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form-gridforms.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<title>Avenxo Admin Theme - shared on themelock.com</title>
<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
<meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0, minimum-scale=1.0, user-scalable=no">
<meta name="apple-mobile-web-app-capable" content="yes">
<meta name="apple-touch-fullscreen" content="yes">
<meta name="description" content="Avenxo Admin Theme">
<meta name="author" content="KaijuThemes">
<link type='text/css' href='http://fonts.googleapis.com/css?family=Source+Sans+Pro:300,400,400italic,600' rel='stylesheet'>
<link type="text/css" href="assets/fonts/font-awesome/css/font-awesome.min.css" rel="stylesheet"> <!-- Font Awesome -->
<link type="text/css" href="assets/fonts/themify-icons/themify-icons.css" rel="stylesheet"> <!-- Themify Icons -->
<link type="text/css" href="assets/css/styles.css" rel="stylesheet"> <!-- Core CSS with all styles -->
<link type="text/css" href="assets/plugins/codeprettifier/prettify.css" rel="stylesheet"> <!-- Code Prettifier -->
<link type="text/css" href="assets/plugins/iCheck/skins/minimal/blue.css" rel="stylesheet"> <!-- iCheck -->
<!--[if lt IE 10]>
<script type="text/javascript" src="assets/js/media.match.min.js"></script>
<script type="text/javascript" src="assets/js/respond.min.js"></script>
<script type="text/javascript" src="assets/js/placeholder.min.js"></script>
<![endif]-->
<!-- The following CSS are included as plugins and can be removed if unused-->
<link type="text/css" href="assets/plugins/gridforms/gridforms/gridforms.css" rel="stylesheet"> <!-- Gridforms -->
</head>
<body class="animated-content">
<header id="topnav" class="navbar navbar-default navbar-fixed-top" role="banner">
<div class="logo-area">
<span id="trigger-sidebar" class="toolbar-trigger toolbar-icon-bg">
<a data-toggle="tooltips" data-placement="right" title="Toggle Sidebar">
<span class="icon-bg">
<i class="ti ti-menu"></i>
</span>
</a>
</span>
<a class="navbar-brand" href="index.html">Avenxo</a>
<div class="toolbar-icon-bg hidden-xs" id="toolbar-search">
<div class="input-group">
<span class="input-group-btn"><button class="btn" type="button"><i class="ti ti-search"></i></button></span>
<input type="text" class="form-control" placeholder="Search...">
<span class="input-group-btn"><button class="btn" type="button"><i class="ti ti-close"></i></button></span>
</div>
</div>
</div><!-- logo-area -->
<ul class="nav navbar-nav toolbar pull-right">
<li class="toolbar-icon-bg visible-xs-block" id="trigger-toolbar-search">
<a href="#"><span class="icon-bg"><i class="ti ti-search"></i></span></a>
</li>
<li class="toolbar-icon-bg hidden-xs">
<a href="#"><span class="icon-bg"><i class="ti ti-world"></i></span></i></a>
</li>
<li class="toolbar-icon-bg hidden-xs">
<a href="#"><span class="icon-bg"><i class="ti ti-view-grid"></i></span></i></a>
</li>
<li class="toolbar-icon-bg hidden-xs" id="trigger-fullscreen">
<a href="#" class="toggle-fullscreen"><span class="icon-bg"><i class="ti ti-fullscreen"></i></span></i></a>
</li>
<li class="dropdown toolbar-icon-bg hidden-xs">
<a href="#" class="hasnotifications dropdown-toggle" data-toggle='dropdown'><span class="icon-bg"><i class="ti ti-email"></i></span><span
class="badge badge-deeporange">2</span></a>
<div class="dropdown-menu notifications arrow">
<div class="topnav-dropdown-header">
<span>Messages</span>
</div>
<div class="scroll-pane">
<ul class="media-list scroll-content">
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Vincent Keller</strong> <span class="text-gray">‒ Design should be ...</span></h4>
<span class="notification-time">2 mins ago</span>
</div>
</a>
</li>
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Frend Pratt</strong> <span class="text-gray">‒ I will start with the ...</span></h4>
<span class="notification-time">40 mins ago</span>
</div>
</a>
</li>
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Cynthia Hines</strong> <span class="text-gray">‒ Interior bits are ...</span></h4>
<span class="notification-time">6 hours ago</span>
</div>
</a>
</li>
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Robin Horton</strong> <span class="text-gray">‒ Are you even ...</span></h4>
<span class="notification-time">8 days ago</span>
</div>
</a>
</li>
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Amanda Torrez</strong> <span class="text-gray">‒ The message is ...</span></h4>
<span class="notification-time">16 hours ago</span>
</div>
</a>
</li>
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Khan Farhan</strong> <span class="text-gray">‒ Expected the stuff ...</span></h4>
<span class="notification-time">2 days ago</span>
</div>
</a>
</li>
<li class="media notification-message">
<a href="#">
<div class="media-left">
<img class="img-circle avatar" src="http://placehold.it/300&text=Placeholder" alt="" />
</div>
<div class="media-body">
<h4 class="notification-heading"><strong>Will Whedon</strong> <span class="text-gray">‒ The movie of this ...</span></h4>
<span class="notification-time">4 days ago</span>
</div>
</a>
</li>
</ul>
</div>
<div class="topnav-dropdown-footer">
<a href="#">See all messages</a>
</div>
</div>
</li>
<li class="dropdown toolbar-icon-bg">
<a href="#" class="hasnotifications dropdown-toggle" data-toggle='dropdown'><span class="icon-bg"><i class="ti ti-bell"></i></span><span class="badge badge-deeporange">2</span></a>
<div class="dropdown-menu notifications arrow">
<div class="topnav-dropdown-header">
<span>Notifications</span>
</div>
<div class="scroll-pane">
<ul class="media-list scroll-content">
<li class="media notification-success">
<a href="#">
<div class="media-left">
<span class="notification-icon"><i class="ti ti-check"></i></span>
</div>
<div class="media-body">
<h4 class="notification-heading">Update 1.0.4 successfully pushed</h4>
<span class="notification-time">8 mins ago</span>
</div>
</a>
</li>
<li class="media notification-info">
<a href="#">
<div class="media-left">
<span class="notification-icon"><i class="ti ti-check"></i></span>
</div>
<div class="media-body">
<h4 class="notification-heading">Update 1.0.3 successfully pushed</h4>
<span class="notification-time">24 mins ago</span>
</div>
</a>
</li>
<li class="media notification-teal">
<a href="#">
<div class="media-left">
<span class="notification-icon"><i class="ti ti-check"></i></span>
</div>
<div class="media-body">
<h4 class="notification-heading">Update 1.0.2 successfully pushed</h4>
<span class="notification-time">16 hours ago</span>
</div>
</a>
</li>
<li class="media notification-indigo">
<a href="#">
<div class="media-left">
<span class="notification-icon"><i class="ti ti-check"></i></span>
</div>
<div class="media-body">
<h4 class="notification-heading">Update 1.0.1 successfully pushed</h4>
<span class="notification-time">2 days ago</span>
</div>
</a>
</li>
<li class="media notification-danger">
<a href="#">
<div class="media-left">
<span class="notification-icon"><i class="ti ti-arrow-up"></i></span>
</div>
<div class="media-body">
<h4 class="notification-heading">Initial Release 1.0</h4>
<span class="notification-time">4 days ago</span>
</div>
</a>
</li>
</ul>
</div>
<div class="topnav-dropdown-footer">
<a href="#">See all notifications</a>
</div>
</div>
</li>
<li class="dropdown toolbar-icon-bg">
<a href="#" class="dropdown-toggle username" data-toggle="dropdown">
<img class="img-circle" src="http://placehold.it/300&text=Placeholder" alt="" />
</a>
<ul class="dropdown-menu userinfo arrow">
<li><a href="#/"><i class="ti ti-user"></i><span>Profile</span><span class="badge badge-info pull-right">80%</span></a></li>
<li><a href="#/"><i class="ti ti-panel"></i><span>Account</span></a></li>
<li><a href="#/"><i class="ti ti-settings"></i><span>Settings</span></a></li>
<li class="divider"></li>
<li><a href="#/"><i class="ti ti-stats-up"></i><span>Earnings</span></a></li>
<li><a href="#/"><i class="ti ti-view-list-alt"></i><span>Statement</span></a></li>
<li><a href="#/"><i class="ti ti-money"></i><span>Withdrawals</span></a></li>
<li class="divider"></li>
<li><a href="#/"><i class="ti ti-shift-right"></i><span>Sign Out</span></a></li>
</ul>
</li>
</ul>
</header>
<div id="wrapper">
<div id="layout-static">
<div class="static-sidebar-wrapper sidebar-default">
<div class="static-sidebar">
<div class="sidebar">
<div class="widget">
<div class="widget-body">
<div class="userinfo">
<div class="avatar">
<img src="http://placehold.it/300&text=Placeholder" class="img-responsive img-circle">
</div>
<div class="info">
<span class="username">Jonathan Smith</span>
<span class="useremail">[email protected]</span>
</div>
</div>
</div>
</div>
<div class="widget stay-on-collapse" id="widget-sidebar">
<nav role="navigation" class="widget-body">
<ul class="acc-menu">
<li class="nav-separator"><span>Explore</span></li>
<li><a href="index.html"><i class="ti ti-home"></i><span>Dashboard</span><span class="badge badge-teal">2</span></a></li>
<li><a href="angular/app/"><i class="ti ti-shield"></i><span>AngularJS</span></span></a></li>
<li><a href="javascript:;"><i class="ti ti-layout"></i><span>Layout</span></a>
<ul class="acc-menu">
<li><a href="layout-grids.html">Grid Scaffolding</a></li>
<li><a href="layout-static-leftbar.html">Static Sidebar</a></li>
<li><a href="layout-sidebar-scroll.html">Scroll Sidebar</a></li>
<li><a href="layout-horizontal.html">Horizontal Nav</a></li>
<li><a href="layout-boxed.html">Boxed</a></li>
</ul>
</li>
<li><a href="javascript:;"><i class="ti ti-view-list-alt"></i><span>UI Kit</span></a>
<ul class="acc-menu">
<li><a href="ui-typography.html">Typography</a></li>
<li><a href="ui-buttons.html">Buttons</a></li>
<li><a href="ui-modals.html">Modal</a></li>
<li><a href="ui-progress.html">Progress</a></li>
<li><a href="ui-paginations.html">Paginations</a></li>
<li><a href="ui-breadcrumbs.html">Breadcrumbs</a></li>
<li><a href="ui-labelsbadges.html">Labels & Badges</a></li>
<li><a href="ui-alerts.html">Alerts</a></li>
<li><a href="ui-tabs.html">Tabs</a></li>
<li><a href="ui-wells.html">Wells</a></li>
<li><a href="ui-icons-fontawesome.html">FontAwesome Icons</a></li>
<li><a href="ui-icons-themify.html">Themify Icons</a></li>
<li><a href="ui-helpers.html">Helpers</a></li>
<li><a href="ui-imagecarousel.html">Images & Carousel</a></li>
</ul>
</li>
<li><a href="javascript:;"><i class="ti ti-control-shuffle"></i><span>Components</span></a>
<ul class="acc-menu">
<li><a href="ui-tiles.html">Tiles</a></li>
<li><a href="custom-skylo.html">Page Progress</a></li>
<li><a href="custom-bootbox.html">Bootbox</a></li>
<li><a href="custom-pines.html">Pines Notification</a></li>
<li><a href="custom-pulsate.html">Pulsate</a></li>
<li><a href="custom-knob.html">jQuery Knob</a></li>
<li><a href="custom-ionrange.html">Ion Range Slider</a></li>
</ul>
</li>
<li><a href="javascript:;"><i class="ti ti-pencil"></i><span>Forms</span></a>
<ul class="acc-menu">
<li><a href="ui-forms.html">Form Layout</a></li>
<li><a href="form-components.html">Form Components</a></li>
<li><a href="form-pickers.html">Pickers</a></li>
<li><a href="form-wizard.html">Form Wizard</a></li>
<li><a href="form-validation.html">Form Validation</a></li>
<li><a href="form-masks.html">Form Masks</a></li>
<li><a href="form-dropzone.html">Dropzone Uploader</a></li>
<li><a href="form-summernote.html">Summernote</a></li>
<li><a href="form-markdown.html">Markdown Editor</a></li>
<li><a href="form-xeditable.html">Inline Editor</a></li>
<li><a href="form-gridforms.html">Grid Forms</a></li>
</ul>
</li>
<li>
<a href="javascript:;"><i class="ti ti-settings"></i><span>Panels</span></a>
<ul class="acc-menu">
<li><a href="ui-panels.html">Panels</a></li>
<li><a href="ui-advancedpanels.html">Draggable Panels</a></li>
</ul>
<li><a href="javascript:;"><i class="ti ti-layout-grid3"></i><span>Tables</span></a>
<ul class="acc-menu">
<li><a href="ui-tables.html">Basic Tables</a></li>
<li><a href="tables-responsive.html">Responsive Tables</a></li>
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<li><a href="charts-flot.html">Flot</a></li>
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<ul class="acc-menu">
<li><a href="maps-google.html">Google Maps</a></li>
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</ul>
</li>
<li><a href="javascript:;"><i class="ti ti-file"></i><span>Pages</span></a>
<ul class="acc-menu">
<li><a href="extras-profile.html">Profile</a></li>
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<li><a href="javascript:;">Email Templates</a>
<ul class="acc-menu">
<li><a href="responsive-email/basic.html">Basic</a></li>
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<li><a href="responsive-email/sidebar-hero.html">Sidebar Hero</a></li>
</ul>
</li>
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</li>
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<li><a href="app-inbox.html"><i class="ti ti-email"></i><span>Inbox</span><span class="badge badge-danger">3</span></a></li>
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</ul>
</nav>
</div>
<div class="widget" id="widget-progress">
<div class="widget-heading">
Progress
</div>
<div class="widget-body">
<div class="mini-progressbar">
<div class="clearfix mb-sm">
<div class="pull-left">Bandwidth</div>
<div class="pull-right">50%</div>
</div>
<div class="progress">
<div class="progress-bar progress-bar-lime" style="width: 50%"></div>
</div>
</div>
<div class="mini-progressbar">
<div class="clearfix mb-sm">
<div class="pull-left">Storage</div>
<div class="pull-right">25%</div>
</div>
<div class="progress">
<div class="progress-bar progress-bar-info" style="width: 25%"></div>
</div>
</div>
</div>
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<ol class="breadcrumb">
<li><a href="index.html">Home</a></li>
<li>Advanced Forms</li>
<li class="active"><a href="form-gridforms.html">Grid Forms</a></li>
</ol>
<div class="container-fluid">
<div class="alert alert-info">
<h3>Grid Forms</h3>
<p>Grid forms are dense forms designed for use in applications that require lots of data to be entered regularly. A tiny Javascript/CSS framework that helps you make forms on grids with ease.</p>
</div>
<div data-widget-group="group1">
<div class="row">
<div class="col-md-12">
<div class="panel panel-white" data-widget='{"draggable": "false"}'>
<div class="panel-heading">
<h2>Demo Form</h2>
<!-- <div class="panel-ctrls" data-actions-container="" data-action-collapse='{"target": ".panel-body"}'></div> -->
</div>
<div class="panel-body">
<form class="grid-form">
<fieldset>
<legend>Please open an account at</legend>
<div data-row-span="1">
<div data-field-span="1">
<label>Branch Name</label>
<input type="text" autofocus>
</div>
</div>
</fieldset>
<br><br>
<fieldset>
<legend>Personal Details (Sole/First Accountholder/Minor)</legend>
<div data-row-span="4">
<div data-field-span="1">
<label>Title</label>
<label><input type="radio" name="customer-title[]"> Mr.</label>
<label><input type="radio" name="customer-title[]"> Mrs.</label>
<label><input type="radio" name="customer-title[]"> Ms.</label>
</div>
<div data-field-span="3">
<label>Full Name</label>
<input type="text">
</div>
</div>
<div data-row-span="2">
<div data-field-span="1">
<label>Date of birth</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Nationality</label>
<select>
<option value="Afghanistan" title="Afghanistan">Afghanistan</option>
<option value="Ã…land Islands" title="Ã…land Islands">Aland Islands</option>
<option value="Albania" title="Albania">Albania</option>
<option value="Algeria" title="Algeria">Algeria</option>
<option value="American Samoa" title="American Samoa">American Samoa</option>
<option value="Andorra" title="Andorra">Andorra</option>
<option value="Angola" title="Angola">Angola</option>
<option value="Anguilla" title="Anguilla">Anguilla</option>
<option value="Antarctica" title="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda" title="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina" title="Argentina">Argentina</option>
<option value="Armenia" title="Armenia">Armenia</option>
<option value="Aruba" title="Aruba">Aruba</option>
<option value="Australia" title="Australia">Australia</option>
<option value="Austria" title="Austria">Austria</option>
<option value="Azerbaijan" title="Azerbaijan">Azerbaijan</option>
<option value="Bahamas" title="Bahamas">Bahamas</option>
<option value="Bahrain" title="Bahrain">Bahrain</option>
<option value="Bangladesh" title="Bangladesh">Bangladesh</option>
<option value="Barbados" title="Barbados">Barbados</option>
<option value="Belarus" title="Belarus">Belarus</option>
<option value="Belgium" title="Belgium">Belgium</option>
<option value="Belize" title="Belize">Belize</option>
<option value="Benin" title="Benin">Benin</option>
<option value="Bermuda" title="Bermuda">Bermuda</option>
<option value="Bhutan" title="Bhutan">Bhutan</option>
<option value="Bolivia, Plurinational State of" title="Bolivia, Plurinational State of">Bolivia, Plurinational State of</option>
<option value="Bonaire, Sint Eustatius and Saba" title="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina" title="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana" title="Botswana">Botswana</option>
<option value="Bouvet Island" title="Bouvet Island">Bouvet Island</option>
<option value="Brazil" title="Brazil">Brazil</option>
<option value="British Indian Ocean Territory" title="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam" title="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria" title="Bulgaria">Bulgaria</option>
<option value="Burkina Faso" title="Burkina Faso">Burkina Faso</option>
<option value="Burundi" title="Burundi">Burundi</option>
<option value="Cambodia" title="Cambodia">Cambodia</option>
<option value="Cameroon" title="Cameroon">Cameroon</option>
<option value="Canada" title="Canada">Canada</option>
<option value="Cape Verde" title="Cape Verde">Cape Verde</option>
<option value="Cayman Islands" title="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic" title="Central African Republic">Central African Republic</option>
<option value="Chad" title="Chad">Chad</option>
<option value="Chile" title="Chile">Chile</option>
<option value="China" title="China">China</option>
<option value="Christmas Island" title="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands" title="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia" title="Colombia">Colombia</option>
<option value="Comoros" title="Comoros">Comoros</option>
<option value="Congo" title="Congo">Congo</option>
<option value="Congo, the Democratic Republic of the" title="Congo, the Democratic Republic of the">Congo, the Democratic Republic of the</option>
<option value="Cook Islands" title="Cook Islands">Cook Islands</option>
<option value="Costa Rica" title="Costa Rica">Costa Rica</option>
<option value="Côte d'Ivoire" title="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Croatia" title="Croatia">Croatia</option>
<option value="Cuba" title="Cuba">Cuba</option>
<option value="Curaçao" title="Curaçao">Curaçao</option>
<option value="Cyprus" title="Cyprus">Cyprus</option>
<option value="Czech Republic" title="Czech Republic">Czech Republic</option>
<option value="Denmark" title="Denmark">Denmark</option>
<option value="Djibouti" title="Djibouti">Djibouti</option>
<option value="Dominica" title="Dominica">Dominica</option>
<option value="Dominican Republic" title="Dominican Republic">Dominican Republic</option>
<option value="Ecuador" title="Ecuador">Ecuador</option>
<option value="Egypt" title="Egypt">Egypt</option>
<option value="El Salvador" title="El Salvador">El Salvador</option>
<option value="Equatorial Guinea" title="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea" title="Eritrea">Eritrea</option>
<option value="Estonia" title="Estonia">Estonia</option>
<option value="Ethiopia" title="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)" title="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands" title="Faroe Islands">Faroe Islands</option>
<option value="Fiji" title="Fiji">Fiji</option>
<option value="Finland" title="Finland">Finland</option>
<option value="France" title="France">France</option>
<option value="French Guiana" title="French Guiana">French Guiana</option>
<option value="French Polynesia" title="French Polynesia">French Polynesia</option>
<option value="French Southern Territories" title="French Southern Territories">French Southern Territories</option>
<option value="Gabon" title="Gabon">Gabon</option>
<option value="Gambia" title="Gambia">Gambia</option>
<option value="Georgia" title="Georgia">Georgia</option>
<option value="Germany" title="Germany">Germany</option>
<option value="Ghana" title="Ghana">Ghana</option>
<option value="Gibraltar" title="Gibraltar">Gibraltar</option>
<option value="Greece" title="Greece">Greece</option>
<option value="Greenland" title="Greenland">Greenland</option>
<option value="Grenada" title="Grenada">Grenada</option>
<option value="Guadeloupe" title="Guadeloupe">Guadeloupe</option>
<option value="Guam" title="Guam">Guam</option>
<option value="Guatemala" title="Guatemala">Guatemala</option>
<option value="Guernsey" title="Guernsey">Guernsey</option>
<option value="Guinea" title="Guinea">Guinea</option>
<option value="Guinea-Bissau" title="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana" title="Guyana">Guyana</option>
<option value="Haiti" title="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands" title="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)" title="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras" title="Honduras">Honduras</option>
<option value="Hong Kong" title="Hong Kong">Hong Kong</option>
<option value="Hungary" title="Hungary">Hungary</option>
<option value="Iceland" title="Iceland">Iceland</option>
<option value="India" title="India">India</option>
<option value="Indonesia" title="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of" title="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq" title="Iraq">Iraq</option>
<option value="Ireland" title="Ireland">Ireland</option>
<option value="Isle of Man" title="Isle of Man">Isle of Man</option>
<option value="Israel" title="Israel">Israel</option>
<option value="Italy" title="Italy">Italy</option>
<option value="Jamaica" title="Jamaica">Jamaica</option>
<option value="Japan" title="Japan">Japan</option>
<option value="Jersey" title="Jersey">Jersey</option>
<option value="Jordan" title="Jordan">Jordan</option>
<option value="Kazakhstan" title="Kazakhstan">Kazakhstan</option>
<option value="Kenya" title="Kenya">Kenya</option>
<option value="Kiribati" title="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of" title="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of" title="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait" title="Kuwait">Kuwait</option>
<option value="Kyrgyzstan" title="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic" title="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia" title="Latvia">Latvia</option>
<option value="Lebanon" title="Lebanon">Lebanon</option>
<option value="Lesotho" title="Lesotho">Lesotho</option>
<option value="Liberia" title="Liberia">Liberia</option>
<option value="Libya" title="Libya">Libya</option>
<option value="Liechtenstein" title="Liechtenstein">Liechtenstein</option>
<option value="Lithuania" title="Lithuania">Lithuania</option>
<option value="Luxembourg" title="Luxembourg">Luxembourg</option>
<option value="Macao" title="Macao">Macao</option>
<option value="Macedonia, the former Yugoslav Republic of" title="Macedonia, the former Yugoslav Republic of">Macedonia, the former Yugoslav Republic of</option>
<option value="Madagascar" title="Madagascar">Madagascar</option>
<option value="Malawi" title="Malawi">Malawi</option>
<option value="Malaysia" title="Malaysia">Malaysia</option>
<option value="Maldives" title="Maldives">Maldives</option>
<option value="Mali" title="Mali">Mali</option>
<option value="Malta" title="Malta">Malta</option>
<option value="Marshall Islands" title="Marshall Islands">Marshall Islands</option>
<option value="Martinique" title="Martinique">Martinique</option>
<option value="Mauritania" title="Mauritania">Mauritania</option>
<option value="Mauritius" title="Mauritius">Mauritius</option>
<option value="Mayotte" title="Mayotte">Mayotte</option>
<option value="Mexico" title="Mexico">Mexico</option>
<option value="Micronesia, Federated States of" title="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of" title="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco" title="Monaco">Monaco</option>
<option value="Mongolia" title="Mongolia">Mongolia</option>
<option value="Montenegro" title="Montenegro">Montenegro</option>
<option value="Montserrat" title="Montserrat">Montserrat</option>
<option value="Morocco" title="Morocco">Morocco</option>
<option value="Mozambique" title="Mozambique">Mozambique</option>
<option value="Myanmar" title="Myanmar">Myanmar</option>
<option value="Namibia" title="Namibia">Namibia</option>
<option value="Nauru" title="Nauru">Nauru</option>
<option value="Nepal" title="Nepal">Nepal</option>
<option value="Netherlands" title="Netherlands">Netherlands</option>
<option value="New Caledonia" title="New Caledonia">New Caledonia</option>
<option value="New Zealand" title="New Zealand">New Zealand</option>
<option value="Nicaragua" title="Nicaragua">Nicaragua</option>
<option value="Niger" title="Niger">Niger</option>
<option value="Nigeria" title="Nigeria">Nigeria</option>
<option value="Niue" title="Niue">Niue</option>
<option value="Norfolk Island" title="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands" title="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway" title="Norway">Norway</option>
<option value="Oman" title="Oman">Oman</option>
<option value="Pakistan" title="Pakistan">Pakistan</option>
<option value="Palau" title="Palau">Palau</option>
<option value="Palestinian Territory, Occupied" title="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama" title="Panama">Panama</option>
<option value="Papua New Guinea" title="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay" title="Paraguay">Paraguay</option>
<option value="Peru" title="Peru">Peru</option>
<option value="Philippines" title="Philippines">Philippines</option>
<option value="Pitcairn" title="Pitcairn">Pitcairn</option>
<option value="Poland" title="Poland">Poland</option>
<option value="Portugal" title="Portugal">Portugal</option>
<option value="Puerto Rico" title="Puerto Rico">Puerto Rico</option>
<option value="Qatar" title="Qatar">Qatar</option>
<option value="Réunion" title="Réunion">Réunion</option>
<option value="Romania" title="Romania">Romania</option>
<option value="Russian Federation" title="Russian Federation">Russian Federation</option>
<option value="Rwanda" title="Rwanda">Rwanda</option>
<option value="Saint Barthélemy" title="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha" title="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis" title="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia" title="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French part)" title="Saint Martin (French part)">Saint Martin (French part)</option>
<option value="Saint Pierre and Miquelon" title="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines" title="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa" title="Samoa">Samoa</option>
<option value="San Marino" title="San Marino">San Marino</option>
<option value="Sao Tome and Principe" title="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia" title="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal" title="Senegal">Senegal</option>
<option value="Serbia" title="Serbia">Serbia</option>
<option value="Seychelles" title="Seychelles">Seychelles</option>
<option value="Sierra Leone" title="Sierra Leone">Sierra Leone</option>
<option value="Singapore" title="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch part)" title="Sint Maarten (Dutch part)">Sint Maarten (Dutch part)</option>
<option value="Slovakia" title="Slovakia">Slovakia</option>
<option value="Slovenia" title="Slovenia">Slovenia</option>
<option value="Solomon Islands" title="Solomon Islands">Solomon Islands</option>
<option value="Somalia" title="Somalia">Somalia</option>
<option value="South Africa" title="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands" title="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan" title="South Sudan">South Sudan</option>
<option value="Spain" title="Spain">Spain</option>
<option value="Sri Lanka" title="Sri Lanka">Sri Lanka</option>
<option value="Sudan" title="Sudan">Sudan</option>
<option value="Suriname" title="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen" title="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland" title="Swaziland">Swaziland</option>
<option value="Sweden" title="Sweden">Sweden</option>
<option value="Switzerland" title="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic" title="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China" title="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan" title="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of" title="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand" title="Thailand">Thailand</option>
<option value="Timor-Leste" title="Timor-Leste">Timor-Leste</option>
<option value="Togo" title="Togo">Togo</option>
<option value="Tokelau" title="Tokelau">Tokelau</option>
<option value="Tonga" title="Tonga">Tonga</option>
<option value="Trinidad and Tobago" title="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia" title="Tunisia">Tunisia</option>
<option value="Turkey" title="Turkey">Turkey</option>
<option value="Turkmenistan" title="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands" title="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu" title="Tuvalu">Tuvalu</option>
<option value="Uganda" title="Uganda">Uganda</option>
<option value="Ukraine" title="Ukraine">Ukraine</option>
<option value="United Arab Emirates" title="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom" title="United Kingdom">United Kingdom</option>
<option value="United States" title="United States">United States</option>
<option value="United States Minor Outlying Islands" title="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay" title="Uruguay">Uruguay</option>
<option value="Uzbekistan" title="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu" title="Vanuatu">Vanuatu</option>
<option value="Venezuela, Bolivarian Republic of" title="Venezuela, Bolivarian Republic of">Venezuela, Bolivarian Republic of</option>
<option value="Viet Nam" title="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British" title="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S." title="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna" title="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara" title="Western Sahara">Western Sahara</option>
<option value="Yemen" title="Yemen">Yemen</option>
<option value="Zambia" title="Zambia">Zambia</option>
<option value="Zimbabwe" title="Zimbabwe">Zimbabwe</option>
</select>
</div>
</div>
<div data-row-span="4">
<div data-field-span="2" data-field-error="Please enter a valid email address">
<label>E-mail</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Mobile No.</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Existing Bank Account No. (if any)</label>
<input type="text">
</div>
</div>
<div data-row-span="2">
<div data-field-span="1">
<label>In case of a minor please provide details (Name of parent and natural guardian)</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Name of father/spouse</label>
<input type="text">
</div>
</div>
<br>
<fieldset>
<legend>Residential address</legend>
<div data-row-span="2">
<div data-field-span="1">
<label>Flat no. and bldg. name</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Road no./name</label>
<input type="text">
</div>
</div>
<div data-row-span="4">
<div data-field-span="3">
<label>Area and landmark</label>
<input type="text">
</div>
<div data-field-span="1">
<label>City</label>
<input type="text">
</div>
</div>
<div data-row-span="4">
<div data-field-span="1">
<label>Telephone Residence</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Office</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Fax</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Pin code</label>
<input type="text">
</div>
</div>
</fieldset>
</fieldset>
<br>
<fieldset>
<legend>Mailing Address (If different from the First Accountholder's address)</legend>
<div data-row-span="1">
<div data-field-span="1">
<label>Company name and department/ Flat no. and bldg. name</label>
<input type="text">
</div>
</div>
<div data-row-span="4">
<div data-field-span="1">
<label>Road no./name</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Area and landmark</label>
<input type="text">
</div>
<div data-field-span="1">
<label>City</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Pin Code</label>
<input type="text">
</div>
</div>
<div data-row-span="4">
<div data-field-span="1">
<label>Telephone Residence</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Office</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Fax</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Mobile No.</label>
<input type="text">
</div>
</div>
<div data-row-span="1">
<div data-field-span="1">
<label>E-mail</label>
<input type="text">
</div>
</div>
</fieldset>
<br><br>
<fieldset>
<legend>Details of Introduction by Existing Customer (If applicable)</legend>
<div data-row-span="2">
<div data-field-span="1">
<label>Customer Name</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Account No.</label>
<input type="text">
</div>
</div>
<div data-row-span="1">
<div data-field-span="1">
<label>Introducer's signature</label>
<textarea></textarea>
</div>
</div>
</fieldset>
<br><br>
<fieldset>
<legend>Account Details</legend>
<div data-row-span="2">
<div data-field-span="1">
<label>Choice of account</label>
<label><input type="checkbox"> Savings</label>
<label><input type="checkbox"> Current</label>
<label><input type="checkbox"> Fixed deposits</label>
</div>
<div data-field-span="1">
<label>Mode of funding</label>
<label><input type="checkbox"> Cash</label>
<label><input type="checkbox"> Cheque</label>
<label><input type="checkbox"> NEFT</label>
</div>
</div>
<div data-row-span="1">
<div data-field-span="1">
<label>Amount</label>
<input type="text">
</div>
</div>
<br>
<fieldset>
<legend>Details of Fixed Deposit</legend>
<div data-row-span="2">
<div data-field-span="1">
<label>Types of deposit</label>
<label><input type="checkbox"> Ordinary</label>
<label><input type="checkbox"> Cumulative</label>
</div>
<div data-field-span="1">
<label>Mode of funding</label>
<label><input type="checkbox"> Cash</label>
<label><input type="checkbox"> Cheque</label>
<label><input type="checkbox"> NEFT</label>
</div>
</div>
<div data-row-span="4">
<div data-field-span="2">
<label>Amount</label>
<input type="text">
</div>
<div data-field-span="1">
<label>No. of deposits</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Individual Deposit Amount</label>
<input type="text">
</div>
</div>
</fieldset>
</fieldset>
<br><br>
<fieldset>
<legend>Personal Details</legend>
<div data-row-span="1">
<div data-field-span="1">
<label>Occupation</label>
<label><input type="checkbox"> Non-executive</label>
<label><input type="checkbox"> Housewife</label>
<label><input type="checkbox"> Retired</label>
<label><input type="checkbox"> Student</label>
<label><input type="checkbox"> Other</label>
<label><input type="checkbox"> Unemployed</label>
</div>
</div>
<div data-row-span="1">
<div data-field-span="1">
<label>Job Title</label>
<input type="text">
</div>
</div>
<div data-row-span="2">
<div data-field-span="1">
<label>Department</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Nature of business</label>
<input type="text">
</div>
</div>
<div data-row-span="2">
<div data-field-span="1">
<label>Education</label>
<label><input type="checkbox"> Under graduate</label>
<label><input type="checkbox"> Graduate</label>
<label><input type="checkbox"> Others</label>
</div>
<div data-field-span="1">
<label>Monthly Income</label>
<label><input type="checkbox"> Zero Income</label>
<label><input type="checkbox"> Less than $10,000</label>
<label><input type="checkbox"> $10,000+</label>
</div>
</div>
<div data-row-span="2">
<div data-field-span="1">
<label>Maritial Status</label>
<label><input type="checkbox"> Married</label>
<label><input type="checkbox"> Single</label>
</div>
<div data-field-span="1">
<label>Spouse name</label>
<input type="text">
</div>
</div>
<br>