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verification.graciousphils.com
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Edit File: request.php
<!doctype html> <?php include 'connection.php'; if(isset($_SESSION['user']) && $_SESSION['position'] == 4){ ?> <html lang="en"> <head> <!-- Required meta tags --> <meta charset="utf-8"> <!-- Bootstrap CSS --> <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.1/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-+0n0xVW2eSR5OomGNYDnhzAbDsOXxcvSN1TPprVMTNDbiYZCxYbOOl7+AMvyTG2x" crossorigin="anonymous"> <link rel="stylesheet" type="text/css" href="styles.css"> <title>VERIFICATION+</title> <style type="text/css"> .requestModal input, .requestModal textarea{ background-color: transparent !important; border:0px transparent !important; } .requestModal label{ font-weight: bold; } </style> <script src = "script.js"></script> <script> function confirmSubmission() { return confirm(" Are you sure you want to submit this Verification request? Please review all the details before confirming."); } </script> </head> <body> <?php include 'navBar.php'; ?> <div class="container-fluid mt-2 mb-2"> <div class="row"> <div class="col-lg-6 offset-lg-3"> <div class="card bg-dark"> <h5 class="card-header text-white">VERIFICATION+ FORM</h5> <div class="card-body"> <form method="POST" action="requestAction.php" onsubmit="return confirmSubmission()"> <div class="row"> <div class="col-lg-4 mb-2"> <div class="form-floating"> <select name="clientType" class="form-select" id="floatingSalesOffice" onchange="myFunction(this.value)" required> <option disabled selected value> -- select an option -- </option> <option value = "NEW">NEW</option> <option value = "RENEW">RENEW</option> </select> <label for="floatingSalesOffice">Client Type*</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingClientNumber" name="clientNumber" placeholder="" onkeypress="return isNumber(event);" readonly> <label for="floatingClientNumber">Existing Client I.D No.*</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <select name="salesOffice" class="form-select" id="floatingSalesOffice" required> <option disabled selected value> -- select an option -- </option> <?php $st = $pdo->prepare("select * from tblsalesoffices"); $st->execute(); while ($data = $st->fetch()) { ?> <option value="<?php echo $data['salesOffice']; ?>"><?php echo $data['salesOffice']?></option> <?php } ?> </select> <label for="floatingSalesOffice">Sales Office*</label> </div> </div> </div> <div class="row"> <div class="col-lg-4 mb-2"> <div class="form-floating"> <select name="pensionProvider" class="form-select" id="floatingPensionProvider" required> <option disabled selected value> -- select an option -- </option> <?php $st = $pdo->prepare("select * from tblpensprovider"); $st->execute(); while ($data = $st->fetch()) { ?> <option value="<?php echo $data['pensProvider']; ?>"><?php echo $data['pensProvider']?></option> <?php } ?> </select> <label for="floatingPensionProvider">Pension Provider*</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="text" name="pensionAccountNumber" minlength="1" maxlength="14" class="form-control" id="floatingPensionAccountNumber" placeholder="" onkeypress="return isNumber(event);" value ="To Follow" required> <label for="floatingPensionAccountNumber">SSS/GSIS No.</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <select name="pensionType" class="form-select" id="floatingPensionType" required> <option disabled selected value> -- select an option -- </option> <?php $st = $pdo->prepare("select * from tblpenstype"); $st->execute(); while ($data = $st->fetch()) { ?> <option value="<?php echo $data['pensType']; ?>"><?php echo $data['pensType']?></option> <?php } ?> </select> <label for="floatingPensionType">Pension Type*</label> </div> </div> <!--<div class="col-lg-2 mb-2"> <div class="form-floating"> <select name="agentName" class="form-select" id="floatingAgentName" required> <option disabled selected value> -- select an option -- </option> <?php $st = $pdo->prepare("select * from tblagents"); $st->execute(); while ($data = $st->fetch()) { ?> <option value="<?php echo $data['agentName']; ?>"><?php echo $data['agentCode'] . "-" . $data['agentName']; ?></option> <?php } ?> </select> <label for="floatingAgentName">Agent Name/ Code</label> </div> </div>--> </div> <div class="row"> <div class="col-lg-12"> <h6 class="text-white">Member's Name</h6> </div> </div> <div class="row"> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingMemberLastName" name="memberLastName" placeholder="" required> <label for="floatingMemberName"><em>Last Name*</em></label> </div> </div> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingMemberFirstName" name="memberFirstName" placeholder="" required> <label for="floatingMemberName"><em>First Name*</em></label> </div> </div> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingMemberMiddleName" name="memberMiddleName" placeholder=""> <label for="floatingMemberName"><em>Middle Name</em></label> </div> </div> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="date" class="form-control" id="floatingMemberBirthday" name="memberBirthday" placeholder="" required> <label for="floatingMemberBirthday">Birthdate*</label> </div> </div> </div> <div class="row"> <div class="col-lg-12 mb-2"> <input type="checkbox" class="form-check-input" id="copyCheckbox"> <label class="form-check-label text-white" for="copyCheckbox"> Pensioner's Name is same as Member's Name </label> </div> </div> <div class="row"> <div class="col-lg-12"> <h6 class="text-white">Pensioner's Name*</h6> </div> </div> <div class="row"> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingPensionerLastName" name="pensionerLastName" placeholder="" required> <label for="floatingPensionerName"><em>Last Name*</em></label> </div> </div> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingPensionerFirstName" name="pensionerFirstName" placeholder="" required> <label for="floatingPensionerName"><em>First Name*</em></label> </div> </div> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingPensionerMiddleName" name="pensionerMiddleName" placeholder=""> <label for="floatingPensionerName"><em>Middle Name</em></label> </div> </div> <div class="col-lg-3 mb-2"> <div class="form-floating"> <input type="date" class="form-control" id="floatingPensionerBirthday" name="pensionerBirthday" placeholder="" required> <label for="floatingPensionerBirthday">Birthdate*</label> </div> </div> </div> <div class="row"> <div class="col-lg-12 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingAddress" name="address" placeholder="" required> <label for="floatingAddress">Address*</label> </div> </div> </div> <div class="row"> <div class="col-lg-4 mb-2"> <div class="form-floating"> <select name="investigationType" class="form-select" id="floatingInvestigationType" required> <option disabled selected value> -- select an option -- </option> <?php $st = $pdo->prepare("select * from tblinvtype"); $st->execute(); while ($data = $st->fetch()) { ?> <option value="<?php echo $data['invType_code']; ?>"><?php echo $data['invType_name']?></option> <?php } ?> </select> <label for="floatingInvestigationType">Investigation Type*</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="text" class="form-control" maxlength="12" id="floatingContactNumber" name="contactNumber" placeholder="" onkeypress="return isNumber(event);" required> <label for="floatingContactNumber">Contact Number*</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingSmAccount" name="smAccount" placeholder="" value ="To Follow" required> <label for="floatingSmAccount">Social Media Account</label> </div> </div> </div> <div class="row"> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="text" class="form-control" id="floatingBankName" name="bankName" placeholder="" required> <label for="floatingBankName">Bank Name*</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="text" minlength="12" maxlength="14" class="form-control" id="floatingBankAccountNumber" name="bankAccountNumber" placeholder="" onkeypress="return isNumber(event);" value ="To Follow" required> <label for="floatingBankAccountNumber">Bank Acct. No.</label> </div> </div> <div class="col-lg-4 mb-2"> <div class="form-floating"> <input type="number" step="any" id="floatingPensionAmount" min="0" class="form-control" name="pensionAmount" value="0.0" required> <label for="floatingPensionAmount">Pension Amount*</label> </div> </div> </div> <div class="row mb-2"> <div class="col-lg-12 mb-2"> <div class="form-floating"> <textarea class="form-control" name="remarks" id="floatingRemarks" style="resize: none;height:100px;" placeholder="All To Follow please state reason here..."></textarea> <label for="floatingRemarks">Remarks</label> </div> </div> </div> <div class="row"> <div class="col-lg-6 mb-2"> <a href="myRequests.php" class="btn btn-primary" style="width: 100%;">Back</a> </div> <div class="col-lg-6"> <button type="submit" class="btn btn-success" name="btnRequest" style="width: 100%;">Request Verification</button> </div> </div> </form> </div> </div> </div> </div> </div> <!-- Optional JavaScript; choose one of the two! --> <!-- Option 1: Bootstrap Bundle with Popper --> <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.0.1/dist/js/bootstrap.bundle.min.js" integrity="sha384-gtEjrD/SeCtmISkJkNUaaKMoLD0//ElJ19smozuHV6z3Iehds+3Ulb9Bn9Plx0x4" crossorigin="anonymous"></script> <!-- Option 2: Separate Popper and Bootstrap JS --> <!-- <script src="https://cdn.jsdelivr.net/npm/@popperjs/core@2.9.2/dist/umd/popper.min.js" integrity="sha384-IQsoLXl5PILFhosVNubq5LC7Qb9DXgDA9i+tQ8Zj3iwWAwPtgFTxbJ8NT4GN1R8p" crossorigin="anonymous"></script> <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.0.1/dist/js/bootstrap.min.js" integrity="sha384-Atwg2Pkwv9vp0ygtn1JAojH0nYbwNJLPhwyoVbhoPwBhjQPR5VtM2+xf0Uwh9KtT" crossorigin="anonymous"></script> --> <!--<script type="text/javascript"> const memberName = document.getElementById('floatingMemberName'); const memberBirthday = document.getElementById('floatingMemberBirthday'); const copyCheckbox = document.getElementById('copyCheckbox'); const businessAddressPanel = document.getElementById('businessAddress'); const pensionerName = document.getElementById('floatingPensionerName'); const pensionerBirthday = document.getElementById('floatingPensionerBirthday'); // Add event listener to the checkbox copyCheckbox.addEventListener('change', function() { // If checkbox is checked, copy the value from source input and select to target input and select if (this.checked) { //Copy Textboxes pensionerName.value = memberName.value; pensionerBirthday.value = memberBirthday.value; } else { pensionerName.value = ''; pensionerBirthday.value = ''; } }); </script>--> <script type="text/javascript"> const memberLastName = document.getElementById('floatingMemberLastName'); const memberFirstName = document.getElementById('floatingMemberFirstName'); const memberMiddleName = document.getElementById('floatingMemberMiddleName'); const memberBirthday = document.getElementById('floatingMemberBirthday'); const copyCheckbox = document.getElementById('copyCheckbox'); const pensionerLastName = document.getElementById('floatingPensionerLastName'); const pensionerFirstName = document.getElementById('floatingPensionerFirstName'); const pensionerMiddleName = document.getElementById('floatingPensionerMiddleName'); const pensionerBirthday = document.getElementById('floatingPensionerBirthday'); // Add event listener to the checkbox copyCheckbox.addEventListener('change', function() { // If checkbox is checked, copy the value from source input and select to target input and select if (this.checked) { //Copy Textboxes pensionerLastName.value = memberLastName.value; pensionerFirstName.value = memberFirstName.value; pensionerMiddleName.value = memberMiddleName.value; pensionerBirthday.value = memberBirthday.value; } else { pensionerLastName.value = ''; pensionerFirstName.value = ''; pensionerMiddleName.value = ''; pensionerBirthday.value = ''; } }); </script> </body> </html> <?php } else{ session_destroy(); header("location:index.php"); } ?>
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