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Rev 35977 Rev 37458
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                            </div>
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                            </div>
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                            <div class="col-lg-2">
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                            <div class="col-lg-2">
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                                <div class="form-group">
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                                <div class="form-group">
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                                    <label>Attachment:</label>
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                                    <label>Attachment:</label>
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                                    <input type="hidden" id="payment-sc-docId" name="paymentAttachment">
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                                    <input type="hidden" id="payment-sc-docId" name="paymentAttachment">
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                                    <input type="file" class="form-control" id="payment-sc-doc" required>
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                                    <input type="file" class="form-control" id="payment-sc-doc" required
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                                           accept=".jpg,.jpeg,.png,.pdf,image/jpeg,image/png,application/pdf">
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                                    <span id="payment-sc-status" class="help-block"></span>
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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 class="col-lg-3">
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                            <div class="col-lg-3">
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                                <div class="form-group">
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                                <div class="form-group">
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                                    <label>Collecting Date:</label>
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                                    <label>Collecting Date:</label>