Mini Shell
<!DOCTYPE html>
<html class="wide wow-animation" lang="en">
<?php
include_once('includes/Header.php');
?>
<a class="d-block" href="" target="blank"><img class="d-block w-100" src="images/MHCB1.jpg" height="200"></a>
<?php
require_once 'config/config.php';
if ($_SERVER["REQUEST_METHOD"] == "POST") {
$FullName = $_POST["FullName"];
$Region = $_POST['Region'];
$Area = $_POST['Area'];
$ClassofHouse = $_POST["ClassofHouse"];
$PAddress = $_POST["PAddress"];
$Email = $_POST['Email'];
$Home = $_POST['Home'];
$Village = $_POST['Village'];
$TA = $_POST['TA'];
$District = $_POST["District"];
$Age = $_POST["Age"];
$MaritalStatus = $_POST['MaritalStatus'];
$Children = $_POST['Children'];
$EmpStatus = $_POST['EmpStatus'];
$Income = $_POST["Income"];
$MHCHome = $_POST["MHCHome"];
$OwnRight = $_POST['OwnRight'];
$AnotherHouse = $_POST['AnotherHouse'];
$LiveAfterRetirement = $_POST["LiveAfterRetirement"];
$PayAfterRetirement = $_POST["PayAfterRetirement"];
$Purchase = $_POST["Purchase"];
$BriefExplanation = $_POST["BriefExplanation"];
$Phone = $_POST["Phone"];
date_default_timezone_set('Africa/Blantyre');
$ApplicationDate = date("d/m/Y");
//Adding new customer details into the database
$sql = mysqli_query($connection,"INSERT INTO houseapplication (Full_Name,Region,Area,ClassOfHouse,Post_Address,Email,Home_Address,Village,TA,District,Age,Marital_Status,Children,Employment_Status,Income,MHC_House,Own_Right,Why_Another,LiveAfterRetire,PayAfterRetire,Purchase,Briefly_Explain,Phone,Applicate_Date,Application_Status)
values('$FullName','$Region','$Area','$ClassofHouse','$PAddress','$Email','$Home','$Village','$TA','$District','$Age','$MaritalStatus','$Children','$EmpStatus','$Income','$MHCHome','$OwnRight','$AnotherHouse','$LiveAfterRetirement','$PayAfterRetirement','$Purchase','$BriefExplanation','$Phone','$ApplicationDate','New')");
if ($sql){
?>
<h5 align = "center" color = "green"> <?php echo "Application Submitted successfully"; ?></h5>
<?php
}else {
?>
<h5 align = "center" color = "green"> <?php echo "Oops! something went wrong. Please Resend"; ?></h5>
<?php
}}
?>
<section class="section section-md bg-gray-100">
<div class="container text-center">
<div class="row row-50 text-start">
<div class="col-lg-6">
<!-- Heading Component-->
<article class="heading-component">
<div class="heading-component-inner">
<h5 class="heading-component-title">HOUSE APPLICATION FORM
</h5>
</div>
</article>
<div class="card-shop">
<ul class="list-md form-wrap">
<li>
<div class="radio-panel">
<table>
<tr>
<td colspan = "3"><p><strong>HOUSE CLASSES DEFINITIONS</strong></p></td>
</tr><tr>
<td><p><strong>F1</strong> - Bed Seater </p></td>
<td><p><strong>F2</strong> - One Bedroom </p></td>
<td><p><strong>E3</strong> - Two Bedrooms</p></td>
</tr>
<tr>
<td><p><strong>E4</strong> - Three Bedrooms</p><td>
<td><p><strong>Flat</strong> - Flat house</p></td>
</tr><tr>
<td colspan = "3"><p><strong>C3</strong> - Two Bedroomeiling, Geyser</p></td>
</tr>
<tr>
<td colspan = "3"><p><strong>D</strong> - 3 Bedrooms with Ceiling, Geyser</p></td>
</tr><tr>
<td colspan = "3"><p><strong>C4</strong> - 3 Bedrooms with Boysquarter, ceiling, Geyser</p></td>
</tr>
<tr>
<td colspan = "3"><p><strong>AB</strong> - 3 bedrooms with Kitchen, Geyser, garage</p></td>
</tr>
</table>
</div>
</li>
</ul>
</div>
</div>
<div class="col-lg-6">
<!-- Heading Component-->
<article class="heading-component">
<div class="heading-component-inner">
<h5 class="heading-component-title">Downloadable forms
</h5>
</div>
</article>
<div class="table-custom-responsive">
<article class="post-classic">
<div class="post-classic-aside"><a class="post-classic-figure" href="Forms/MHC_PLOT_APPLICATION_FORM.pdf"><img src="images/PDF.png" alt="" width="34" height="34"/> House Application Form</a></div>
<div class="post-classic-main">
</div>
</article>
<!-- Post Classic-->
<article class="post-classic">
<div class="post-classic-aside"><a class="post-classic-figure" href="Forms/MHC_PLOT_APPLICATION_FORM.pdf"><img src="images/PDF.png" alt="" width="34" height="34"/> Plot Application Form</a></div>
<div class="post-classic-main">
</div>
</article>
<!-- Post Classic-->
<article class="post-classic">
<div class="post-classic-aside"><a class="post-classic-figure" href="Forms/Rent Payment Platforms.pdf"><img src="images/PDF.png" alt="" width="34" height="34"/> Rent Payment Platforms </a></div>
<div class="post-classic-main">
</div>
</article>
</div>
</div>
<div class="col-md-12">
<div class="row row-50">
<div class="col-lg-6">
<!-- Heading Component-->
<article class="heading-component">
<div class="heading-component-inner">
<h5 class="heading-component-title">Personal Details
</h5>
</div>
</article>
<form action="" method="POST">
<div class="form-wrap">
<div class="row row-10 row-narrow">
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="FullName">Full Name</label>
<input class="form-input" id="FullName" type="text" name="FullName" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Home">Current Location</label>
<input class="form-input" id="Home" type="text" name="Home" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Village">Home Village</label>
<input class="form-input" id="Village" type="text" name="Village" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="TA">Traditional Athourity</label>
<input class="form-input" id="TA" type="text" name="TA" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="District">District</label>
<input class="form-input" id="District" type="text" name="District" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<select name="MaritalStatus" class="form-control selectpicker" required >
<option value=""><h6>Marital Status</h6></option>
<option value="Single"><h6>Single</h6></option>
<option value="Married"><h6>Married</h6></option>
<option value="Divorced"><h6>Divorced</h6></option>
<option value="Widowed"><h6>Widowed</h6></option>
</select> </div>
</div>
<div class="col-md-3">
<div class="form-wrap">
<label class="form-label" for="Children">Number of Children</label>
<input class="form-input" id="Children" type="text" name="Children" data-constraints="@Numeric">
</div>
</div>
<div class="col-md-3">
<div class="form-wrap">
<label class="form-label" for="Age">Age</label>
<input class="form-input" id="Age" type="text" name="Age" data-constraints="@Required @Numeric">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Email">Email Address</label>
<input class="form-input" id="Email" type="text" name="Email" data-constraints="@Email">
</div>
</div>
<div class="col-md-12">
<div class="form-wrap">
<label class="form-label" for="PAddress">Postal Address</label>
<input class="form-input" id="PAddress" type="text" name="PAddress" >
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<select name="EmpStatus" class="form-control selectpicker" required >
<option value=""><h6>Select Employement Status</h6></option>
<option value="Working"><h6>Working</h6></option>
<option value="Business"><h6>Business</h6></option>
<option value="Student"><h6>Student</h6></option>
<option value="Nothing"><h6>Nothing</h6></option>
</select> </div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Income">Present Salary/Income</label>
<input class="form-input" id="Income" type="text" name="Income" data-constraints="@Required @Numeric">
</div>
</div>
<div class="col-md-12">
<div class="form-wrap">
<input name="input-radio" value="radio-1" type="radio" required>DECLARATION AND UNDERTAKING: I declare that the information given in this form is true and correct to the best of my knowledge and belief and to undertake to use the house for the purpose of private dwelling only and to abide by the terms and conditions for tenancies applicable to the type of house applied for
</div>
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<!-- Heading Component-->
<article class="heading-component">
<div class="heading-component-inner">
<h5 class="heading-component-title">Application Details
</h5>
</div>
</article>
<div class="form-wrap">
<div class="row row-10 row-narrow">
<div class="col-md-6">
<div class="form-wrap">
<select name="Region" class="form-control selectpicker" required >
<option value=""><h6>Select Region</h6></option>
<option value="South"><h6>South</h6></option>
<option value="East"><h6>East</h6></option>
<option value="Center"><h6>Center</h6></option>
<option value="North"><h6>North</h6></option>
</select> </div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Area">Urban Area</label>
<input class="form-input" id="Area" type="text" name="Area" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<select name="ClassofHouse" class="form-control selectpicker" required >
<option value=""><h6>Select Class of the house</h6></option>
<option value="F1"><h6>F1</h6></option>
<option value="F2"><h6>F2</h6></option>
<option value="E3"><h6>E3</h6></option>
<option value="C3"><h6>C3</h6></option>
<option value="E4"><h6>E4</h6></option>
<option value="D"><h6>D</h6></option>
<option value="C4"><h6>C4</h6></option>
<option value="AB"><h6>AB</h6></option>
<option value="FLAT"><h6>FLAT</h6></option>
</select> </div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="MHCHome">Do you live in MHC House</label>
<input class="form-input" id="MHCHome" type="text" name="MHCHome" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="OwnRight">If yes, did you get it in your own right</label>
<input class="form-input" id="OwnRight" type="text" name="OwnRight">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="AnotherHouse">If Yes, why Applying for another one</label>
<input class="form-input" id="AnotherHouse" type="text" name="AnotherHouse" >
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="LiveAfterRetirement">Do you plan to live in this urban area after retirement</label>
<input class="form-input" id="LiveAfterRetirement" type="text" name="LiveAfterRetirement" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="PayAfterRetirement">Can you afford to pay rent after retirement</label>
<input class="form-input" id="PayAfterRetirement" type="text" name="PayAfterRetirement" data-constraints="@Required">
</div>
</div>
<div class="col-md-12">
<div class="form-wrap">
<label class="form-label" for="BriefExplanation">Explain in brief why you need a house in the urban area mentioned</label>
<input class="form-input" id="BriefExplanation" type="text" name="BriefExplanation" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Purchase">If allocated, could you purchase it</label>
<input class="form-input" id="Purchase" type="text" name="Purchase" data-constraints="@Required">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
<label class="form-label" for="Phone">Phone number</label>
<input class="form-input" id="Phone" type="text" name="Phone" data-constraints="@Required @Numeric">
</div>
</div>
<div class="col-md-6">
<div class="form-wrap">
</div>
</div>
<div class="col-md-6">
<button class="button button-lg button-primary button-block" type="submit">Send Application</button>
</div>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
</section>
<!-- Page Footer-->
<?php
include_once('includes/Footer.php');
?>
</body>
</html>