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clientInfo.html
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clientInfo.html
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
<!-- Framework CSS -->
<link rel="stylesheet" href="css/maincss.css" type="text/css" media="screen, projection" />
<link rel="stylesheet" href="css/screen.css" type="text/css" media="screen, projection" />
<link rel="stylesheet" href="css/print.css" type="text/css" media="print" />
<!--[if lt IE 8]><link rel="stylesheet" href="css/ie.css" type="text/css" media="screen, projection" /><![endif]-->
</head>
<body>
<!-- Container Begins-->
<div class="container">
<!--Header-->
<div class="topAlign append-1"><a href="yourSettings.html">Your Settings</a> | <a href="index.html">Log Out</a> </div>
<div><span class="logo"></span><span class="menu"><a href="home.html" class="tablightorange">Home</a><a href="clientsAcc.html" class="taborange">Clients and Accounts</a><a href="reports.html" class="tablightorange">Reports</a><a href="admin.html" class="tablightorange">Admin</a></span></div>
<div class="clear"></div>
<div class="orangeline"> </div>
<!-- Main Content Begins-->
<div class="content marginAuto">
<div class="borders span-22">
<div class="borderbtm span-22">
<p class="span-6 completeIMG silverheading">Select Group/Branch office</p>
<p class="span-5 arrowIMG orangeheading ">Client Information</p>
<p class="span-4 arrowIMG1 orangeheading ">MFI Information</p>
<p class="span-3 arrowIMG1 orangeheading last">Review & Submit</p>
</div>
<div class="subcontent ">
<form method="" action="" name="formname">
<p class="font15"><span class="fontBold">Create new Client</span> -- <span class="orangeheading">Enter personal information</span></p>
<div>Complete the fields below. Then click Continue. Click Cancel to return to Clients & Accounts without submitting information </div>
<div><span class="red">* </span>Fields marked with an asterisk are required. </div>
<p class="error" id="error1">Errors..............</p>
<p><span class="fontBold">Branch Office selected:</span><span> our office</span></p>
<p class="fontBold">Personal information</p>
<div class="prepend-1 span-22 last">
<div class="span-21 "><span class="span-4 rightAlign"><span class="red">* </span>Salutation</span> :
<select name="Salutation">
<option >--Select--</option>
<option >Ms</option>
<option >Sir</option>
<option >Mrs</option>
<option >Mr</option>
<option >sri</option>
<option >frank</option>
<option >Rev.</option>
<option >Madam</option>
<option >Cdr.</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign"><span class="red">* </span>First Name</span> :
<input id="fname" name="fname" type="text" />
</div>
<div class="span-21 "><span class="span-4 rightAlign">Middle Name</span> :
<input id="mname" name="mname" type="text" />
</div>
<div class="span-21 "><span class="span-4 rightAlign">Second Last Name</span> :
<input id="slname" name="slname" type="text" />
</div>
<div class="span-21 "><span class="span-4 rightAlign"><span class="red">* </span>Last Name</span> :
<input id="lname" name="lname" type="text" />
</div>
<div class="span-21 "><span class="span-4 rightAlign">Government Id</span> :
<input id="govtId" name="govtId" type="text" />
</div>
<div class="span-10 last"><span class="span-4 rightAlign"><span class="red">* </span>Date Of Birth</span> :
<input type="text" name="date" maxlength="2" size="1" /> DD <input type="text" name="month" maxlength="2" size="1" /> MM <input type="text" name="year" maxlength="4" size="3" /> YYYY
</div>
<div class="span-21 "><span class="span-4 rightAlign"><span class="red">* </span>Gender</span> :
<select name="Gender">
<option >--Select--</option>
<option >Male</option>
<option >Female</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Marital Status</span> :
<select name="MaritalStatus">
<option >--Select--</option>
<option >Single</option>
<option >Married</option>
<option >Divorced</option>
<option >Widowed</option>
<option >Seperated</option>
<option >Mrs</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Number Of Children</span> :
<input type="text" />
</div>
<div class="span-21 "><span class="span-4 rightAlign">Citizenship</span> :
<select name="Citizenship">
<option >--Select--</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Ethnicity</span> :
<select name="Ethnicity">
<option >--Select--</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Education Level</span> :
<select name="EducationLevel">
<option >--Select--</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Activities</span> :
<select name="Activities">
<option >--Select--</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign"><span class="red">*</span>Poverty Status</span> :
<select name="PovertyStatus">
<option >Poor</option>
<option >Very poor</option>
<option >Non-poor</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Handicapped</span> :
<select name="Handicapped">
<option >--Select--</option>
</select>
</div>
<div class="span-21 "><span class="span-4 rightAlign">Photograph</span> :
<input type="file" name="choose" value="Choose File" />
</div>
<div class="span-21 "><span class="span-4 rightAlign"><span class="red">*</span>Spouse/Father Name :</span>
<span class="span-4">Relationship<select name="Spouse/Father">
<option >--Select--</option>
<option >Spouse</option>
<option >Father</option>
</select></span>
<span class="span-3 "><span class="red">*</span>First Name
<input type="text" size="12" /></span>
<span class="span-3 ">Middle Name
<input type="text" size="12" /></span>
<span class="span-3 ">Second Last Name
<input type="text" size="12" /></span>
<span class="span-3 "><span class="red">*</span>Last Name
<input type="text" size="12" /></span>
</div>
</div>
<p class="fontBold">Address</p>
<div class="prepend-1 span-21 last">
<div class="span-20 "><span class="span-4 rightAlign">Address1</span> :
<input id="address1" name="address1" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">Address2</span> :
<input id="address2" name="address2" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">Address3</span> :
<input id="address3" name="address3" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">City/District</span> :
<input id="cityDistrict" name="cityDistrict" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">State</span> :
<input id="state" name="state" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">Country</span> :
<input id="country" name="country" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">Postal Code</span> :
<input id="postalCode" name="postalCode" type="text" />
</div>
<div class="span-20 "><span class="span-4 rightAlign">Telephone</span> :
<input id="telephone" name="telephone" type="text" />
</div>
</div>
<div class="clear"> </div>
<hr />
<div class="prepend-8">
<input class="buttn" type="button" name="continue" value="Continue" onclick="location.href='clientMFI.html'" />
<input class="buttn2" type="button" name="cancel" value="Cancel" onclick="location.href='clientsAcc.html'"/>
</div>
<div class="clear"> </div>
</form>
</div><!--Subcontent Ends-->
</div>
</div>
<!--Main Content Ends-->
<div class="footer"> </div>
</div>
<!--Container Ends-->
</body>
</html>