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mail@pastecode.io avatarunknown
html
a month ago
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<form method="post" id="form3Aedit" class="needs-validation" novalidate>
        
                    <input type="hidden" name="id3a" id="id3a" >

                    <div class="row mt-3">
                        <div class="col-lg-4">
                            <div class="mb-1 position-relative" id="3adateInputpicker">
                                <label class="form-label">Date</label>
                                <input type="text" data-date-autoclose="true" class="form-control" id="3adate"
                                    name="3adate" data-provide="datepicker" data-date-format="MM dd, yyyy"
                                    data-date-container="#3adateInputpicker" required>
                            </div>


                        </div>
                        <div class="col-lg-4">
                            <div class="mb-1">
                                <label for="3apagenumedit" class="form-label">Page Number</label>
                                <input type="number" name="3apagenumedit" id="3apagenumedit" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-4">
                            <div class="mb-1">
                                <label for="3abooknumedit" class="form-label">Book Number</label>
                                <input type="number" name="3abooknumedit" id="3abooknumedit" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3agroomnameedit" class="form-label">Groom Name</label>
                                <input type="text" name="3agroomnameedit" id="3agroomnameedit" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3abridenameedit" class="form-label">Bride Name</label>
                                <input type="text" name="3abridenameedit" id="3abridenameedit" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3agroomageedit" class="form-label">Groom Age</label>
                                <input type="text" name="3agroomageedit" id="3agroomageedit" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3abrideageedit" class="form-label">Bride Age</label>
                                <input type="text" name="3abrideageedit" id="3abrideageedit" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3agroomcitizenedit" class="form-label">Groom Citizenship</label>
                                <input type="text" name="3agroomcitizenedit" id="3agroomcitizenedit" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Bride Citizenship</label>
                                <input type="text" name="3abridecitizen" id="3abridecitizen" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Groom Civil Status</label>
                                <input type="text" name="3agroomcivil" id="3agroomcivil" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Bride Civil Status</label>
                                <input type="text" name="3abridecivil" id="3abridecivil" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Groom's Mother</label>
                                <input type="text" name="3agroommother" id="3agroommother" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Bride's Mother</label>
                                <input type="text" name="3abridemother" id="3abridemother" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Groom's Father</label>
                                <input type="text" name="3agroomfather" id="3agroomfather" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Bride's Father</label>
                                <input type="text" name="3abridefather" id="3abridefather" class="form-control">
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Registry Number</label>
                                <input type="text" name="3aregistrynum" id="3aregistrynum" class="form-control">
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1 position-relative" id="3adateInputpickerreg">
                                <label class="form-label">Date of Registration</label>
                                <input type="text" data-date-autoclose="true" class="form-control" id="3adatereg"
                                    name="3adatereg" data-provide="datepicker" data-date-format="MM dd, yyyy"
                                    data-date-container="#3adateInputpickerreg" required>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1 position-relative" id="3adateInputpickermar">
                                <label class="form-label">Date of Marriage</label>
                                <input type="text" data-date-autoclose="true" class="form-control" id="3adatemarriage"
                                    name="3adatemarriage" data-provide="datepicker" data-date-format="MM dd, yyyy"
                                    data-date-container="#3adateInputpickermar" required>
                            </div>


                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="simpleinput" class="form-label">Place of Marriage</label>
                                <input type="text" name="3aplacemarriage" id="3aplacemarriage" class="form-control">
                            </div>
                        </div>
                    </div>
                    <!-- new -->

                    <div class="row justify-content-center">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3aissued" class="form-label">Issued To</label>
                                <input type="text" id="3aissued" name="3aissued" onchange="handleChange()"
                                    class="form-control capslockview" required>
                            </div>
                        </div>
                    </div>
                    <div class="row justify-content-center">
                        <div class="col-md-10">
                            <div class="mb-3">
                                <label for="3aremarks" class="form-label">Remarks</label>
                                <textarea class="form-control" id="3aremarks" name="3aremarks" rows="3"></textarea>
                            </div>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-lg-4">
                            <div class="mb-1">
                                <label for="amountPaidInput3a" class="form-label">Amount Paid</label>
                                <input type="text" id="amountPaidInput3a" name="amountPaidInput3a" class="form-control"
                                    required>
                            </div>
                        </div>

                        <div class="col-lg-4">
                            <div class="mb-1">
                                <label for="3aorNumber" class="form-label">O.R. Number</label>
                                <input type="text" id="3aorNumber" name="3aorNumber" class="form-control" required>
                            </div>
                        </div>
                        <div class="col-lg-4">
                            <div class="mb-1 position-relative" id="3adatePaidInputpicker">
                                <label class="form-label">Date Paid</label>
                                <input type="text" data-date-autoclose="true" class="form-control" id="3adatePaid"
                                    name="3adatePaid" data-provide="datepicker" data-date-format="MM dd, yyyy"
                                    data-date-container="#3adatePaidInputpicker" required>
                            </div>

                        </div>
                    </div>

                    <div class="row">
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3averify" class="form-label">Verified By</label>
                                <input type="text" id="3averify" name="3averify"
                                    value="<?php echo $userData['verified'];  ?>"
                                    oninput="this.value = this.value.toUpperCase()" class="form-control" required>
                            </div>
                        </div>
                        <div class="col-lg-6">
                            <div class="mb-1">
                                <label for="3amcr" class="form-label">Municipal Civil Registrar</label>
                                <input type="text" id="3amcr" name="3amcr"
                                    oninput="this.value = this.value.toUpperCase()" value="ISMAEL D. MALICDEM, JR."
                                    class="form-control" required>
                            </div>
                        </div>

                    </div>
                    <div class="row">
                        <div class="col-lg-6">

                            <div class="mb-1">
                                <label for="3adesignation" class="form-label">Designation</label>
                                <div class="dropdown">
                                    <select id="3adesignation" name="3adesignation" class="form-select" required>
                                        <option value="" selected disabled></option>
                                        <option value="Administrative Aide I" <?php
                                            if($userData['designation']=="Administrative Aide I" ) { echo "selected" ; }
                                            ?>
                                            >Administrative Aide I</option>
                                        <option value="Administrative Aide II" <?php
                                            if($userData['designation']=="Administrative Aide II" ) { echo "selected" ;
                                            } ?>
                                            >Administrative Aide II</option>
                                        <option value="Administrative Aide III" <?php
                                            if($userData['designation']=="Administrative Aide III" ) { echo "selected" ;
                                            } ?>
                                            >Administrative Aide III</option>
                                        <option value="Administrative Assistant I" <?php
                                            if($userData['designation']=="Administrative Assistant I" ) {
                                            echo "selected" ; } ?>>Administrative Assistant I</option>
                                        <option value="Others" <?php if($userData['designation']=="Others" ) {
                                            echo "selected" ; } ?>>Others</option>
                                    </select>
                                    <div class="row justify-content-center">
                                        <div class="col-md-10">
                                            <input type="text" value="<?php echo $userData['others'];  ?>"
                                                class="form-control" id="3acustomInput" name="3acustomInput"
                                                placeholder="Position" style="display: none; margin-top: 5px" />
                                        </div>
                                    </div>

                                </div>

                            </div>
                        </div>

                    </div>