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<?php
include('header.php');
include('left_sidebar.php');
$objID=$_REQUEST['objID'];
if($objID!="")
{
$CatRs=mysql_query("select * from tbl_request where application_no='".$objID."'") ;
$CatRow=mysql_fetch_assoc($CatRs) ;
$CatRs2=mysql_query("select * from tbl_tworequest where application_no='".$objID."'") ;
$CatRow2=mysql_fetch_assoc($CatRs2) ;
$CatRs3=mysql_query("select * from tbl_threerequest where application_no='".$objID."'") ;
$CatRow3=mysql_fetch_assoc($CatRs3) ;
$CatRs4=mysql_query("select * from tbl_fourrequest where application_no='".$objID."'") ;
$CatRow4=mysql_fetch_assoc($CatRs4) ;
}
if(isset($_POST["newSubmit"]))
{
extract($_POST);
$Register_no=date('YmdHis');
$cQuery="insert into tbl_wwwrequest set register_no='".mysql_real_escape_string($Register_no)."',
center_id='".mysql_real_escape_string($_REQUEST["center_id"])."',
agent_id='".mysql_real_escape_string($_REQUEST["agent_id"])."',
name='".mysql_real_escape_string($_REQUEST["name"])."',
gender='".mysql_real_escape_string($_REQUEST["gender"])."',
age='".mysql_real_escape_string($_REQUEST["age"])."',
contact='".mysql_real_escape_string($_REQUEST["contact"])."',
email='".mysql_real_escape_string($_REQUEST["email"])."',
address='".mysql_real_escape_string($_REQUEST["address"])."',
locality='".mysql_real_escape_string($_REQUEST["locality"])."',
city='".mysql_real_escape_string($_REQUEST["city"])."',
state='".mysql_real_escape_string($_REQUEST["state"])."',
pincode='".mysql_real_escape_string($_REQUEST["pincode"])."',
landmark='".mysql_real_escape_string($_REQUEST["landmark"])."',
referred_by='".mysql_real_escape_string($_REQUEST["referred_by"])."',
sample_collection='".mysql_real_escape_string($_REQUEST["sample_collection"])."',
time='".mysql_real_escape_string($_REQUEST["time"])."',
date='".mysql_real_escape_string($_REQUEST["date"])."',
status='".mysql_real_escape_string($_REQUEST["status"])."'";
if($_FILES['image1']['name']!="")
{
$image=time()."-".md5(rand())."-".$_FILES['image1']['name'];
if($image!="")
{
$cQuery.=",image ='".$image."'" ;
$target="upload/values/";
$source=$_FILES["image1"]["tmp_name"];
$target=$target.$image;
move_uploaded_file($source,$target) ;
}
}
$RowCons=mysql_query($cQuery) or die(mysql_error());
if($RowCons)
{
$_SESSION["msg"]="One Record Is Inserted ";
header("location:add_test.php?fdafddasdf=".$Register_no);
exit() ;
}
}
?>
<!-- ============================================================== -->
<!-- Page wrapper -->
<!-- ============================================================== -->
<div class="page-wrapper">
<!-- ============================================================== -->
<!-- Container fluid -->
<!-- ============================================================== -->
<div class="container-fluid">
<!-- ============================================================== -->
<!-- Bread crumb and right sidebar toggle -->
<!-- ============================================================== -->
<div class="row page-titles">
<div class="col-md-5 col-8 align-self-center">
<h3 class="text-themecolor">User Detail</h3>
</div>
<div class="col-md-7 col-4 align-self-center">
<div class="d-flex m-t-10 justify-content-end">
<ol class="breadcrumb">
<li class="breadcrumb-item"><a href="javascript:void(0)">Home</a></li>
<li class="breadcrumb-item active">User Detail</li>
</ol>
</div>
</div>
</div>
<!-- ============================================================== -->
<!-- End Bread crumb and right sidebar toggle -->
<!-- ============================================================== -->
<!-- ============================================================== -->
<!-- Start Page Content -->
<!-- ============================================================== -->
<!-- Row -->
<div class="row">
<div class="col-sm-12">
<div class="card">
<div class="card-body">
<h4 class="card-title">User Detail</h4>
<form class="form" method="post" action="" enctype="multipart/form-data">
<?php if(isset($_SESSION["msg"]))
{ ?>
<div class="alert alert-danger"> <?php echo $_SESSION["msg"]; ?>
<button type="button" class="close" data-dismiss="alert" aria-label="Close"> <span aria-hidden="true">×</span> </button>
</div>
<?php unset($_SESSION["msg"]); }
?>
<div class="form-group m-t-40 row">
<img src="../upload/<?php echo $CatRow4['image'];?>" height="150" class="col-2" alt="profile"/>
<div class="col-10">
</div>
</div>
<h4 class="card-title">First Form</h4>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Application no.</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="name" value="<?php echo $CatRow['application_no'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Application Type</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="name" value="<?php echo $CatRow['application_type'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Fist Name</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="name" value="<?php echo $CatRow['fname'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-number-input" class="col-2 col-form-label">Middle Name</label>
<div class="col-10">
<input class="form-control" type="text" id="example-number-input" name="age" value="<?php echo $CatRow['mname'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-number-input" class="col-2 col-form-label">Last Name</label>
<div class="col-10">
<input class="form-control" type="text" id="example-number-input" name="age" value="<?php echo $CatRow['lname'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-number-input" class="col-2 col-form-label">Previous Surname</label>
<div class="col-10">
<input class="form-control" type="text" id="example-number-input" name="age" value="<?php echo $CatRow['lname'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-number-input" class="col-2 col-form-label">Previous Name</label>
<div class="col-10">
<input class="form-control" type="text" id="example-number-input" name="age" value="<?php echo $CatRow['fname'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-number-input" class="col-2 col-form-label">Birthdate</label>
<div class="col-10">
<input class="form-control" type="text" id="example-number-input" name="age" value="<?php echo $CatRow['dob'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-tel-input" class="col-2 col-form-label">Contact Number</label>
<div class="col-10">
<input class="form-control" type="tel" name="contact" id="example-tel-input" value="<?php echo $CatRow['telephone'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-email-input" class="col-2 col-form-label">Email</label>
<div class="col-10">
<input class="form-control" type="email" name="email" id="example-email-input" placeholder="Email" value="<?php echo $CatRow['email'];?>" required>
</div>
</div>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Passport type</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="address" value="<?php echo $CatRow['passport_type'];?>" required>
</div>
</div>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Port Of Arrival</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="locality" value="<?php echo $CatRow['port_arrival'];?>" required>
</div>
</div>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Passport No.</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="city" value="<?php echo $CatRow['pnumber'];?>" required>
</div>
</div>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Arrival Date</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="pincode" value="<?php echo $CatRow['arrival_date'];?>" required>
</div>
</div>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Visa Type</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow['visa_type'];?>" required>
</div>
</div>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Passport</label>
<div class="col-10">
<img src="../upload/<?php echo $CatRow['image'];?>" height="150" class="col-4" alt="passport"/>
</div>
</div>
<hr />
<h4 class="card-title">Second Form</h4>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">Gender</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['gender'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Province/Town/City of birth</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['town'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Country of birth</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['birth_contry'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">National Id</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['citizenshipid'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Religion</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['religion'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">visible identification mark</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['ident_mark'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Education Qualification</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['education'];?>" required>
</div>
</div> <div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Prev Nationality</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['pre_nationality'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Applicant's Passport Number</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['passport'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Place of Issue</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['PlaceofIssue'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Date of Issue</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['dateiss'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Date of Expiry</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['DateofExpiry'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Country of Issue</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['othercountry'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Any Other Valid Passport/IC No</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['otherPassporticNo'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Any Other Valid Passport Date of Issue</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['otherDateissue'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Place of Issuee</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['other_placeissue'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Nationality </label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow2['other_nationality'];?>" required>
</div>
</div>
<hr />
<h4 class="card-title">Third Form</h4>
<h5 class="card-title">Present Address</h5>
<div class="form-group m-t-40 row">
<label for="example-text-input" class="col-2 col-form-label">House No.</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['house'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Village/Town/City</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['twon_city'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">State/Province/District</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['state'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Postal Zip Code</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['postal'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Country</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['country'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Contact No</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['phone'];?>" required>
</div>
</div>
<h5 class="card-title">Permanent Address</h5>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">House/Street</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['per_house'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Village/Town/City</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['per_town'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">State/Province/District</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['per_state'];?>" required>
</div>
</div>
<h5 class="card-title">Family Details</h5>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Applicant's Father Name</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['fathername'];?>" required>
</div>
</div><div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Nationality of Father</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['f_national'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Previous Nationality of Father</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['f_prenational'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Father Place of birth</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['f_birthplace'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Father Country of Birth</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['f_birth_country'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Applicant's Mother Name</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['m_name'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Nationality of Mother</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['m_national'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Previous Nationality of Mother</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['m_prenational'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Mother Place of birth</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['m_birthplace'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Applicant´s Maritial Status</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['marital_status'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Grandfather/ Grandmother (paternal/maternal) Pakistan Nationals or Belong to Pakistan</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['pak'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Present Occupasion</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['profession'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Employer Name/business</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['employer'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Designation</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['designation'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Address</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['job_address'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Military/Semi-Military/Police/Security. Organization</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['socialOrganisation'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Designation</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['socialDesignation'];?>" required>
</div>
</div> <div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Rank</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['socialrank'];?>" required>
</div>
</div> <div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Place of Posting</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow3['socialposting'];?>" required>
</div>
</div>
<hr />
<h4 class="card-title">Fourth Form</h4>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Duration of visit (in Days)</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['visa_duration'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">No of Entries</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['visa_entry_id'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Expected Port of Exit from India</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['expected_port'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Places likely to be visited</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['place_u_like'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Address of stay during your last visit</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_address'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Cities in India visited</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_city'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Last Indian Visa no / Currently valid Visa no</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_visano'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Previous Type of Visa</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_visatype'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Place of Issue</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_visa_issueplace'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Date of Issue</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_date_issue'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">permission to visit or to extend stay in India previously been refused?</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['india_permission'];?>" required>
</div>
</div><div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Countries visited in last 10 years</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['countries_pre_years'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Saarc Country</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['saarc_country'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Saarc Year</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['select_year'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Saarc Visitors</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['pre_visitors'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Reference Name or Hotel Name in India</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['reference_hotel'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Reference Address or Hotel Address
</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['reference_hoteladdress'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">City</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['reference_hotel_city'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">State</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['reference_hotel_state'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">Country</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['reference_hotel_country'];?>" required>
</div>
</div>
<div class="form-group row">
<label for="example-text-input" class="col-2 col-form-label">ZIP Code / POST Code</label>
<div class="col-10">
<input class="form-control" type="text" id="example-text-input" name="landmark" value="<?php echo $CatRow4['reference_hotel_zipcode'];?>" required>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
<!-- ============================================================== -->
<!-- End PAge Content -->
<!-- ============================================================== -->
<?php include('footer.php');?>