forked from furiouscollective/gridforms
-
Notifications
You must be signed in to change notification settings - Fork 0
/
example.html
597 lines (587 loc) · 28.1 KB
/
example.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
586
587
588
589
590
591
592
593
594
595
596
597
<!DOCTYPE html>
<head>
<title>Grid Forms · Example - Personal Bank Account Initial Application</title>
<link rel="stylesheet" type="text/css" href="gridforms/gridforms.css">
<script type="text/javascript" src="http://ajax.googleapis.com/ajax/libs/jquery/1.7.2/jquery.min.js"></script>
<script type="text/javascript" src="gridforms/gridforms.js"></script>
<meta name="viewport" content="initial-scale=1.0, maximum-scale=1.0, minimum-scale=1.0, user-scalable=no">
<style type="text/css">
body {font-family:arial, sans-serif}
</style>
</head>
<body>
<h1>Example Form</h1>
<h2>Personal Bank Account Initial Application</h2>
<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>
<input id="r1" name="customer-title" type="radio"><label for="r1"> Mr.</label>
<input id="r2" name="customer-title" type="radio"><label for="r2"> Mrs.</label>
<input id="r3" name="customer-title" type="radio"><label for="r3"> 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="Åland Islands" title="Åland 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>
<fieldset>
<legend>Other existing bank accounts, if any</legend>
<div data-row-span="2">
<div data-field-span="1">
<label>Name of the Bank / branch</label>
<input type="text">
</div>
<div data-field-span="1">
<label>Name of the Bank / branch</label>
<input type="text">
</div>
</div>
</fieldset>
</fieldset>
<br><br>
<fieldset>
<legend>Reason for Account opening</legend>
<div data-row-span="2">
<div data-field-span="1">
<label>Please specify</label>
<input type="text">
</div>
</div>
</fieldset>
<br><br>
<fieldset>
<legend>Terms And Conditions</legend>
<div data-row-span="1">
<div data-field-span="1">
<label></label>
<label><input type="checkbox"> I/We confirm having read and understood the account rules of The Banking Corporation Limited ('the Bank'), and hereby agree to be bound by the terms and conditions and amendments governing the account(s) issued by the Bank from time-to-time.</label>
</div>
</div>
</fieldset>
</form>
<br><br><br><br><br>
</body>
</html>