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yuva.php
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<html>
<head>
<title>Subsidy assistance</title>
<style >
body{
background-image:url("img4.jpg");
background-repeat:no-repeat;
background-size:2500px 2800px;
}
div {
width: 900px;
border: 3px solid green;
padding: 25px;
margin: 25px;
}
</style>
<body>
<table name="title" border="0">
<tr>
<td>
<img src="neo.jpg" height="150" width="300"></td>
<td width="900">
<h1><font color="darkblue">NEO-FISHERIES</h1></font>
<p><font size="5">fishermen welfare organisation</p></font>
</td>
<td><marquee direction="down" behavior="alternate" scrollamount="2"><h2 style="color:green;">Toll-free Number<img src="hand.png" align="right" height="40" width="45"></marquee><h2>
<img src="logo.png" height="25" width="25" align="left"><p style="font-size:20;">1800-425-1660</p><h3><font color="darkpink">E-mail:</font>neofisheries@gmail.com</h3>
<table name="socialmedia" border="1">
<tr>
<td><a href="https://www.facebook.com/Neo-Fisheries-2387827567917070/?modal=admin_todo_tour"><img src="fb.png" height="30" width="30"></a></td>
<td><a href="https://twitter.com/FisheriesNeo"><img src="tweet.png" height="30" width="30"></a></td>
</table>
</td>
</tr>
</table>
<hr />
<center><p><b><font face="Comic Sans MS" color="violet"><h1 class="a">APPLICATION FORM TO AVAIL SUBSIDY ASSISTANCE FOR PURCHASE OF EQUIPMENT FOR USE IN FISHING VESSELS</h1></font></b></p></center><br/><br/>
<b><div><center><font face="Comic Sans MS" color="blue"><h2>PARTICULARS OF APPLICANT:</h2></font></b>
<form name="page 1" action="page3.php" method="POST">
<font face="Comic Sans MS" color="brown"><b>NAME OF THE APPLICANT:</b></font>
<input type="text" name="a" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>GENDER:         </b></font>
<input type="radio" name="gen" value="m">MALE <input type="radio" name="gen" value="f">FEMALE <input type="radio" name="gen" value="o">OTHERS<br /><br />
<font face="Comic Sans MS" color="brown"><b>AGE                            :</b></font>
<input type="text" name="b" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>DATE OF BIRTH              :</b></font>
<input type="text" name="c" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>ADDRESS                      :                     </b></font><br/>
<textarea rows="5" cols="50" name="d" placeholder="" required></textarea><br/><br/>
<font face="Comic Sans MS" color="brown"><b>ANNUAL INCOME              :</b></font>
<select>
<option value="">Below 50,000</option>
<option value="">50,000-70,000</option>
<option value="">70,000-80,000</option>
<option value="">Above 1,00,000</option>
</select><br/><br/>
<b><font face="Comic Sans MS" color="blue"><h2>PARTICULARS OF FISHING BOAT AND ENGINE:</h2></font></b>
<font face="Comic Sans MS" color="brown"><b>(A)NAME OF FISHING VESSEL:</b></font>
<input type="text" name="f" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>(B)MAJOR DIMENSION OF BOAT:                   </b></font><br/><br/>
<font face="Comic Sans MS" color="brown"><b>(i)LENGTH                         :</b></font>
<input type="text" name="g" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>(ii)BREADTH                       :</b></font>
<input type="text" name="h" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>(iii)DEPTH                         :</b></font>
<input type="text" name="i" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>(iv)GROSS TON                   :</b></font>
<input type="text" name="j" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>(C)TYPE OF FISHING       :</b></font>
<input type="checkbox" name="fv" value="in">INLAND  <input type="checkbox" name="fv" value="mar">MARINE<br/><br/>
<font face="Comic Sans MS" color="brown"><b>(D)PLACE OF OPERATION       :</b></font>
<input type="text" name="l" placeholder="" required><br/><br/>
<b><font face="Comic Sans MS" color="blue"><h2>PARTICULARS OF FINANCIAL INSTITUTE:</h2></font></b>
<font face="Comic Sans MS" color="brown"><b>NAME OF THE BANK               </b></font>
<select>
<option value="">Indian overseas bank</option>
<option value="">Indian bank</option>
<option value="">Canara bank</option>
<option value="">Axis bank</option>
<option value="">State bank of India</option>
<option value="">Karur vaysya bank</option></select><br/><br/>
<font face="Comic Sans MS" color="brown"><b>BANK ACCOUNT NUMBER         </b></font>
<input type="text" name="n" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>SANCTION LOAN ACCOUNT      </b></font>
<input type="text" name="o" placeholder="" required><br/><br/>
<b><font face="Comic Sans MS" color="blue"><h2>PARTICULARS OF FINANCIAL ASSISTANCE:</h2></font></b>
<font face="Comic Sans MS" color="brown"><b>FINANCIAL ASSISTANCE :</b></font>
<input type="checkbox" name="" value="">fishing net  <input type="checkbox" name="" value="">fishing equipment<br/><br/>
<font face="Comic Sans MS" color="brown"><b>COST OF ITEM IN Rs.     :</b></font>
<select>
<option value="">Below 50,000</option>
<option value="">50,000-70,000</option>
<option value="">70,000-80,000</option>
<option value="">Above 1,00,000</option>
</select><br/><br/>
<font face="Comic Sans MS" color="brown"><b>LOAN/OWN CONTRIBUTION   :</b></font>
<input type="radio" name="" value="">YES <input type="radio" name="" value="">NO <input type="radio" name="" value="">PARTIAL<br /><br />
<font face="Comic Sans MS" color="brown"><b>SUBSIDY IN Rs.50%             :</b></font>
<input type="text" name="s" placeholder="" required><br/><br/>
<b><font face="Comic Sans MS" color="blue"><h2>PARTICULARS OF INVOICES/BILLS:</h2></font></b>
<font face="Comic Sans MS" color="brown"><b>NAME OF THE DEALER           :</b></font>
<input type="text" name="t" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>ADDRESS OF THE DEALER       :                    </b></font><br/>
<textarea rows="5" cols="50" name="u" placeholder="" required></textarea><br/><br/>
<font face="Comic Sans MS" color="brown"><b>VAT/TIN NUMBER                 :</b></font>
<input type="text" name="v" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>DATED                               :</b></font>
<input type="text" name="w" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>INVOICE OR BILL NUMBER       :</b></font>
<input type="text" name="x" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>DATED                               :</b></font>
<input type="text" name="y" placeholder="" required><br/><br/>
<font face="Comic Sans MS" color="brown"><b>COST AS PER PURCHASE BILL   :</b></font>
<input type="text" name="z" placeholder="" required><br/><br/>
<b><font face="Comic Sans MS" color="blue"><h2>DOCUMENTS REQUIRED:</h2></font></b>
<b> (i)fisheries certificate             :</b>
<input type="file" name="fish" accept="pdf" required><br/><br/>
<b> (ii)ration card                          :</b>
<input type="file" name="ration" accept="pdf" required><br/><br/>
<b> (iii)first page of passbook        :</b>
<input type="file" name="passbook" accept="pdf" required><br/><br/>
<center><font face="Comic Sans MS" color="brown"><b>DECLARATION</b></font></center>
<hr />
                       I hereby declare that the above said details are true to the best of my knowledge and my belief.<br />If there is any faulty or
fake information in it,I (the applicant)takes the responsiblity of it.The certificate I uploaded are government certified.<br /><br />
<center><input type="radio" name="dec" required>I accept<br /><br />
<center>
<input type="submit" class="button" name="submit" value="SUBMIT">            <input type="reset" class="button" value="RESET" name="reset">           <input type="submit" class="button" onclick="index.php" value="CANCEL" name="cancel"></center>
</div></form></center>
</body>
</html>