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Rev Author Line No. Line
21817 kshitij.so 1 
<html>
2 
<head>
3 
 
21947 kshitij.so 4 
<script type="text/javascript" src="js/jquery-1.10.2.min.js"></script>
21817 kshitij.so 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 -->
21948 kshitij.so 11 
<script src="js/bootstrap.min.js"></script>
21817 kshitij.so 12 
<script src="js/bootstrapValidator.js"></script>
13 
<script src="js/reg.js"></script>
14 
<script src="js/reqformvalidator.js"></script>
21938 kshitij.so 15 
<script src="js/jquery.blockUI.js"></script>
21817 kshitij.so 16 
<script type="text/javascript">
21996 rajender 17 
 var contexPath = "$action.getContextPath()";
21817 kshitij.so 18 
 $(document).ready(function(){
21825 kshitij.so 19 
 
21817 kshitij.so 20 
    $("input[name$='bEntity']").click(function() {
21 
        var test1 = $(this).val();
22 
       $(".box").hide();
21826 kshitij.so 23 
       $('input[name=dinNumber]').each(function(){
21832 rajender 24 
         $(this).prop('disabled', true);
25 
      });
21826 kshitij.so 26 
 
27 
       var dinNumberInput = $("#sale"+test1+ " input[name=dinNumber]");
21832 rajender 28 
       if (dinNumberInput.prop('disabled') == true){
29 
            dinNumberInput.prop('disabled', false);
30 
       }
21817 kshitij.so 31 
        $("#sale" + test1).show();
32 
});
33 
});
34 
</script>
35 
 
36 
<script type="text/javascript">
37 
$(document).ready(function(){
21822 rajender 38 
    $("input[name$='bPmpDetail']").click(function() {
21817 kshitij.so 39 
        var test1 = $(this).val();
40 
       $(".pmp").hide();
41 
        $("#Pmp" + test1).show();
42 
    });
43 
});
44 
 
45 
</script>
46 
 
47 
<script type="text/javascript">
48 
$(document).ready(function(){
21822 rajender 49 
    $("input[name$='shopStatus']").click(function() {
21817 kshitij.so 50 
        var test1 = $(this).val();
21832 rajender 51 
          $("#shopsemifurnished, #shopfullfurnished").find("input[type=checkbox]").each(function(){
52 
         $(this).prop('disabled', true);
53 
    });
54 
 
21817 kshitij.so 55 
       $(".status").hide();
21832 rajender 56 
       $("#shop" + test1).show();
57 
       $("#shop" + test1).find("input[type=checkbox]").prop('disabled', false);
58 
 
59 
 
60 
 
61 
 
21817 kshitij.so 62 
    });
63 
});
64 
 
65 
</script>
66 
<script type="text/javascript">
67 
$(document).ready(function(){
21822 rajender 68 
    $("input[name$='sellingOnline']").click(function() {
21817 kshitij.so 69 
        var test1 = $(this).val();
70 
       $(".Names").hide();
71 
        $("#selling" + test1).show();
72 
    });
73 
});
74 
 
75 
</script>
76 
 
77 
 
78 
<script type="text/javascript">
79 
$(document).ready(function(){
21832 rajender 80 
    associateValidator();
21822 rajender 81 
    $("input[name$='insurance']").click(function() {
21817 kshitij.so 82 
        var test1 = $(this).val();
83 
       $(".doc").hide();
84 
        $("#doc" + test1).show();
85 
    });
86 
});
87 
 
88 
</script>
89 
 
90 
<script type="text/javascript">
91 
$(document).ready(function(){
92 
    $("input[name$='loan']").click(function() {
93 
        var test1 = $(this).val();
94 
       $(".document").hide();
95 
        $("#document" + test1).show();
96 
        $("#showHide").show();
97 
    });
21996 rajender 98 
 
99 
  docsArray = ['doc_bEntityDoc','doc_gstDoc','doc_panDoc','doc_itrDoc','doc_angleDoc1','doc_angleDoc2','doc_angleDoc3','doc_angleDoc4','doc_angleDoc5','doc_ownershipDoc','doc_insuranceDoc','doc_loanDoc','doc_sanctionDoc','doc_chequeCopy'];
100 
  docsArray.forEach(function(inputName){
101 
 
102 
	   $('input[name="' + inputName + '"]').change(function(e){
103 
	    var formData = new FormData();
104 
	    that = this;
105 
		formData.append("file", $(this)[0].files[0]);
106 
		jQuery.ajax({
107 
	          url: "upload",
108 
	          type: 'POST',
109 
	          data: formData,
110 
	            processData: false,
111 
	           success: function (data) {
112 
	           	hiddenInput = inputName.split("_")[1];
113 
	               $('input[name="' + hiddenInput + '"]').val(data);
114 
	               console.log(data);
115 
	           }
116 
	    });
117 
	});
118 
 
119 
  });
21817 kshitij.so 120 
});
121 
 
122 
function queryStringToJSON(queryString) {
123 
 
124 
 
125 
  var pairs = queryString.split('&');
126 
  var result = {};
127 
  pairs.forEach(function(pair) {
128 
    pair = pair.split('=');
129 
    result[pair[0]] = decodeURIComponent(pair[1] || '');
130 
 
131 
  });
132 
  return result;
133 
}
134 
 
135 
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"}
136 
 
137 
function jQFormSerializeArrToJson(formSerializeArr){
138 
 var jsonObj = {};
139 
 jQuery.map( formSerializeArr, function( n, i ) {
140 
     jsonObj[n.name] = n.value;
141 
 });
142 
 return jsonObj;
143 
}
144 
 
145 
</script>
146 
 
21826 kshitij.so 147 
<style>
148 
.loading-image {
149 
position: fixed;
150 
top: 50%;
151 
left: 50%;
152 
margin-top: -50px;
153 
margin-left: -100px;
154 
z-index: 100;
155 
}
156 
</style>
157 
 
21817 kshitij.so 158 
</head>
159 
 
160 
<body>
161 
<div class="container">
162 
    <div class="row">
163 
         <div class ="header">
21834 rajender 164 
		 <h3 class="header">HOTSPOT PARTNER STORE</h3>
21833 kshitij.so 165 
         <h4 class="header">Powered by Profit Mandi (A Unit of Spice Group)</h4>
21817 kshitij.so 166 
         </div>
167 
 
168 
        <div class="header">
169 
            <h5 class="header">APPLICATION FOR REGISTRATION</h5>
170 
       </div>
171 
        <hr />
172 
 
173 
        <div class="row">
174 
            <div class="col-sm-8">
175 
 
176 
                <form role="form" name="myform" id ="form"  enctype="multipart/form-data"  data-toggle="validator" novalidate>
21834 rajender 177 
             <h4 class="page-header">1. Registered Business Name of HSPS (in Block Letters)</h4>
21817 kshitij.so 178 
                     <div class="form-group ">
179 
 
180 
                     <label for=""></label>
21938 kshitij.so 181 
                     <input type="text" name="registeredBusinessName" style="text-transform:uppercase;" id="demo" class="bform" placeholder="Business Name"/>
21817 kshitij.so 182 
                     </div>
183 
 
184 
 
185 
             <h4 class="page-header">2. Registered Address (In Block Letters)</h4>
186 
 
187 
                    <div class="form-group float-label-control">
21832 rajender 188 
                        <label for="">Line 1</label>
189 
                        <input type="text" name ="line1" class="form-control" placeholder="Line 1">
21817 kshitij.so 190 
                    </div>
191 
                     <div class="form-group float-label-control">
21832 rajender 192 
                        <label for="">Line 2</label>
193 
                        <input type="text" name ="line2"class="form-control" placeholder="Line 2">
21817 kshitij.so 194 
                    </div>
195 
                     <div class="form-group float-label-control">
21832 rajender 196 
                        <label for="">Line 3</label>
197 
                        <input type="text" name="line3" class="form-control" placeholder="Line 3">
21817 kshitij.so 198 
                    </div>
199 
                     <div class="form-group float-label-control">
200 
                        <label for="">City</label>
201 
                        <input type="text" name="city" class="form-control" placeholder="City">
202 
                    </div>
21832 rajender 203 
                      <div class="form-group float-label-control">
204 
                        <label for="">District</label>
205 
                        <input type="text" name="district" class="form-control" placeholder="District">
206 
                    </div>
21817 kshitij.so 207 
                     <div class="form-group float-label-control">
208 
                        <label for="">Pincode</label>
209 
                        <input  type="text" name="pincode" maxlength="6" class="form-control" pattern="[0-9]{6}" title="Please enter correct Pin Code"placeholder="Pincode">
210 
                      </div>
211 
 
212 
                     <div class="form-group float-label-control">
213 
 
214 
                      <select class="form-control" name = "state" placeholder="State">
215 
                       <option value=" ">State</option>
216 
                     <option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>
217 
                            <option value="Andhra Pradesh">Andhra Pradesh</option>
218 
                            <option value="Arunachal Pradesh">Arunachal Pradesh</option>
219 
                            <option value="Assam">Assam</option>
220 
                            <option value="Bihar">Bihar</option>
221 
                            <option value="Chandigarh">Chandigarh</option>
222 
                            <option value="Chhattisgarh">Chhattisgarh</option>
223 
                            <option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>
224 
                            <option value="Daman and Diu">Daman and Diu</option>
225 
                            <option value="Delhi">Delhi</option>
226 
                            <option value="Goa">Goa</option>
227 
                            <option value="Gujarat">Gujarat</option>
228 
                            <option value="Haryana">Haryana</option>
229 
                            <option value="Himachal Pradesh">Himachal Pradesh</option>
230 
                            <option value="Jammu and Kashmir">Jammu and Kashmir</option>
231 
                            <option value="Jharkhand">Jharkhand</option>
232 
                            <option value="Karnataka">Karnataka</option>
233 
                            <option value="Kerala">Kerala</option>
234 
                            <option value="Lakshadweep">Lakshadweep</option>
235 
                            <option value="Madhya Pradesh">Madhya Pradesh</option>
236 
                            <option value="Maharashtra">Maharashtra</option>
237 
                            <option value="Manipur">Manipur</option>
238 
                            <option value="Meghalaya">Meghalaya</option>
239 
                            <option value="Mizoram">Mizoram</option>
240 
                            <option value="Nagaland">Nagaland</option>
241 
                            <option value="Orissa">Orissa</option>
242 
                            <option value="Pondicherry">Pondicherry</option>
243 
                            <option value="Punjab">Punjab</option>
244 
                            <option value="Rajasthan">Rajasthan</option>
245 
                            <option value="Sikkim">Sikkim</option>
246 
                            <option value="Tamil Nadu">Tamil Nadu</option>
247 
                            <option value="Tripura">Tripura</option>
248 
                            <option value="Telangana">Telangana</option>
249 
                            <option value="Uttaranchal">Uttaranchal</option>
250 
                            <option value="Uttar Pradesh">Uttar Pradesh</option>
251 
                            <option value="West Bengal">West Bengal</option>
252 
                                              </select>
253 
                    </div>
254 
 
21832 rajender 255 
 
21817 kshitij.so 256 
                      <div class="form-group float-label-control">
257 
                        <label for="">Email1</label>
21822 rajender 258 
                        <input type="email" class="form-control" name="registeredEmail1" placeholder="Email1">
21817 kshitij.so 259 
                      </div>
21834 rajender 260 
                         <p>Example:- xyz<strong>.hsps@gmail.com</strong></p>
21817 kshitij.so 261 
 
262 
 
263 
 
264 
                        <div class="form-group float-label-control">
265 
                        <label for="">Email2</label>
21822 rajender 266 
                        <input type="email" class="form-control" name="registeredEmail2" placeholder="Email2">
21832 rajender 267 
                      </div>
21817 kshitij.so 268 
 
21832 rajender 269 
 
270 
                       <div class="form-group float-label-control">
271 
                        <label for="">Mobile</label>
272 
                        <input  type="text" class="form-control" name="mobile" maxlength = "10" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Mobile">
273 
                      </div>
274 
 
275 
                    <label>Landline</label>
276 
                      <div class="form-group Pmpform">
21851 rajender 277 
                      <input type="text" name="stdcode" maxlength = "5" pattern="[0-9]*" title="Please enter valid Phone number" placeholder="STDcode"/>
21832 rajender 278 
 
279 
 
21851 rajender 280 
                      <input type="text" name="telephone" maxlength = "10" pattern="[0-9]*" title="Please enter valid Phone number" placeholder="Telephone"/>
21832 rajender 281 
                      </div>
282 
 
283 
 
284 
 
21817 kshitij.so 285 
             <h4 class="page-header">3. Type of Business Entity</h4>
286 
 
287 
                   <div class="funkyradio">
288 
 
289 
                    <div class="funkyradio-primary">
290 
                        <input type="radio" name="bEntity" id="radio1" value="SaleProprietorship" required>
21832 rajender 291 
                        <label for="radio1">Proprietor</label>
21817 kshitij.so 292 
                    </div>
293 
                    <div class="funkyradio-primary">
294 
                        <input type="radio" name="bEntity" id="radio2" value="Partnership" required>
295 
                        <label for="radio2">Partnership</label>
296 
                    </div>
297 
                    <div class="funkyradio-primary">
298 
                        <input type="radio" name="bEntity" id="radio3" value="PrivateLimitedCompany" required>
299 
                        <label for="radio3">Private Limited company</label>
300 
                    </div>
301 
                    <div class="funkyradio-primary">
302 
                        <input type="radio" name="bEntity" id="radio4" value="LimitedLiabilityPartnership" required>
303 
                        <label for="radio4">Limited Liability Partnership</label>
304 
                    </div>
305 
                </div>
306 
                  <div class ="Entity">
307 
                    <div class="SaleProprietorship box" id ="saleSaleProprietorship">Upload <strong>Proprietership proof</strong></div>
308 
                     <div class="partnership box" id="salePartnership">Upload <strong>Partnership Deed</strong></div>
309 
                     </div>
310 
                      <div class="limitedcompany box" id="salePrivateLimitedCompany">
21825 kshitij.so 311 
                      <div class="form-group float-label-control">
21817 kshitij.so 312 
                        <label for="">DIN Number</label>
21826 kshitij.so 313 
                        <input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number">
21817 kshitij.so 314 
                    </div>Upload <strong>Incorporation certificate,Memorandum & Article of association</strong>
315 
                      </div>
316 
 
317 
 
318 
                      <div class="LimitedLiabilityPartnership box" id="saleLimitedLiabilityPartnership">
319 
 
320 
 
321 
                           <div class="form-group float-label-control">
322 
                        <label for="">DIN Number</label>
21826 kshitij.so 323 
                        <input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number">
21817 kshitij.so 324 
                    </div>Upload <strong>Registration certificate & partnership Deed</strong>
325 
                     </div>
326 
 
327 
                    <div class = "form-group file upload">
21996 rajender 328 
                   <input type="file" accept="application/pdf,image/*" id="doc" name ="doc_bEntityDoc">
329 
 
22000 rajender 330 
                   <input type="hidden" name="bEntityDoc"/>
21817 kshitij.so 331 
                    </div>
21996 rajender 332 
 
21817 kshitij.so 333 
                     <h4 class="page-header">4. Goods And Services Tax Number(GST)</h4>
334 
                    <div class="Pmpform">
335 
 
21822 rajender 336 
                        <input type="text" name="gst" class="bform" placeholder="Goods And Services Tax Number"/>
21817 kshitij.so 337 
                    </div>
338 
                     <p>Provide Copy of GST document</p>
339 
                    <div class = "file upload">
21996 rajender 340 
                   <input type="file"  accept="application/pdf,image/*" name ="doc_gstDoc">
341 
                     <input type="hidden" name="gstDoc"/>
21817 kshitij.so 342 
                    </div>
343 
 
344 
 
21832 rajender 345 
                     <h4 class="page-header">5. Permanent Account Number(PAN)</h4>
21817 kshitij.so 346 
                    <div class="form-group ">
347 
 
348 
                     <label for=""></label>
21822 rajender 349 
                     <input type="text" name="pan" maxlength="10" class="bform" placeholder="Permanent Account Number"/></div>
21832 rajender 350 
                     <p>Provide Copy of PAN </p>
21817 kshitij.so 351 
 
352 
                    <div class = "form-group file upload">
353 
 
21996 rajender 354 
                   <input type="file" accept="application/pdf,image/*" name="doc_panDoc">
355 
                     <input type="hidden" name="panDoc"/>
21817 kshitij.so 356 
                    </div>
357 
 
358 
 
21833 kshitij.so 359 
             <h4 class="page-header">6. Full Details Of Business Entity</h4>
21817 kshitij.so 360 
 
361 
                   <div class="funkyradio">
362 
                    <div class="funkyradio-primary">
21822 rajender 363 
                        <input type="radio" name="bPmpDetail" id="business1" value="Proprietor" required>
21817 kshitij.so 364 
                        <label for="business1">Proprietor</label>
365 
                    </div>
366 
                    <div class="funkyradio-primary">
21822 rajender 367 
                        <input type="radio" name="bPmpDetail" id="business2" value="Partners" required>
21817 kshitij.so 368 
                        <label for="business2">Partners</label>
369 
                    </div>
370 
                    <div class="funkyradio-primary">
21822 rajender 371 
                        <input type="radio" name="bPmpDetail" id="business3" value="Directors" required>
21817 kshitij.so 372 
                        <label for="business3">Directors</label>
373 
                    </div>
374 
                </div>
375 
 
376 
                <div class="tablecontainer">
377 
   <table class="businessdetail">
378 
              <tr>
379 
              <th class ="PMPName">Name</th>
21832 rajender 380 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 381 
              <th class="PMPtelno">Mobile</th>
21832 rajender 382 
              <th class="PMPpan">PAN</th>
383 
              <th class="PMPAdhaar">Aadhaar Number</th>
21817 kshitij.so 384 
              <th class="PMPemail">Email</th>
385 
              <th class="PMPownership">Share %</th>
386 
 
387 
               </tr>
388 
            <tr>
389 
 
21822 rajender 390 
                   <td class="form-group"><input type="text" name="proprietorBusineesName"size="25"></td>
391 
                   <td class="form-group"><textarea row="3" name="proprietorAddress"></textarea></td>
392 
                   <td class="form-group"><input type="text" name="proprietorPhone" maxlength="10" pattern="[0-9]{10}"size="10"></th>
393 
                   <td class="form-group"><input type="text" name="proprietorPan" maxlength="10" title="Please enter correct pan number"size="10"></td>
394 
                    <td class="form-group"><input type="text"  name= "proprietorAdhaar" size="15"></td>
395 
                   <td class="form-group"><input type="email"  name= "proprietorEmail" size="20"></td>
396 
                   <td class="form-group"><input type="text" pattern="[0-9]" name="proprietorOwner" size="10"></td>
21817 kshitij.so 397 
 
398 
                   </tr>
399 
 
400 
 
401 
            </table>
402 
 
403 
            </div>
404 
            <div class="Partners pmp" id= "PmpPartners">
405 
            <table class="businessdetail">
406 
 
407 
             <tr>
408 
              <th class ="PMPName">Name</th>
21832 rajender 409 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 410 
              <th class="PMPtelno">Mobile</th>
21832 rajender 411 
              <th class="PMPpan">PAN</th>
412 
              <th class="PMPAdhaar">Aadhaar Number</th>
413 
              <th class="PMPemail">Email</th>
21817 kshitij.so 414 
              <th class="PMPownership">Share %</th>
415 
 
416 
               </tr>
417 
                <tr>
418 
 
419 
                   <td class="form-group"><input name="partnerName1"type="text" size="25"></td>
420 
                   <td class="form-group"><textarea name="partnerAddress1" type="text" size="60"></textarea></td>
21822 rajender 421 
                   <td class="form-group"><input name = "partnerPhone1" pattern="[0-9]{10}"type="text" size="10"></th>
422 
                   <td class="form-group"><input  name ="partnerPan1"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
423 
                    <td class="form-group"><input name="partnerAdhaar1" type="text"  size="15"></td>
424 
                   <td class="form-group"><input name="partnerEmail1" type="email"  size="20"></td>
425 
                   <td class="form-group"><input name="partnerOwner1" type="text"pattern="[0-9]"size="10"></td>
21817 kshitij.so 426 
 
427 
                   </tr>
428 
 
429 
 
430 
            </table>
431 
 
432 
                   <table class="businessdetail">
433 
 
434 
             <tr>
435 
              <th class ="PMPName">Name</th>
21832 rajender 436 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 437 
              <th class="PMPtelno">Mobile</th>
21832 rajender 438 
              <th class="PMPpan">PAN</th>
439 
              <th class="PMPAdhaar">Aadhaar Number</th>
440 
              <th class="PMPemail">Email</th>
21817 kshitij.so 441 
              <th class="PMPownership">Share %</th>
442 
 
443 
               </tr>
444 
              <tr>
445 
 
446 
                   <td class="form-group"><input name="partnerName2"type="text" size="25"></td>
447 
                   <td class="form-group"><textarea name="partnerAddress2" type="text" size="60"></textarea></td>
21822 rajender 448 
                   <td class="form-group"><input name = "partnerPhone2" pattern="[0-9]{10}" type="text" size="10"></th>
449 
                   <td class="businesspan"><input  name ="partnerPan2"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
450 
                   <td class="form-group"><input name="partnerAdhaar2" type="text" size="15"></td>
451 
                   <td class="form-group"><input name="partnerEmail2" type="email" size="20"></td>
452 
                   <td class="form-group"><input name="partnerOwner2" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 453 
 
454 
                   </tr>
455 
 
456 
            </table>
457 
                   <table class="businessdetail">
458 
             <tr>
21832 rajender 459 
            <th class ="PMPName">Name</th>
460 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 461 
              <th class="PMPtelno">Mobile</th>
21832 rajender 462 
              <th class="PMPpan">PAN</th>
463 
              <th class="PMPAdhaar">Aadhaar Number</th>
464 
              <th class="PMPemail">Email</th>
21817 kshitij.so 465 
              <th class="PMPownership">Share %</th>
466 
 
467 
               </tr>
468 
                 <tr>
469 
 
470 
                   <td class="form-group"><input name="partnerName3"type="text" size="25"></td>
471 
                   <td class="form-group"><textarea name="partnerAddress3" type="text" size="60"></textarea></td>
21822 rajender 472 
                   <td class="form-group"><input name = "partnerPhone3" type="text"  maxlength = "10" pattern="[0-9]{10}"  size="10"></th>
473 
                   <td class="form-group"><input  name ="partnerPan3"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
474 
                    <td class="form-groupr"><input name="partnerAdhaar3" type="text" size="15"></td>
475 
                   <td class="form-group"><input name="partnerEmail3"  type="email" size="20"></td>
476 
                   <td class="form-group"><input name="partnerOwner3" pattern="[0-9"  type="text" size="10"></td>
21817 kshitij.so 477 
 
478 
                   </tr>
479 
 
480 
 
481 
            </table>
482 
 
483 
 
484 
 
485 
           <table class="businessdetail">
486 
       <tr>
21832 rajender 487 
                <th class ="PMPName">Name</th>
488 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 489 
              <th class="PMPtelno">Mobile</th>
21832 rajender 490 
              <th class="PMPpan">PAN</th>
491 
              <th class="PMPAdhaar">Aadhaar Number</th>
492 
              <th class="PMPemail">Email</th>
21817 kshitij.so 493 
              <th class="PMPownership">Share %</th>
494 
               </tr>
495 
               <tr>
496 
 
497 
                   <td class="form-group"><input name="partnerName4"type="text" size="25"></td>
498 
                   <td class="form-group"><textarea name="partnerAddress4" type="text" size="60"></textarea></td>
21822 rajender 499 
                   <td class="form-group"><input name = "partnerPhone4"  pattern="[0-9]{10}" type="text" size="10"></th>
500 
                   <td class="form-group"><input  name ="partnerPan4"type="text" maxlength = "10"title="Please enter correct pan number"size="10"></td>
501 
                    <td class="form-group"><input name="partnerAdhaar4" type="text" size="15"></td>
502 
                   <td class="form-group"><input name="partnerEmail4" type="email" size="20"></td>
503 
                   <td class="form-group"><input name="partnerOwner4" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 504 
 
505 
                   </tr>
506 
 
507 
 
508 
            </table>
509 
 
510 
            </div>
511 
 
512 
 
513 
             <div class="Directors pmp" id= "PmpDirectors">
514 
            <table class="businessdetail">
515 
               <tr>
21832 rajender 516 
               <th class ="PMPName">Name</th>
517 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 518 
              <th class="PMPtelno">Mobile</th>
21832 rajender 519 
              <th class="PMPpan">PAN</th>
520 
              <th class="PMPAdhaar">Aadhaar Number</th>
521 
              <th class="PMPemail">Email</th>
21817 kshitij.so 522 
              <th class="PMPownership">Share %</th>
523 
 
524 
               </tr>
525 
               <tr>
526 
                   <td class="form-group"><input name="shareholderName1"type="text" size="25"></td>
527 
                   <td class="form-group"><textarea name="shareholderAddress1" type="text" size="60"></textarea></td>
21822 rajender 528 
                   <td class="form-group"><input name = "shareholderPhone1" pattern="[0-9]{10}" type="text" size="10"></th>
529 
                   <td class="form-group"><input  name ="shareholderPan1"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
530 
                   <td class="form-group"><input name="shareholderAdhaar1" type="text" size="15"></td>
531 
                   <td class="form-group"><input name="shareholderEmail1" type="email" size="20"></td>
532 
                   <td class="form-group"><input name="shareholderOwner1" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 533 
 
534 
                   </tr>
535 
 
536 
 
537 
            </table>
538 
 
539 
                   <table class="businessdetail">
540 
          <tr>
21832 rajender 541 
                <th class ="PMPName">Name</th>
542 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 543 
              <th class="PMPtelno">Mobile</th>
21832 rajender 544 
              <th class="PMPpan">PAN</th>
545 
              <th class="PMPAdhaar">Aadhaar Number</th>
546 
              <th class="PMPemail">Email</th>
21817 kshitij.so 547 
              <th class="PMPownership">Share %</th>
548 
               </tr>
549 
                 <tr>
550 
                   <td class="form-group"><input name="shareholderName2"type="text" size="25"></td>
551 
                   <td class="form-group"><textarea name="shareholderAddress2" type="text" size="60"></textarea></td>
21822 rajender 552 
                   <td class="form-group"><input name = "shareholderPhone2" pattern="[0-9]{10}" type="text" size="10"></th>
553 
                   <td class="form-group"><input  name ="shareholderPan2"type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
554 
                    <td class="form-group"><input name="shareholderAdhaar2" type="text" size="15"></td>
555 
                   <td class="form-group"><input name="shareholderEmail2"  type="email" size="20"></td>
556 
                   <td class="form-group"><input name="shareholderOwner2" pattern="[0-9]"  type="text" size="10"></td>
21817 kshitij.so 557 
 
558 
                   </tr>
559 
            </table>
560 
 
561 
                   <table class="businessdetail">
562 
              <tr>
21832 rajender 563 
                <th class ="PMPName">Name</th>
564 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 565 
              <th class="PMPtelno">Mobile</th>
21832 rajender 566 
              <th class="PMPpan">PAN</th>
567 
              <th class="PMPAdhaar">Aadhaar Number</th>
568 
              <th class="PMPemail">Email</th>
21817 kshitij.so 569 
              <th class="PMPownership">Share %</th>
570 
 
571 
               </tr>
572 
                   <tr>
573 
                   <td class="form-group"><input name="shareholderName3"type="text" size="25"></td>
574 
                   <td class="form-group"><textarea name="shareholderAddress3" type="text" size="60"></textarea></td>
21822 rajender 575 
                   <td class="form-group"><input name = "shareholderPhone3" pattern="[0-9]{10}" type="text" size="10"></th>
576 
                   <td class="form-group"><input  name ="shareholderPan3" type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td>
577 
                   <td class="form-group"><input name="shareholderAdhaar3" type="text" size="15"></td>
578 
                   <td class="form-group"><input name="shareholderEmail3" type="email" size="20"></td>
579 
                   <td class="form-group"><input name="shareholderOwner3" pattern="[0-9]" type="text" size="10"></td>
21817 kshitij.so 580 
 
581 
                   </tr>
582 
 
583 
            </table>
584 
 
585 
                   <table class="businessdetail">
586 
             <tr>
21832 rajender 587 
                <th class ="PMPName">Name</th>
588 
              <th  class="PMPAddress">Address</th>
21817 kshitij.so 589 
              <th class="PMPtelno">Mobile</th>
21832 rajender 590 
              <th class="PMPpan">PAN</th>
591 
              <th class="PMPAdhaar">Aadhaar Number</th>
592 
              <th class="PMPemail">Email</th>
21817 kshitij.so 593 
              <th class="PMPownership">Share %</th>
594 
               </tr>
595 
                     <tr>
21825 kshitij.so 596 
                   <td class="form-group"><input name="shareholderName4" type="text" size="25"></td>
21817 kshitij.so 597 
                   <td class="form-group"><textarea name="shareholderAddress4" type="text" size="60"></textarea></td>
21825 kshitij.so 598 
                   <td class="form-group"><input name = "shareholderPhone4" type="text" pattern="[0-9]{10}" size="10"></th>
599 
                   <td class="form-group"><input  name ="shareholderPan4" type="text" maxlength = "10"  title="Please enter correct pan number"size="10"></td>
600 
                    <td class="form-group"><input name="shareholderAdhaar4" type="text" size="15"></td>
21822 rajender 601 
                   <td class="form-group"><input name="shareholderEmail4"  type="email" size="20"></td>
602 
                   <td class="form-group"><input name="shareholderOwner4" pattern="[0-9]"  type="text" size="10"></td>
21817 kshitij.so 603 
 
604 
                   </tr>
605 
 
606 
 
607 
            </table>
608 
 
609 
            </div>
610 
 
21834 rajender 611 
         <h4 class="page-header">7. Store Manager Details</h4>
21817 kshitij.so 612 
 
613 
 
614 
                    <div class="form-group">
615 
                    <label for="">Name
21822 rajender 616 
                    <input type="text" name="managerName"placeholder="Name"></label>
21817 kshitij.so 617 
                    <label for="">Mobile
21822 rajender 618 
                        <input type="text" name="managerNo" pattern="[0-9]{10}" title="Please enter Valid Mobile number" placeholder="Mobile No"> </label>
21817 kshitij.so 619 
                    <label for="">Email
21822 rajender 620 
                        <input type="email" name="managerEmail"size="25px" placeholder="Emailid"> </label>
21817 kshitij.so 621 
 
622 
                    </div>
623 
 
624 
 
625 
            <h4 class="page-header">8. Manpower Details</h4>
626 
 
627 
               <div class="form-group">
628 
                    <label for="">Number of Employees
21832 rajender 629 
                    <input type="text" pattern="[0-9]" name="noOfEmployees"placeholder="Number of Employees"></label>
630 
                    <label for="">Number of Management Staff
631 
                        <input type="text" pattern="[0-9]" name="managementStaff" placeholder="Management Staff"> </label>
21817 kshitij.so 632 
 
633 
                    </div>
634 
 
635 
              <h4 class="page-header">9. Experience In Telecom Trade/other Trade (Brand & Product Category)</h4>
636 
                <div class="bcontacts">
21822 rajender 637 
                   <textarea rows="4" name="experienceinTelecome"cols="50" placeholder="Describe yourself here..."></textarea>
21817 kshitij.so 638 
                </div>
639 
 
640 
            <h4 class="page-header">10. Description of Existing Business & Annual Turnover</h4>
641 
                <div class="bcontacts">
21822 rajender 642 
                      <textarea rows="4" name="descriptionofExistingBusiness"cols="50" placeholder="Describe yourself here..."></textarea>
21817 kshitij.so 643 
                </div>
644 
                <p>Please Provide ITR of last Two years</p>
645 
                <div class = "form-group file upload">
21996 rajender 646 
                   <input type="file" accept="application/pdf,image/*" name ="doc_itrDoc">
647 
                      <input type="hidden" name="itrDoc"/>
21817 kshitij.so 648 
                    </div>
649 
 
650 
 
651 
            <h4 class="page-header">11.Business Model</h4>
652 
 
653 
            <div class="btn-group">
654 
                    <label class="btn btn-default">
21822 rajender 655 
                   <input type="radio" name="businessModel" value="Retailer" required>
21817 kshitij.so 656 
                   <span>Retailer</span>
657 
                  </label>
658 
                <label class="btn btn-default">
21822 rajender 659 
                    <input type="radio" name="businessModel" value="Distributor" required>
21817 kshitij.so 660 
                    <span>Distributor</span>
661 
                </label>
662 
                <label class="btn btn-default">
21822 rajender 663 
                    <input type="radio" name="businessModel" value="Franchises" required>
21834 rajender 664 
                    <span>Franchise</span>
21817 kshitij.so 665 
                </label>
666 
                  <label class="btn btn-default">
21822 rajender 667 
                    <input type="radio" name="businessModel" value="Other" required>
21817 kshitij.so 668 
                    <span>Other</span>
669 
                </label>
670 
              </div>
671 
 
672 
 
21834 rajender 673 
          <h4 class="page-header">12. Selling Online (if yes, please specify Portal Names)</h4>
21817 kshitij.so 674 
 
675 
                    <div class="btn-group">
676 
                    <label class="btn btn-default">
21822 rajender 677 
                   <input type="radio" name="sellingOnline" value="yes">
21817 kshitij.so 678 
                   <span>Yes</span>
679 
                  </label>
680 
                <label class="btn btn-default">
21822 rajender 681 
                    <input type="radio" name="sellingOnline" value="no">
21817 kshitij.so 682 
                    <span>No</span>
683 
                </label>
684 
              </div>
685 
                   <div class="form-group portal Names" id = "sellingyes">
686 
                   <label>Portal Names</label>
687 
                       <input type="text" name="portalName1" size="25">
688 
                       <input type="text" name="portalName2" size="25">
689 
                       <input type="text" name="portalName3" size="25">
690 
                  </div>
21834 rajender 691 
            <h4 class="page-header">13. Area of Shop(in Sq Feet)</h4>
21817 kshitij.so 692 
              <div>
693 
                 <div class="form-group">
694 
                    <label>
695 
 
696 
                    <input type="number" name="east"  placeholder="East(Sq Feet)">
697 
                    <input type="number" name="west"  placeholder="West(Sq Feet)">
21822 rajender 698 
                    <input type="number" name="north" placeholder="North(Sq Feet)">
21817 kshitij.so 699 
                    </label>
700 
                </div>
701 
                    <br>
702 
                      <div class="form-group">
703 
                    <label>
704 
 
705 
                    <input type="number" name="south" placeholder="South(Sq Feet)">
706 
                    <input type="number" name="front" placeholder="Front(Sq Feet)">
21822 rajender 707 
                    <input type="number" name="roadSize" placeholder="Road Size in Front(Sq Feet)">
21817 kshitij.so 708 
 
709 
                    </label>
710 
                </div>
711 
 
712 
                  </div>
713 
                  <div class="shopArea">
714 
                   <div class="btn-group">
715 
                    <label class="btn btn-default">
716 
                   <input type="radio" name="shopArea" value="Singleside">
717 
                   <span>Single Side</span>
718 
                  </label>
719 
                <label class="btn btn-default">
720 
                    <input type="radio" name="shopArea" value"Twoside">
721 
                    <span>Two Side</span>
722 
                </label>
723 
                  <label class="btn btn-default">
724 
                    <input type="radio" name="shopArea" value="Corner">
725 
                    <span>Corner</span>
726 
                </label>
727 
              </div>
728 
              </div>
729 
 
730 
 
731 
              <h4 class="page-header">14. Status of Shop</h4>
732 
 
733 
                 <div class="btn-group">
734 
                    <label class="btn btn-default">
21822 rajender 735 
                   <input type="radio" name="shopStatus" value="semifurnished">
21817 kshitij.so 736 
                   <span>Semi Furnished</span>
737 
                  </label>
738 
                <label class="btn btn-default">
21822 rajender 739 
                    <input type="radio" name="shopStatus" value="fullfurnished">
21828 kshitij.so 740 
                    <span>Fully Furnished</span>
21817 kshitij.so 741 
                </label>
742 
                </div>
743 
 
744 
                 <div class="checkboxes status" id ="shopsemifurnished">
745 
                 <div class="btn btn-default">
21828 kshitij.so 746 
   <label for="success1" class="btn btn-success">Flooring<input type="checkbox" name="flooring"
21832 rajender 747 
          value ="flooring" id="success1" class="badgebox"><span class="badge">&check;</span></label>
21834 rajender 748 
        <label for="warning1" class="btn btn-success">Ceiling<input type="checkbox" name="cieling" value="ceiling" id="warning1" class="badgebox"><span class="badge">&check;</span></label>
21832 rajender 749 
 
750 
 
21817 kshitij.so 751 
              </div>
752 
            </div>
753 
 
754 
<div class ="checkboxes status"  id ="shopfullfurnished">
755 
          <div class="row text-center">
21826 kshitij.so 756 
    <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>
757 
        <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>
758 
        <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>
759 
        <label for="success" class="btn btn-success">Electricity<input type="checkbox" name="electricity"
760 
          value ="yes" id="success" class="badgebox"><span class="badge">&check;</span></label>
761 
        <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 762 
  </div>
763 
    </div>
764 
 
765 
 
766 
              <h4 class="page-header">15. Shop Available At</h4>
767 
 
768 
                     <div class="btn-group">
769 
                    <label class="btn btn-default">
770 
                   <input type="radio" name="shopAvailbility" value="Basement">
771 
                   <span>Basement</span>
772 
                  </label>
773 
                <label class="btn btn-default">
774 
                    <input type="radio" name="shopAvailbility" value="Groundfloor">
775 
                    <span>Ground Floor</span>
776 
                </label>
777 
                  <label class="btn btn-default">
778 
                    <input type="radio" name="shopAvailbility" value="firstfloor">
779 
                    <span>First Floor</span>
780 
                </label>
781 
 
782 
                  <label class="btn btn-default">
783 
                    <input type="radio" name="shopAvailbility" value="secondfloor">
784 
                    <span>Second Floor</span>
785 
                </label>
786 
 
787 
                 <label class="btn btn-default">
788 
                    <input type="radio" name="shopAvailbility" value="thirdfloor">
789 
                    <span>Third Floor</span>
790 
                </label>
791 
                </div>
792 
 
793 
                <div class="form-group bdetail">
21834 rajender 794 
                   <p>Provide pictures of the shop from 3 different angles, ceiling and flooring</p>
21996 rajender 795 
                      <input type="file" name="doc_angleDoc1" accept="application/pdf,image/*" >
796 
                      <input type="hidden" name="angleDoc1"/>
797 
                      <input type="file" name="doc_angleDoc2" accept="application/pdf,image/*" >
798 
                      <input type="hidden" name="angleDoc2"/>
799 
                      <input type="file" name="doc_angleDoc3"  accept="application/pdf,image/*" >
800 
                      <input type="hidden" name="angleDoc3"/>
801 
                      <input type="file" name="doc_angleDoc4"  accept="application/pdf,image/*" >
802 
                      <input type="hidden" name="angleDoc4"/>
803 
                      <input type="file" name="doc_angleDoc5" accept="application/pdf,image/*">
804 
                      <input type="hidden" name="angleDoc5"/>
21817 kshitij.so 805 
                  </div>
806 
 
807 
         <h4 class="page-header">16. Location of Shop</h4>
808 
                        <div class="btn-group">
809 
                    <label class="btn btn-default">
810 
                   <input type="radio" name="location" value="shoppingMall">
811 
                   <span>Shopping Mall</span>
812 
                  </label>
813 
                <label class="btn btn-default">
814 
                    <input type="radio" name="location" value="MainMobileMarket">
815 
                    <span>Main Mobile Market</span>
816 
                </label>
817 
                  <label class="btn btn-default">
818 
                    <input type="radio" name="location" value="LocalMarket">
819 
                    <span>Local Market</span>
820 
                </label>
821 
 
822 
                </div>
823 
 
824 
 
825 
 
826 
             <h4 class="page-header">17.Nearest Mobile Store</h4>
827 
                           <div class="btn-group">
828 
                    <label class="btn btn-default">
21822 rajender 829 
                   <input type="radio" name="nearestStore" value="100mtrs">
21817 kshitij.so 830 
                   <span>100Mtrs</span>
831 
                  </label>
832 
                <label class="btn btn-default">
21822 rajender 833 
                    <input type="radio" name="nearestStore" value="200mtrs">
21817 kshitij.so 834 
                    <span>200Mtrs</span>
835 
                </label>
836 
                  <label class="btn btn-default">
21822 rajender 837 
                    <input type="radio" name="nearestStore" value="500mtrs">
21817 kshitij.so 838 
                    <span>500Mtrs</span>
839 
                </label>
840 
 
841 
                </div>
842 
 
843 
                 <div class="form-group location">
844 
                   <label>Name of the Shop</label>
21822 rajender 845 
                       <input type="text" size ="35" name="storeName">
21817 kshitij.so 846 
                       <br>
847 
                       <br>
848 
                        <label>Address of the Shop</label>
849 
                       <input type="text" size ="65" name="storeAddress">
850 
                  </div>
851 
 
852 
 
853 
 
21834 rajender 854 
            <h4 class="page-header">18. Ownership of Shop</h4>
21817 kshitij.so 855 
 
856 
                    <div class="btn-group">
857 
                    <label class="btn btn-default">
858 
                   <input type="radio" name="ownership" value="Selfowned">
859 
                   <span>Self Owned</span>
860 
                  </label>
861 
                <label class="btn btn-default">
862 
                    <input type="radio" name="ownership" value="Rented">
863 
                    <span>Rented</span>
864 
                </label>
865 
                  <label class="btn btn-default">
866 
                    <input type="radio" name="ownership" value="lease">
867 
                    <span>Lease</span>
868 
                </label>
869 
                  </label>
870 
                  <label class="btn btn-default">
871 
                    <input type="radio" name="ownership" value="collaboration">
872 
                    <span>Collaboration</span>
873 
                </label>
874 
 
875 
                </div>
876 
 
877 
                 <div class="form-group bdetail">
878 
                   <p>Provide relevant documents (Electricity bill/Rent Agreement/Lease Deed)to prove the status of ownership</p>
21996 rajender 879 
                     <input type="file" accept="application/pdf,image/*" name="doc_ownershipDoc">
880 
                     <input type="hidden" name="ownershipDoc"/>
21817 kshitij.so 881 
                   </div>
882 
 
883 
 
21834 rajender 884 
           <h4 class="page-header">19. Insurance of Shop (if yes, please provide the copy of the same)</h4>
21817 kshitij.so 885 
 
886 
 
887 
                    <div class="btn-group">
888 
                    <label class="btn btn-default">
21822 rajender 889 
                   <input type="radio" name="insurance" value="yes">
21817 kshitij.so 890 
                   <span>Yes</span>
891 
                  </label>
892 
                <label class="btn btn-default">
21822 rajender 893 
                    <input type="radio" name="insurance" value="no">
21817 kshitij.so 894 
                    <span>No</span>
895 
                </label>
896 
              </div>
897 
 
898 
                 <div class="form-group insurance doc"  id= "docyes">
899 
                  <p>Please provide copy of insurance document</p>
21996 rajender 900 
                     <input type="file" accept="application/pdf,image/*" name="doc_insuranceDoc">
901 
                      <input type="hidden" name="insuranceDoc"/>
21817 kshitij.so 902 
                   </div>
903 
 
904 
 
21834 rajender 905 
         <h4 class="page-header">20. Loan on Shop (LAP/BL/CC/others)</h4>
21817 kshitij.so 906 
 
907 
                     <div class="btn-group">
908 
                    <label class="btn btn-default">
909 
                   <input type="radio" name="loan" value="yes">
910 
                   <span>Yes</span>
911 
                  </label>
912 
                <label class="btn btn-default">
913 
                    <input type="radio" name="loan" value="no">
914 
                    <span>No</span>
915 
                </label>
916 
              </div>
917 
 
918 
                 <div class="form-group loan document" id ="documentyes">
919 
                  <p>Please provide current statement Letter</p>
21996 rajender 920 
                     <input type="file" accept="application/pdf,image/*" name="doc_loanDoc">
921 
                     <input type="hidden" name="loanDoc"/>
21817 kshitij.so 922 
                      <p>Please provide current sanction Letter</p>
21996 rajender 923 
                     <input type="file" accept="application/pdf,image/*" name="doc_sanctionDoc">
924 
                     <input type="hidden" name="sanctionDoc"/>
21817 kshitij.so 925 
                   </div>
926 
 
927 
 
928 
            <h4 class="page-header">21. Bank Name & Address</h4>
929 
 
930 
                  <div class="form-group float-label-control">
931 
                        <label for="">Account Number</label>
21822 rajender 932 
                        <input type="text" name="accountNumber"class="form-control" placeholder="Account Number">
21817 kshitij.so 933 
                    </div>
934 
                     <div class="form-group float-label-control">
935 
                        <label for="">Bank Name</label>
21822 rajender 936 
                        <input type="text" name="bankName"class="form-control" placeholder="Bank Name">
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                    </div>
938 
                     <div class="form-group float-label-control">
939 
                        <label for="">IFSC Code</label>
21822 rajender 940 
                        <input type="text" name="ifscCode"class="form-control" placeholder="IFSC Code">
21817 kshitij.so 941 
                    </div>
942 
                     <div class="form-group float-label-control">
943 
                        <label for="">Branch Name</label>
21822 rajender 944 
                        <input type="text" name="branchName" class="form-control" placeholder="Branch Name">
21817 kshitij.so 945 
                    </div>
946 
                     <div >
21834 rajender 947 
                  <p>Please attach the copy of cancelled cheque</p>
21817 kshitij.so 948 
                      <div class="form-group">
21996 rajender 949 
                     <input type="file" name="doc_chequeCopy" accept="application/pdf,image/*">
950 
                     <input type="hidden" name="chequeCopy"/>
21817 kshitij.so 951 
                   </div>
952 
 
953 
 
21832 rajender 954 
                  <h4 class="page-header">22. HSPS Bank Account Detail</h4>
21817 kshitij.so 955 
 
21834 rajender 956 
                  <p>Please deposit amount of <strong> Rs 1 Lac </strong>as advance payment in following account through NEFT and submit the UTR No.</p>
21817 kshitij.so 957 
                    <div class="form-group float-label-control">
958 
                        <label for="">UTR Number</label>
959 
                        <input type="text" name="utr" class="form-control" placeholder="UTR No">
960 
                    </div>
21837 amit.gupta 961 
                    <p><b>Note:</b> Advance amount deposited shall be adjustable in the first billing. This amount is 100% refundable in case of withdrawal of application by applicant.</p>
21817 kshitij.so 962 
 
963 
 
964 
 
21834 rajender 965 
                      <div class ="Account">
966 
                      <label>Account Name: New Spice Solutions Pvt Ltd</label><br>
21837 amit.gupta 967 
                       <label>Bank Name: IndusInd Bank Ltd.</label><br>
21834 rajender 968 
                        <label>Account No.:201000488351</label><br>
969 
                        <label>Branch:M-56, Greater Kailash-II, Main Market New Delhi-110048</label><br>
970 
                         <label>IFSC:INDB0000012</label><br>
971 
                        </div>
972 
 
21817 kshitij.so 973 
                <div class="submit">
21832 rajender 974 
                    <button type="submit" class="btn btn-success btn-lg">Submit</button>
975 
                </div>
976 
 
977 
                <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>
21817 kshitij.so 978 
 
979 
 
980 
 
981 
 
982 
 <!--             <fieldset hidden disabled="disabled">
983 
              <h4 class="page-header">PMP STORE REGISTRATION APPROVAL</h4>
984 
                 <p>(FOR OFFICE USE ONLY)</P>
985 
 
986 
                <div class=breg>
987 
                 <div class=bApproval>
988 
 
989 
                  <label>Recommended by</label>
990 
                  <input type="text" name = "recommended"class="reg-control" size="50">
991 
 
992 
                  </div>
993 
                  <br>
994 
 
995 
                    <div class=bApproval>
996 
                  <label>Business Manager</label>
997 
                  <input type="text" name=" bManager" class="reg-control" size="50">
998 
                </div>
999 
                      <br>
1000 
                        <div class=bApproval>
1001 
                    <label>Operations Manager</label>
1002 
                  <input type="text"name="operation"class="reg-control"  size="50">
1003 
                </div>
1004 
                  <br>
1005 
               <div class=bApproval>
1006 
                     <label>BusinessHeadCategoryHead</label>
1007 
                  <input type="text" name="bhead"class="reg-control" size="50">
1008 
                </div>
1009 
 
1010 
 
1011 
                 </div>
1012 
               </fieldset> -->
1013 
 
1014 
                      </form>
1015 
                    </div>
1016 
          </div>
1017 
   <div class="col-sm-4">
1018 
                <div class="panel panel-default">
1019 
 
1020 
                    <div class="panel-body">
1021 
 
1022 
 
21835 amit.gupta 1023 
                   <label>Spice Global Knowledge Park - 6th Floor, Plot No.19A & 19B, Sector 125, Noida, UP - 201301</label>
1024 
                   <br>
1025 
                    <label>Email - care@profitmandi.com</<label>
1026 
                    <br>
1027 
                    <label>Contact - 8588842949 </label>
21817 kshitij.so 1028 
                    </div>
1029 
                </div>
1030 
            </div>
1031 
 
1032 
        </div>
1033 
 
1034 
    </div>
21826 kshitij.so 1035 
    </div>
21817 kshitij.so 1036 
</body>
1037 
</html>