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<html><head><script type="text/javascript" src="$action.getContextPath()/js/jquery-1.10.2.min.js"></script><link rel="stylesheet" href="$action.getContextPath()/css/bootstrap.min.css"/><link rel="stylesheet" type="text/css" href="$action.getContextPath()/css/main.css"/><!-- Optional theme --><link rel="stylesheet" href="$action.getContextPath()/css/bootstrap-theme.min.css" /><!-- Latest compiled and minified JavaScript --><script src="$action.getContextPath()/js/bootstrap.min.js" type="script/javascript"></script><script src="$action.getContextPath()/js/bootstrapValidator.js"></script><script src="$action.getContextPath()/js/reg.js"></script><script src="$action.getContextPath()/js/reqformvalidator.js"></script><script src="$action.getContextPath()/js/fofoedit.js"></script><script src="$action.getContextPath()/js/jquery.blockUI.js"></script><script type="text/javascript">var jsonObj=$action.fofoFormJson();console.log(JSON.stringify(jsonObj));$(document).ready(function(){readForm();$("input[name$='bEntity']").click(function() {var test1 = $(this).val();$(".box").hide();$('input[name=dinNumber]').each(function(){$(this).prop('disabled', true);});var dinNumberInput = $("#sale"+test1+ " input[name=dinNumber]");if (dinNumberInput.prop('disabled') == true){dinNumberInput.prop('disabled', false);}$("#sale" + test1).show();});});</script><script type="text/javascript">$(document).ready(function(){$("input[name$='bPmpDetail']").click(function() {var test1 = $(this).val();$(".pmp").hide();$("#Pmp" + test1).show();});});</script><script type="text/javascript">$(document).ready(function(){$("input[name$='shopStatus']").click(function() {var test1 = $(this).val();$("#shopsemifurnished, #shopfullfurnished").find("input[type=checkbox]").each(function(){$(this).prop('disabled', true);});$(".status").hide();$("#shop" + test1).show();$("#shop" + test1).find("input[type=checkbox]").prop('disabled', false);});});</script><script type="text/javascript">$(document).ready(function(){$("input[name$='sellingOnline']").click(function() {var test1 = $(this).val();$(".Names").hide();$("#selling" + test1).show();});});</script><script type="text/javascript">$(document).ready(function(){associateValidator();$("input[name$='insurance']").click(function() {var test1 = $(this).val();$(".doc").hide();$("#doc" + test1).show();});});</script><script type="text/javascript">$(document).ready(function(){$("input[name$='loan']").click(function() {var test1 = $(this).val();$(".document").hide();$("#document" + test1).show();$("#showHide").show();});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'];docsArray.forEach(function(inputName){$('input[name="' + inputName + '"]').change(function(e){var formData = new FormData();that = this;formData.append("file", $(this)[0].files[0]);jQuery.ajax({url: "upload",type: 'POST',data: formData,processData: false,success: function (data) {hiddenInput = inputName.split("_")[1];$('input[name="' + hiddenInput + '"]').val(data);console.log(data);}});});});});function queryStringToJSON(queryString) {var pairs = queryString.split('&');var result = {};pairs.forEach(function(pair) {pair = pair.split('=');result[pair[0]] = decodeURIComponent(pair[1] || '');});return result;}function jQFormSerializeArrToJson(formSerializeArr){var jsonObj = {};jQuery.map( formSerializeArr, function( n, i ) {jsonObj[n.name] = n.value;});return jsonObj;}</script><style>.loading-image {position: fixed;top: 50%;left: 50%;margin-top: -50px;margin-left: -100px;z-index: 100;}</style></head><body><div class="container"><div class="row"><div class ="header"><h3 class="header">HOTSPOT PARTNER STORE</h3><h4 class="header">Powered by Profit Mandi (A Unit of Spice Group)</h4></div><div class="header"><h5 class="header">APPLICATION FOR REGISTRATION</h5></div><hr /><div class="row"><div class="col-sm-8"><form role="form" name="myform" id ="form" enctype="multipart/form-data" data-toggle="validator" novalidate><h4 class="page-header">1. Registered Business Name of HSPS (in Block Letters)</h4><input type="hidden" name="_id" /><div class="form-group "><label for=""></label><input type="text" name="registeredBusinessName" id="demo" class="bform" placeholder="Business Name"/></div><h4 class="page-header">2. Registered Address (In Block Letters)</h4><div class="form-group float-label-control"><label for="">Line 1</label><input type="text" name ="line1" class="form-control" placeholder="Line 1"></div><div class="form-group float-label-control"><label for="">Line 2</label><input type="text" name ="line2" class="form-control" placeholder="Line 2"></div><div class="form-group float-label-control"><label for="">Line 3</label><input type="text" name="line3" class="form-control" placeholder="Line 3"></div><div class="form-group float-label-control"><label for="">City</label><input type="text" name="city" class="form-control" placeholder="City"></div><div class="form-group float-label-control"><label for="">District</label><input type="text" name="district" class="form-control" placeholder="District"></div><div class="form-group float-label-control"><label for="">Pincode</label><input type="text" name="pincode" maxlength="6" class="form-control" pattern="[0-9]{6}" title="Please enter correct Pin Code"placeholder="Pincode"></div><div class="form-group float-label-control"><select class="form-control" name = "state" placeholder="State"><option value=" ">State</option><option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option><option value="Andhra Pradesh">Andhra Pradesh</option><option value="Arunachal Pradesh">Arunachal Pradesh</option><option value="Assam">Assam</option><option value="Bihar">Bihar</option><option value="Chandigarh">Chandigarh</option><option value="Chhattisgarh">Chhattisgarh</option><option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option><option value="Daman and Diu">Daman and Diu</option><option value="Delhi">Delhi</option><option value="Goa">Goa</option><option value="Gujarat">Gujarat</option><option value="Haryana">Haryana</option><option value="Himachal Pradesh">Himachal Pradesh</option><option value="Jammu and Kashmir">Jammu and Kashmir</option><option value="Jharkhand">Jharkhand</option><option value="Karnataka">Karnataka</option><option value="Kerala">Kerala</option><option value="Lakshadweep">Lakshadweep</option><option value="Madhya Pradesh">Madhya Pradesh</option><option value="Maharashtra">Maharashtra</option><option value="Manipur">Manipur</option><option value="Meghalaya">Meghalaya</option><option value="Mizoram">Mizoram</option><option value="Nagaland">Nagaland</option><option value="Orissa">Orissa</option><option value="Pondicherry">Pondicherry</option><option value="Punjab">Punjab</option><option value="Rajasthan">Rajasthan</option><option value="Sikkim">Sikkim</option><option value="Tamil Nadu">Tamil Nadu</option><option value="Tripura">Tripura</option><option value="Telangana">Telangana</option><option value="Uttaranchal">Uttaranchal</option><option value="Uttar Pradesh">Uttar Pradesh</option><option value="West Bengal">West Bengal</option></select></div><div class="form-group float-label-control"><label for="">Email1</label><input type="email" class="form-control" name="registeredEmail1" placeholder="Email1"></div><p>Example:- xyz<strong>.hsps@gmail.com</strong></p><div class="form-group float-label-control"><label for="">Email2</label><input type="email" class="form-control" name="registeredEmail2" placeholder="Email2"></div><div class="form-group float-label-control"><label for="">Mobile</label><input type="text" class="form-control" name="mobile" maxlength = "10" pattern="[0-9]{10}" title="Please enter valid Phone number" placeholder="Mobile"></div><label>Landline</label><div class="form-group Pmpform"><input type="text" name="stdcode" maxlength = "5" pattern="[0-9]*" title="Please enter valid Phone number" placeholder="STDcode"/><input type="text" name="telephone" maxlength = "10" pattern="[0-9]*" title="Please enter valid Phone number" placeholder="Telephone"/></div><h4 class="page-header">3. Type of Business Entity</h4><div class="funkyradio"><div class="funkyradio-primary"><input type="radio" name="bEntity" id="radio1" value="SaleProprietorship" required><label for="radio1">Proprietor</label></div><div class="funkyradio-primary"><input type="radio" name="bEntity" id="radio2" value="Partnership" required><label for="radio2">Partnership</label></div><div class="funkyradio-primary"><input type="radio" name="bEntity" id="radio3" value="PrivateLimitedCompany" required><label for="radio3">Private Limited company</label></div><div class="funkyradio-primary"><input type="radio" name="bEntity" id="radio4" value="LimitedLiabilityPartnership" required><label for="radio4">Limited Liability Partnership</label></div></div><div class ="Entity"><div class="SaleProprietorship box" id ="saleSaleProprietorship">Upload <strong>Proprietership proof</strong></div><div class="partnership box" id="salePartnership">Upload <strong>Partnership Deed</strong></div></div><div class="limitedcompany box" id="salePrivateLimitedCompany"><div class="form-group float-label-control"><label for="">DIN Number</label><input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number"></div>Upload <strong>Incorporation certificate,Memorandum & Article of association</strong></div><div class="LimitedLiabilityPartnership box" id="saleLimitedLiabilityPartnership"><div class="form-group float-label-control"><label for="">DIN Number</label><input type="text" class="form-control" name="dinNumber" disabled placeholder="DIN Number"></div>Upload <strong>Registration certificate & partnership Deed</strong></div><div class = "form-group file upload"><input type="file" accept="application/pdf,image/*" id="doc" name ="doc_bEntityDoc"><input type="hidden" name="bEntityDoc"/><a href="somelink" id="link-bEntityDoc" style="display:none">View bEntity Document</a></div><h4 class="page-header">4. Goods And Services Tax Number(GST)</h4><div class="Pmpform"><input type="text" name="gst" class="bform" placeholder="Goods And Services Tax Number"/></div><p>Provide Copy of GST document</p><div class = "file upload"><input type="file" accept="application/pdf,image/*" name ="doc_gstDoc"><input type="hidden" name="gstDoc"/><a href="somelink" id="link-gstDoc" style="display:none">View GST Document</a></div><h4 class="page-header">5. Permanent Account Number(PAN)</h4><div class="form-group "><label for=""></label><input type="text" name="pan" maxlength="10" class="bform" placeholder="Permanent Account Number"/></div><p>Provide Copy of PAN </p><div class = "form-group file upload"><input type="file" accept="application/pdf,image/*" name="doc_panDoc"><input type="hidden" name="panDoc"/><a href="somelink" id="link-panDoc" style="display:none">View Pan Document</a></div><h4 class="page-header">6. Full Details Of Business Entity</h4><div class="funkyradio"><div class="funkyradio-primary"><input type="radio" name="bPmpDetail" id="business1" value="Proprietor" required><label for="business1">Proprietor</label></div><div class="funkyradio-primary"><input type="radio" name="bPmpDetail" id="business2" value="Partners" required><label for="business2">Partners</label></div><div class="funkyradio-primary"><input type="radio" name="bPmpDetail" id="business3" value="Directors" required><label for="business3">Directors</label></div></div><div class="tablecontainer"><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input type="text" name="proprietorBusineesName"size="25"></td><td class="form-group"><textarea row="3" name="proprietorAddress"></textarea></td><td class="form-group"><input type="text" name="proprietorPhone" maxlength="10" pattern="[0-9]{10}"size="10"></th><td class="form-group"><input type="text" name="proprietorPan" maxlength="10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input type="text" name= "proprietorAdhaar" size="15"></td><td class="form-group"><input type="email" name= "proprietorEmail" size="20"></td><td class="form-group"><input type="text" pattern="[0-9]" name="proprietorOwner" size="10"></td></tr></table></div><div class="Partners pmp" id= "PmpPartners"><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="partnerName1"type="text" size="25"></td><td class="form-group"><textarea name="partnerAddress1" type="text" size="60"></textarea></td><td class="form-group"><input name = "partnerPhone1" pattern="[0-9]{10}"type="text" size="10"></th><td class="form-group"><input name ="partnerPan1"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="partnerAdhaar1" type="text" size="15"></td><td class="form-group"><input name="partnerEmail1" type="email" size="20"></td><td class="form-group"><input name="partnerOwner1" type="text"pattern="[0-9]"size="10"></td></tr></table><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="partnerName2"type="text" size="25"></td><td class="form-group"><textarea name="partnerAddress2" type="text" size="60"></textarea></td><td class="form-group"><input name = "partnerPhone2" pattern="[0-9]{10}" type="text" size="10"></th><td class="businesspan"><input name ="partnerPan2"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="partnerAdhaar2" type="text" size="15"></td><td class="form-group"><input name="partnerEmail2" type="email" size="20"></td><td class="form-group"><input name="partnerOwner2" pattern="[0-9]" type="text" size="10"></td></tr></table><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="partnerName3"type="text" size="25"></td><td class="form-group"><textarea name="partnerAddress3" type="text" size="60"></textarea></td><td class="form-group"><input name = "partnerPhone3" type="text" maxlength = "10" pattern="[0-9]{10}" size="10"></th><td class="form-group"><input name ="partnerPan3"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-groupr"><input name="partnerAdhaar3" type="text" size="15"></td><td class="form-group"><input name="partnerEmail3" type="email" size="20"></td><td class="form-group"><input name="partnerOwner3" pattern="[0-9" type="text" size="10"></td></tr></table><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="partnerName4"type="text" size="25"></td><td class="form-group"><textarea name="partnerAddress4" type="text" size="60"></textarea></td><td class="form-group"><input name = "partnerPhone4" pattern="[0-9]{10}" type="text" size="10"></th><td class="form-group"><input name ="partnerPan4"type="text" maxlength = "10"title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="partnerAdhaar4" type="text" size="15"></td><td class="form-group"><input name="partnerEmail4" type="email" size="20"></td><td class="form-group"><input name="partnerOwner4" pattern="[0-9]" type="text" size="10"></td></tr></table></div><div class="Directors pmp" id= "PmpDirectors"><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="shareholderName1"type="text" size="25"></td><td class="form-group"><textarea name="shareholderAddress1" type="text" size="60"></textarea></td><td class="form-group"><input name = "shareholderPhone1" pattern="[0-9]{10}" type="text" size="10"></th><td class="form-group"><input name ="shareholderPan1"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="shareholderAdhaar1" type="text" size="15"></td><td class="form-group"><input name="shareholderEmail1" type="email" size="20"></td><td class="form-group"><input name="shareholderOwner1" pattern="[0-9]" type="text" size="10"></td></tr></table><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="shareholderName2"type="text" size="25"></td><td class="form-group"><textarea name="shareholderAddress2" type="text" size="60"></textarea></td><td class="form-group"><input name = "shareholderPhone2" pattern="[0-9]{10}" type="text" size="10"></th><td class="form-group"><input name ="shareholderPan2"type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="shareholderAdhaar2" type="text" size="15"></td><td class="form-group"><input name="shareholderEmail2" type="email" size="20"></td><td class="form-group"><input name="shareholderOwner2" pattern="[0-9]" type="text" size="10"></td></tr></table><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="shareholderName3"type="text" size="25"></td><td class="form-group"><textarea name="shareholderAddress3" type="text" size="60"></textarea></td><td class="form-group"><input name = "shareholderPhone3" pattern="[0-9]{10}" type="text" size="10"></th><td class="form-group"><input name ="shareholderPan3" type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="shareholderAdhaar3" type="text" size="15"></td><td class="form-group"><input name="shareholderEmail3" type="email" size="20"></td><td class="form-group"><input name="shareholderOwner3" pattern="[0-9]" type="text" size="10"></td></tr></table><table class="businessdetail"><tr><th class ="PMPName">Name</th><th class="PMPAddress">Address</th><th class="PMPtelno">Mobile</th><th class="PMPpan">PAN</th><th class="PMPAdhaar">Aadhaar Number</th><th class="PMPemail">Email</th><th class="PMPownership">Share %</th></tr><tr><td class="form-group"><input name="shareholderName4" type="text" size="25"></td><td class="form-group"><textarea name="shareholderAddress4" type="text" size="60"></textarea></td><td class="form-group"><input name = "shareholderPhone4" type="text" pattern="[0-9]{10}" size="10"></th><td class="form-group"><input name ="shareholderPan4" type="text" maxlength = "10" title="Please enter correct pan number"size="10"></td><td class="form-group"><input name="shareholderAdhaar4" type="text" size="15"></td><td class="form-group"><input name="shareholderEmail4" type="email" size="20"></td><td class="form-group"><input name="shareholderOwner4" pattern="[0-9]" type="text" size="10"></td></tr></table></div><h4 class="page-header">7. Store Manager Details</h4><div class="form-group"><label for="">Name<input type="text" name="managerName"placeholder="Name"></label><label for="">Mobile<input type="text" name="managerNo" pattern="[0-9]{10}" title="Please enter Valid Mobile number" placeholder="Mobile No"> </label><label for="">Email<input type="email" name="managerEmail"size="25px" placeholder="Emailid"> </label></div><h4 class="page-header">8. Manpower Details</h4><div class="form-group"><label for="">Number of Employees<input type="text" pattern="[0-9]" name="noOfEmployees"placeholder="Number of Employees"></label><label for="">Number of Management Staff<input type="text" pattern="[0-9]" name="managementStaff" placeholder="Management Staff"> </label></div><h4 class="page-header">9. Experience In Telecom Trade/other Trade (Brand & Product Category)</h4><div class="bcontacts"><textarea rows="4" name="experienceinTelecome"cols="50" placeholder="Describe yourself here..."></textarea></div><h4 class="page-header">10. Description of Existing Business & Annual Turnover</h4><div class="bcontacts"><textarea rows="4" name="descriptionofExistingBusiness"cols="50" placeholder="Describe yourself here..."></textarea></div><p>Please Provide ITR of last Two years</p><div class = "form-group file upload"><input type="file" accept="application/pdf,image/*" name ="doc_itrDoc"><input type="hidden" name="itrDoc"/><a href="somelink" id="link-itrDoc" style="display:none">View ITR Document</a></div><h4 class="page-header">11.Business Model</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="businessModel" value="Retailer" required><span>Retailer</span></label><label class="btn btn-default"><input type="radio" name="businessModel" value="Distributor" required><span>Distributor</span></label><label class="btn btn-default"><input type="radio" name="businessModel" value="Franchises" required><span>Franchise</span></label><label class="btn btn-default"><input type="radio" name="businessModel" value="Other" required><span>Other</span></label></div><h4 class="page-header">12. Selling Online (if yes, please specify Portal Names)</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="sellingOnline" value="yes"><span>Yes</span></label><label class="btn btn-default"><input type="radio" name="sellingOnline" value="no"><span>No</span></label></div><div class="form-group portal Names" id = "sellingyes"><label>Portal Names</label><input type="text" name="portalName1" size="25"><input type="text" name="portalName2" size="25"><input type="text" name="portalName3" size="25"></div><h4 class="page-header">13. Area of Shop(in Sq Feet)</h4><div><div class="form-group"><label><input type="number" name="east" placeholder="East(Sq Feet)"><input type="number" name="west" placeholder="West(Sq Feet)"><input type="number" name="north" placeholder="North(Sq Feet)"></label></div><br><div class="form-group"><label><input type="number" name="south" placeholder="South(Sq Feet)"><input type="number" name="front" placeholder="Front(Sq Feet)"><input type="number" name="roadSize" placeholder="Road Size in Front(Sq Feet)"></label></div></div><div class="shopArea"><div class="btn-group"><label class="btn btn-default"><input type="radio" name="shopArea" value="Singleside"><span>Single Side</span></label><label class="btn btn-default"><input type="radio" name="shopArea" value"Twoside"><span>Two Side</span></label><label class="btn btn-default"><input type="radio" name="shopArea" value="Corner"><span>Corner</span></label></div></div><h4 class="page-header">14. Status of Shop</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="shopStatus" value="semifurnished"><span>Semi Furnished</span></label><label class="btn btn-default"><input type="radio" name="shopStatus" value="fullfurnished"><span>Fully Furnished</span></label></div><div class="checkboxes status" id ="shopsemifurnished"><div class="btn btn-default"><label for="success1" class="btn btn-success">Flooring<input type="checkbox" name="flooring"value ="flooring" id="success1" class="badgebox"><span class="badge">✓</span></label><label for="warning1" class="btn btn-success">Ceiling<input type="checkbox" name="cieling" value="ceiling" id="warning1" class="badgebox"><span class="badge">✓</span></label></div></div><div class ="checkboxes status" id ="shopfullfurnished"><div class="row text-center"><label for="default" class="btn btn-success">Store <input type="checkbox" name="store" value="yes" id="default" class="badgebox"><span class="badge">✓</span></label><label for="primary" class="btn btn-success">Washroom <input type="checkbox" name="washroom" value="yes" id="primary" class="badgebox"><span class="badge">✓</span></label><label for="info" class="btn btn-success">Water Supply<input type="checkbox" name="waterSupply" value="yes" id="info" class="badgebox"><span class="badge">✓</span></label><label for="success" class="btn btn-success">Electricity<input type="checkbox" name="electricity"value ="yes" id="success" class="badgebox"><span class="badge">✓</span></label><label for="warning" class="btn btn-success">Pantry<input type="checkbox" name="pantry" value="yes" id="warning" class="badgebox"><span class="badge">✓</span></label></div></div><h4 class="page-header">15. Shop Available At</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="shopAvailbility" value="Basement"><span>Basement</span></label><label class="btn btn-default"><input type="radio" name="shopAvailbility" value="Groundfloor"><span>Ground Floor</span></label><label class="btn btn-default"><input type="radio" name="shopAvailbility" value="firstfloor"><span>First Floor</span></label><label class="btn btn-default"><input type="radio" name="shopAvailbility" value="secondfloor"><span>Second Floor</span></label><label class="btn btn-default"><input type="radio" name="shopAvailbility" value="thirdfloor"><span>Third Floor</span></label></div><div class="form-group bdetail"><p>Provide pictures of the shop from 3 different angles, ceiling and flooring</p><input type="file" name="doc_angleDoc1" accept="application/pdf,image/*" ><input type="hidden" name="angleDoc1"/><a href="somelink" id="link-angleDoc1" style="display:none">View angleDoc1 Document</a><input type="file" name="doc_angleDoc2" accept="application/pdf,image/*" ><input type="hidden" name="angleDoc2"/><a href="somelink" id="link-angleDoc2" style="display:none">View angleDoc2 Document</a><input type="file" name="doc_angleDoc3" accept="application/pdf,image/*" ><input type="hidden" name="angleDoc3"/><a href="somelink" id="link-angleDoc3" style="display:none">View angleDoc3 Document</a><input type="file" name="doc_angleDoc4" accept="application/pdf,image/*" ><input type="hidden" name="angleDoc4"/><a href="somelink" id="link-angleDoc4" style="display:none">View angleDoc4 Document</a><input type="file" name="doc_angleDoc5" accept="application/pdf,image/*"><input type="hidden" name="angleDoc5"/><a href="somelink" id="link-angleDoc5" style="display:none">View angleDoc5Document</a></div><h4 class="page-header">16. Location of Shop</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="location" value="shoppingMall"><span>Shopping Mall</span></label><label class="btn btn-default"><input type="radio" name="location" value="MainMobileMarket"><span>Main Mobile Market</span></label><label class="btn btn-default"><input type="radio" name="location" value="LocalMarket"><span>Local Market</span></label></div><h4 class="page-header">17.Nearest Mobile Store</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="nearestStore" value="100mtrs"><span>100Mtrs</span></label><label class="btn btn-default"><input type="radio" name="nearestStore" value="200mtrs"><span>200Mtrs</span></label><label class="btn btn-default"><input type="radio" name="nearestStore" value="500mtrs"><span>500Mtrs</span></label></div><div class="form-group location"><label>Name of the Shop</label><input type="text" size ="35" name="storeName"><br><br><label>Address of the Shop</label><input type="text" size ="65" name="storeAddress"></div><h4 class="page-header">18. Ownership of Shop</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="ownership" value="Selfowned"><span>Self Owned</span></label><label class="btn btn-default"><input type="radio" name="ownership" value="Rented"><span>Rented</span></label><label class="btn btn-default"><input type="radio" name="ownership" value="lease"><span>Lease</span></label></label><label class="btn btn-default"><input type="radio" name="ownership" value="collaboration"><span>Collaboration</span></label></div><div class="form-group bdetail"><p>Provide relevant documents (Electricity bill/Rent Agreement/Lease Deed)to prove the status of ownership</p><input type="file" accept="application/pdf,image/*" name="doc_ownershipDoc"><input type="hidden" name="ownershipDoc"/><a href="somelink" id="link-ownershipDoc" style="display:none">View OwnershipDoc Document</a></div><h4 class="page-header">19. Insurance of Shop (if yes, please provide the copy of the same)</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="insurance" value="yes"><span>Yes</span></label><label class="btn btn-default"><input type="radio" name="insurance" value="no"><span>No</span></label></div><div class="form-group insurance doc" id= "docyes"><p>Please provide copy of insurance document</p><input type="file" accept="application/pdf,image/*" name="doc_insuranceDoc"><input type="hidden" name="insuranceDoc"/><a href="somelink" id="link-insuranceDoc" style="display:none">View InsuranceDoc Document</a></div><h4 class="page-header">20. Loan on Shop (LAP/BL/CC/others)</h4><div class="btn-group"><label class="btn btn-default"><input type="radio" name="loan" value="yes"><span>Yes</span></label><label class="btn btn-default"><input type="radio" name="loan" value="no"><span>No</span></label></div><div class="form-group loan document" id ="documentyes"><p>Please provide current statement Letter</p><input type="file" accept="application/pdf,image/*" name="doc_loanDoc"><input type="hidden" name="loanDoc"/><a href="somelink" id="link-loanDoc" style="display:none">View loanDoc Document</a><p>Please provide current sanction Letter</p><input type="file" accept="application/pdf,image/*" name="doc_sanctionDoc"><input type="hidden" name="sanctionDoc"/><a href="somelink" id="link-sanctionDoc" style="display:none">View sanctionDoc Document</a></div><h4 class="page-header">21. Bank Name & Address</h4><div class="form-group float-label-control"><label for="">Account Number</label><input type="text" name="accountNumber"class="form-control" placeholder="Account Number"></div><div class="form-group float-label-control"><label for="">Bank Name</label><input type="text" name="bankName"class="form-control" placeholder="Bank Name"></div><div class="form-group float-label-control"><label for="">IFSC Code</label><input type="text" name="ifscCode"class="form-control" placeholder="IFSC Code"></div><div class="form-group float-label-control"><label for="">Branch Name</label><input type="text" name="branchName" class="form-control" placeholder="Branch Name"></div><div ><p>Please attach the copy of cancelled cheque</p><div class="form-group"><input type="file" name="doc_chequeCopy" accept="application/pdf,image/*"><input type="hidden" name="chequeCopy"/><a href="somelink" id="link-chequeCopy" style="display:none">View chequeCopy Document</a></div><h4 class="page-header">22. HSPS Bank Account Detail</h4><p>Please deposit amount of <strong> Rs 1 Lac </strong>as advance payment in following account through NEFT and submit the UTR No.</p><div class="form-group float-label-control"><label for="">UTR Number</label><input type="text" name="utr" class="form-control" placeholder="UTR No"></div><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><div class ="Account"><label>Account Name: New Spice Solutions Pvt Ltd</label><br><label>Bank Name: IndusInd Bank Ltd.</label><br><label>Account No.:201000488351</label><br><label>Branch:M-56, Greater Kailash-II, Main Market New Delhi-110048</label><br><label>IFSC:INDB0000012</label><br></div><div class="submit"><button type="submit" class="btn btn-success btn-lg">Submit</button></div><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><!-- <fieldset hidden disabled="disabled"><h4 class="page-header">PMP STORE REGISTRATION APPROVAL</h4><p>(FOR OFFICE USE ONLY)</P><div class=breg><div class=bApproval><label>Recommended by</label><input type="text" name = "recommended"class="reg-control" size="50"></div><br><div class=bApproval><label>Business Manager</label><input type="text" name=" bManager" class="reg-control" size="50"></div><br><div class=bApproval><label>Operations Manager</label><input type="text"name="operation"class="reg-control" size="50"></div><br><div class=bApproval><label>BusinessHeadCategoryHead</label><input type="text" name="bhead"class="reg-control" size="50"></div></div></fieldset> --></form></div></div><div class="col-sm-4"><div class="panel panel-default"><div class="panel-body"><label>Spice Global Knowledge Park - 6th Floor, Plot No.19A & 19B, Sector 125, Noida, UP - 201301</label><br><label>Email - care@profitmandi.com</<label><br><label>Contact - 8588842949 </label></div></div></div></div></div></div><div id="ajax-spinner" style="display:none;"><img src="$action.getContextPath()/images/loading.gif" class="loading-image"></div></body></html>