*">
21817 kshitij.so 897
                   </div>
898
 
899
 
900
                  <h4 class="page-header">22. Advance Payment Amount</h4> 
901
 
902
 
903
                      <div class ="Account">
904
                         <h5>Account Detail:-</h5>
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                       <label>Account Name: New Spice Solutions Pvt Ltd</label><br>
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                       <label>Bank Name: Indusind Bank Ltd.</label><br>
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                        <label>Account No.:201000488351</label><br>
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                        <label>Branch:M-56, Greater Kailash-II, Main Market New Delhi-110048</label><br>
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                         <label>IFSC:INDB0000012</label><br>
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                        </div>
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                  <p>Please deposit amount of <strong> Rs 1 Lac </strong>as advance payment in following account through NEFT/RTGS and submit the UTR No
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                    <div class="form-group float-label-control">
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                        <label for="">UTR Number</label>
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                        <input type="text" name="utr" class="form-control" placeholder="UTR No">
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                    </div>
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                    <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>
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                <div class="submit">
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              		<button type="submit" class="btn btn-success btn-lg">Submit</button>
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             	</div>
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             	<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>
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 <!--             <fieldset hidden disabled="disabled">
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              <h4 class="page-header">PMP STORE REGISTRATION APPROVAL</h4>
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                 <p>(FOR OFFICE USE ONLY)</P>
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                <div class=breg>
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                 <div class=bApproval>
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                  <label>Recommended by</label>
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                  <input type="text" name = "recommended"class="reg-control" size="50">
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                  </div>
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                  <br>
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                    <div class=bApproval>
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                  <label>Business Manager</label>
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                  <input type="text" name=" bManager" class="reg-control" size="50">
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                </div>
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                      <br>
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                        <div class=bApproval>
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                    <label>Operations Manager</label>
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                  <input type="text"name="operation"class="reg-control"  size="50">
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                </div>
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                  <br>
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               <div class=bApproval>
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                     <label>BusinessHeadCategoryHead</label>
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                  <input type="text" name="bhead"class="reg-control" size="50">
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                </div>
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                 </div>
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               </fieldset> -->
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                      </form>
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                    </div>
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          </div>
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   <div class="col-sm-4">
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                <div class="panel panel-default">
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                    <div class="panel-body">
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                       <label>Email:care@profitmandi.com</label><br>
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                       <label>Contact:8588842949 </label><br>
972
                       <label>Address:Spice knowledge park,Sector 125, Noida, Uttar Pradesh</label>
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                    </div>
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                </div>
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            </div>
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        </div>
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    </div>
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    </div>
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    <div id="ajax-spinner" style="display:none;">
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		<img src="images/loading.gif" class="loading-image">
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	</div>
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</body>
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</html>