DOMICILE HTML
Uploaded by
ravikishan91173DOMICILE HTML
Uploaded by
ravikishan91173<html xmlns="http://www.w3.
org/1999/xhtml"><head id="Head1"><meta name="viewport"
content="width=device-width, initial-scale=1"><title>
निवास प्रमाण-पत्र हेतु आवेदन-पत्र
</title><link rel="stylesheet" href="../../../Css/BS/bootstrap.min.css">
<script src="../../../Css/BS/jquery.min.js"></script>
<script src="../../../Css/BS/bootstrap.min.js"></script>
<link rel="stylesheet" href="../../../Css/BS/jquery-ui.css">
<script src="../../../Css/BS/jquery-ui.js"></script>
<script type="text/javascript">
window.onload = window.history.forward(0);
</script>
<script type="text/javascript">
//$(document).ready(function () {
// $('#Name').popover();
//});
</script>
<link rel="stylesheet" href="../../../css/jquery.autocomplete.css" type="text/css">
<script type="text/javascript" src="../../../js/jquery.autocomplete.js"></script>
<link rel="stylesheet" href="../../../Css/BS/jquery.timepicker.min.css">
<script src="../../../Css/BS/jquery.timepicker.min.js"></script>
<link href="../../../Css/BS/bootstrapValidator.min.css" rel="stylesheet" type="text/css">
<script src="../../../Css/BS/bootstrapValidator.min.js" type="text/javascript"></script>
<script src="certDomicileApp.js" type="text/javascript"></script>
<script type="text/javascript">
$(function () {
var d = new Date();
var n = d.getFullYear() - 0;
$("#db").datepicker({
dateFormat: 'dd/mm/yy',
changeMonth: true,
changeYear: true,
yearRange: '1916:' + n,
onSelect: function (dateText, inst) {
$('#contactForm').bootstrapValidator('revalidateField', 'db');
}).keydown(false);;
});
</script>
<style>
div.row
margin-right: 20px;
margin-left: 10px;
.popover{
width:200px;
height:50px;
.help-block {
color:red !important;
font-size:medium;
</style>
<link href="../../../App_Themes/ThemeText/cssClassFile.css" type="text/css" rel="stylesheet"></head>
<body style="background-color:#f5f6eb;">
<div class="container" style="width:85%;">
<div class="panel panel-default" style="background-color: #fdfdfd;">
<div class="panel-heading" style="font-family: Arial Unicode MS; text-align: center;background-
color:#ff9933; color: White; height: 60px; padding: 1px;">
<h3>
<strong>निवास प्रमाण-पत्र हेतु आवेदन-पत्र</strong>
</h3>
</div>
<div class="panel-body">
<form name="contactForm" method="post" action="./CertDomicil_upd.aspx" id="contactForm"
class="form-horizontal bv-form" enctype="multipart/form-data" novalidate="novalidate"><button
type="submit" class="bv-hidden-submit" style="display: none; width: 0px; height: 0px;"></button>
<div>
<input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="">
<input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="">
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</div>
<div class="row">
<div class="form-group">
<div class="col-md-4">
<label>
1. सॆवा का प्रकार :</label>
</div>
<div class="col-md-2">
<table id="RadioButtonList2" border="0" style="width: 180px;">
<tbody><tr>
<td><input id="RadioButtonList2_0" type="radio" name="RadioButtonList2"
value="RURAL" checked="checked"><label
for="RadioButtonList2_0"> ग्रामीण</label></td><td><input id="RadioButtonList2_1"
type="radio" name="RadioButtonList2" value="URBAN"
onclick="javascript:setTimeout('__doPostBack(\'RadioButtonList2$1\',\'\')', 0)"><label
for="RadioButtonList2_1"> नगरीय</label></td>
</tr>
</tbody></table>
</div>
<div class="col-md-3">
<label>
आवेदन संख्या :</label><span id="application_no">************760</span>
</div>
<div class="col-md-3">
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4 ">
<label>
2.1. प्रार्थी का नाम (हिंदी में)* :</label>
</div>
<div class="col-md-8" style="padding-left: 0px; padding-right: 0px;">
<div class="col-md-12">
<input name="Name" type="text" value="गुंजा" maxlength="50" id="Name" class="form-
control" placeholder="प्रार्थी का नाम हिंदी में भरे/Description (max 50 Chars)" data-
placement="top" data-toggle="popover" data-trigger="hover" data-content=" प्रार्थी का नाम भरे"
style="border-width:1px;border-style:solid;" data-bv-field="Name"><i class="form-control-feedback"
data-bv-icon-for="Name" style="display: none;"></i>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4 ">
<label>
2.2. प्रार्थी का नाम (अंग्रेजी में)* :</label>
</div>
<div class="col-md-8" style="padding-left: 0px; padding-right: 0px;">
<div class="col-md-12">
<input name="NameEng" type="text" value="GUNJA " maxlength="50" id="NameEng"
class="form-control" placeholder="प्रार्थी का नाम अंग्रेजी में भरे/Description (max 50 Chars)"
style="border-width:1px;border-style:solid;" data-bv-field="NameEng"><i class="form-control-feedback"
data-bv-icon-for="NameEng" style="display: none;"></i>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-2">
<label>
3. पिता/पति/संरक्षक का नाम* :</label>
</div>
<div class="col-md-2">
<table id="RadioButtonList1" border="0">
<tbody><tr>
<td><input id="RadioButtonList1_0" type="radio" name="RadioButtonList1" value="0"
checked="checked"><label for="RadioButtonList1_0"> पिता </label></td><td><input
id="RadioButtonList1_1" type="radio" name="RadioButtonList1" value="1"><label
for="RadioButtonList1_1"> पति </label></td><td><input id="RadioButtonList1_2"
type="radio" name="RadioButtonList1" value="2"><label
for="RadioButtonList1_2"> संरक्षक</label></td>
</tr>
</tbody></table>
</div>
<div class="col-md-8" style="padding-left: 0px; padding-right: 0px;">
<div class="col-md-12">
<input name="fat_husb" type="text" value="राजकुमार" maxlength="50" id="fat_husb"
class="form-control" placeholder="प्रार्थी के पिता/पति/संरक्षक का नाम भरे/Description (max 50
chars)" style="border-width:1px;border-style:solid;" data-bv-field="fat_husb"><i class="form-control-
feedback" data-bv-icon-for="fat_husb" style="display: none;"></i>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>
4. माता का नाम‌* :</label>
</div>
<div class="col-md-8" style="padding-left: 0px; padding-right: 0px;">
<div class="col-md-12">
<input name="mothername" type="text" value="पुनीता देवी" maxlength="50"
id="mothername" class="form-control" placeholder="माता का नाम‌ भरे/Description (max 50
chars)" style="border-width:1px;border-style:solid;" data-bv-field="mothername"><i class="form-
control-feedback" data-bv-icon-for="mothername" style="display: none;"></i>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12" style="text-align: left;">
<h5>
<label>
5. वर्तमान पता (मकान नम्बर,मौहल्ला/पोस्ट,ग्राम मे एक पद अनिवार्य
है)</label><span id="Aerror" style="color:Red;">*</span>
</h5>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>
5 (क). मकान नम्बर :</label>
</div>
<div class="col-md-3">
<input name="Address" type="text" maxlength="10" id="Address" class="form-control"
placeholder="Max 10 Chars" style="border-width:1px;border-style:solid;" data-bv-field="Address"><i
class="form-control-feedback" data-bv-icon-for="Address" style="display: none;"></i>
</div>
<div class="col-md-2">
<label>
5 (ख). मौहल्ला/पोस्ट :</label>
</div>
<div class="col-md-3">
<input name="pmohalla" type="text" value="सिन्दुरिया" maxlength="100"
id="pmohalla" class="form-control" placeholder="मौहल्ला/पोस्ट भरे/Description (Max 100 Char)"
style="border-width:1px;border-style:solid;" data-bv-field="pmohalla"><i class="form-control-feedback"
data-bv-icon-for="pmohalla" style="display: none;"></i>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-4">
<label>
5 (ग). जिला *:</label>
</div>
<div class="col-md-3">
<select name="district" onchange="javascript:setTimeout('__doPostBack(\'district\',\'\')',
0)" id="district" class="form-control">
<option selected="selected" value="057">महाराज गंज</option>
</select>
</div>
<div class="col-md-2">
<label>
5 (घ). तहसील *:</label>
</div>
<div class="col-md-3">
<select name="tehsil" onchange="javascript:setTimeout('__doPostBack(\'tehsil\',\'\')', 0)"
id="tehsil" class="form-control">
<option selected="selected" value="0004">महाराजगंज</option>
<option value="0001">नौतन्वा</option>
<option value="0002">निचलौल</option>
<option value="0003">फरेन्दा</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-4">
<label>
5 (ङ). थाना *:</label>
</div>
<div class="col-md-3">
<select name="thana" id="thana" class="form-control">
<option value="0020">कोठीभार</option>
<option selected="selected" value="0001">कोतवाली</option>
<option value="0002">घुघुली</option>
<option value="0005">चौक आंशिक</option>
<option value="0004">पनियरा</option>
<option value="0022">महिला थाना</option>
<option value="0003">श्‍यामदेउरवां</option>
</select>
</div>
<div id="GramRow" class="col-md-5">
<div class="col-md-5" style="padding-left:0px;padding-right:0px;">
<label>
5 (ङ). ग्राम *:</label>
</div>
<div class="col-md-7" style="padding-left:5px;padding-right:0px;">
<select name="ppgram" id="ppgram" class="form-control">
<option value="pgc">--ग्राम चुनें--</option>
<option value="07752400">अगया</option>
<option value="07775600">अडवडहवा</option>
<option value="07684301">अन्ध्या</option>
<option value="07746000">अमरूतिया</option>
<option value="07778400">अमवा</option>
<option value="07767200">अमसहा</option>
<option value="07764100">अमोढा</option>
<option value="07755800">अरनहवा</option>
<option value="07744300">अराजी जगपुर</option>
<option value="07748300">अहमद पुर</option>
<option value="07764800">अहिरौली</option>
<option value="07760700">अहिरौली</option>
<option value="07775900">अहिरौली</option>
<option value="07787300">अहिरौली</option>
<option value="07788400">इमिलिया</option>
<option value="07751900">इमिलीया</option>
<option value="07774000">इलहाबाद</option>
<option value="07781400">उटी खास</option>
<option value="07771200">उस्‍का</option>
<option value="07754200">ओवरी</option>
<option value="07775700">औरहिया</option>
<option value="07771800">औसानी</option>
<option value="07774800">कुआचाप</option>
<option value="07757600">कुईया कंचनपुर</option>
<option value="07753400">कुईया महेशपुर</option>
<option value="07745400">कटहरा खास</option>
<option value="07779000">कुडवा ऊर्फ मुरकटिया</option>
<option value="07782300">कतरारी</option>
<option value="07770000">कनैला</option>
<option value="07771500">कमता बुजुर्ग</option>
<option value="07771600">कमताखुर्द</option>
<option value="07753500">कमहरिया कला</option>
<option value="07784400">कमहरिया खुर्द</option>
<option value="07773900">कमासीन खुर्द</option>
<option value="07773800">कमासीन बुजुर्ग</option>
<option value="07748400">कुर्थिया</option>
<option value="07746100">करमहा</option>
<option value="07762100">करमही</option>
<option value="07754600">करौता</option>
<option value="07787600">करौता नेबुइया</option>
<option value="07786800">कल्‍यान चक</option>
<option value="07754900">केवलापुर कला</option>
<option value="07744500">केवलापुर खुर्द</option>
<option value="07755900">कसमरिया</option>
<option value="07785300">कुस्‍महा</option>
<option value="07751800">किरीत पिपरा</option>
<option value="07749300">कॉंध</option>
<option value="07766400">कोटवा</option>
<option value="07785500">कोटवा</option>
<option value="07751200">कोटामुकुन्‍दपुर</option>
<option value="07752200">कोदइला</option>
<option value="07753200">कोल्‍हुआ</option>
<option value="07770900">खैंचा</option>
<option value="07770700">खजुरिया</option>
<option value="07756100">खजुरिया</option>
<option value="07750300">खुटहा</option>
<option value="07768500">खुन्‍ता मैदान</option>
<option value="07750900">खेमपिपरा</option>
<option value="07767900">खानपुर</option>
<option value="07761100">गगराई</option>
<option value="07767000">गुडधोवा</option>
<option value="07762500">गनेशपुर</option>
<option value="07773600">गेहुअना</option>
<option value="07776300">गांगी</option>
<option value="07774500">गिरगिटिया</option>
<option value="07751700">गीदहा</option>
<option value="07782200">गोधवल</option>
<option value="07777600">गोनहा</option>
<option value="07759600">गोपाल</option>
<option value="07761600">गोपाला</option>
<option value="07749200">गोपी</option>
<option value="07761400">गोविन्‍दपुर</option>
<option value="07746900">गौनरिया बाबू</option>
<option value="07755000">गौनरिया राजा</option>
<option value="07764700">घघरूआ खडेसर</option>
<option value="07765800">घुघली बुजुर्ग</option>
<option value="07766100">चूअनी</option>
<option value="07750000">चक बेलबरा</option>
<option value="07772400">चन्‍दन चकी</option>
<option value="07765700">चैनपुर</option>
<option value="07753700">चैनपुर</option>
<option value="07771100">चुनवटीया</option>
<option value="07754100">चौक</option>
<option value="07787800">चौपरिया</option>
<option value="07747400">चौपरीया</option>
<option value="07767800">चौमुखा</option>
<option value="07784500">छपिया</option>
<option value="07787700">छातिराम</option>
<option value="07768800">ज 0 ज 0 ऊर्फ सूचितपुर</option>
<option value="07769900">ज 0 ज 0 ऊर्फ अन्‍नतपुर</option>
<option value="07766900">जगदीषपुर</option>
<option value="07744400">जगपुर ऊर्फ सलामतगढ्</option>
<option value="07769700">जगंल जरलहा ऊर्फ आराजी</option>
<option value="07769600">जंगल जरलहा ऊर्फ कनवा</option>
<option value="07769800">जंगल जरलहा ऊर्फ कनवा प्रथम</option>
<option value="07768700">जंगल जहरला उर्फ बडहरा</option>
<option value="07749000">जंगल दुदई ऊर्फ चेहरी</option>
<option value="07748200">जंगल फरदंज अली</option>
<option value="07774700">जंगल बडहरा</option>
<option value="07772100">जंगल बाकी टुकडा नं0 14</option>
<option value="07779700">जगंल वाकी तुकरा नं 8</option>
<option value="07785800">जमुनिया</option>
<option value="07769300">जरदी</option>
<option value="07773200">जरार</option>
<option value="07764200">जोगिया</option>
<option value="07754000">टेगरहना</option>
<option value="07766600">टेढवा</option>
<option value="07762300">टोला किशनुपुर</option>
<option value="07771900">डमरीगिरी</option>
<option value="07753000">डुमार भर</option>
<option value="07786200">डेरवां</option>
<option value="07776900">डिगुरी</option>
<option value="07776100">डोमरा</option>
<option value="07767300">ढेकही</option>
<option value="07765600">ढोढिला</option>
<option value="07768900">तेन्‍दुअहिया</option>
<option value="07747600">तरकुलवा</option>
<option value="07786700">तरकुलवा</option>
<option value="07765500">तिलकवनिया</option>
<option value="07778300">तिवारीपुर</option>
<option value="07749600">दुबौली</option>
<option value="07755200">दरहटा</option>
<option value="07752000">दरौली</option>
<option value="07774900">देवीपुर</option>
<option value="07778200">दैालत पुर</option>
<option value="07770400">धनखरी</option>
<option value="07788500">धनगडा</option>
<option value="07767700">धनगढी मुडेरी</option>
<option value="07745900">धनेवा धनेई</option>
<option value="07779200">धनहा</option>
<option value="07788200">धनहानायक</option>
<option value="07786300">धरमपुर</option>
<option value="07762900">धरमपुर</option>
<option value="07753900">धर्मपुर</option>
<option value="07753100">धरमौली</option>
<option value="07788700">धरमौली</option>
<option value="07783300">नकरौली</option>
<option value="07781000">नटवा</option>
<option value="07750800">नटवा</option>
<option value="07750700">नेतासुरहुरवा</option>
<option value="07755600">नदुआ</option>
<option value="07758500">नन्‍दना</option>
<option value="07782800">नन्‍दना</option>
<option value="07756200">नन्‍दाभार</option>
<option value="07776200">नरकटहा</option>
<option value="07781600">नरायनपुर</option>
<option value="07758100">नरायनपुर</option>
<option value="07765000">नरायनपुर</option>
<option value="07777000">नेवास पोखर</option>
<option value="07770200">नवीगंज</option>
<option value="07775200">नसिराबाद</option>
<option value="07752900">नाथ नगर</option>
<option value="07755100">पकडियार खुर्द्र</option>
<option value="07766700">पकडी विशुनपुर</option>
<option value="07760200">पकडी सिसवा</option>
<option value="07757000">पकडीयार बुजुर्ग</option>
<option value="07768100">पकडीयार विशुनपुर</option>
<option value="07749500">पकरी</option>
<option value="07751100">पकरी</option>
<option value="07787100">पकरी</option>
<option value="07748600">प‍करी नौनिया</option>
<option value="07783800">पचदेउरी</option>
<option value="07762400">पचरूखिया</option>
<option value="07763900">पटखौली</option>
<option value="07759700">पडरी खुर्द</option>
<option value="07757400">पतेरगवां</option>
<option value="07765200">पतालकुई</option>
<option value="07756000">पनेवा पनेई</option>
<option value="07777100">पनियरा</option>
<option value="07788000">परतावल</option>
<option value="07779500">पुरैना</option>
<option value="07763700">पुरैना खण्‍डी चौरा</option>
<option value="07759400">पुरूशोत्‍तमपुर</option>
<option value="07780000">परसा ऊर्फ परसौना</option>
<option value="07787000">परसा खुर्द</option>
<option value="07756900">परसा चक गोबरही</option>
<option value="07787900">परसा बुजुर्ग</option>
<option value="07755300">परसा राजा</option>
<option value="07760100">परसागिदही</option>
<option value="07756700">परसामीर</option>
<option value="07761900">परसिया</option>
<option value="07782500">परसिया इन्‍द्रपुर</option>
<option value="07766800">परसौनी बुजुर्ग</option>
<option value="07744700">पारस खार</option>
<option value="07763200">पिपपराइच ऊर्फ पचरूखिया</option>
<option value="07780700">पिपरपातीं</option>
<option value="07785700">पिपरपाती तिवारी</option>
<option value="07786900">पिपरा</option>
<option value="07769100">पिपरा खुर्द</option>
<option value="07784200">पिपरा जददू</option>
<option value="07771700">पिपरा दरगाह</option>
<option value="07757100">पिपरा नरायन</option>
<option value="07773700">पिपरा बक्‍क्ष</option>
<option value="07746300">पिपरा बाबू</option>
<option value="07768300">पिपरा बा्म्‍हन ऊर्फ बारीगॉंव</option>
<option value="07763300">पिपरा मुडेरी</option>
<option value="07754500">पिपरा मानिक राज</option>
<option value="07754700">पिपरा सोनाडी</option>
<option value="07756600">पिपराकल्‍याण</option>
<option value="07780600">पिपराखादर</option>
<option value="07783200">पिपरिया</option>
<option value="07763800">पिपरिया करंजहा</option>
<option value="07754400">पिपरिया गुरू गोविन्‍द राय</option>
<option value="07772900">पिपरीया</option>
<option value="07748900">पीपरा रसूलपुर</option>
<option value="07764000">पोखरभिण्‍डा</option>
<option value="07765300">पौहरिया</option>
<option value="07747000">फुलवरीया</option>
<option value="07751300">बेइलिया</option>
<option value="07747800">बगहवा</option>
<option value="07774100">बैजू डेहरा</option>
<option value="07745700">बैजनाथ पुर कला</option>
<option value="07749100">बैजनाथ पुर खुर्द</option>
<option value="07780200">बैजौली</option>
<option value="07774200">बडवार</option>
<option value="07780500">ब‍डहरा बरिईपार</option>
<option value="07744800">बडहरा राजा</option>
<option value="07756400">बडहरा वैदया</option>
<option value="07757700">बडहरामीर</option>
<option value="07770300">बडहरालाला</option>
<option value="07779400">बुद्विरामपुर</option>
<option value="07769200">बैदा</option>
<option value="07787200">बनकटिया</option>
<option value="07775000">बेनीगंज</option>
<option value="07779600">बभनौली</option>
<option value="07751600">बभनौली</option>
<option value="07777900">बभनौली बुर्जुग</option>
<option value="07778100">बभनौली माफी</option>
<option value="07781500">बरगदवा</option>
<option value="07764500">बरगदवा मधोपुर</option>
<option value="07745000">ब‍रगदवा राजा</option>
<option value="07761700">बरगदही</option>
<option value="07754800">बरगदही बसन्‍त नाथ</option>
<option value="07776000">बरबास</option>
<option value="07778600">बरवा ऊर्फ सिमरहीभार</option>
<option value="07762700">बरवा खुर्द</option>
<option value="07763400">बरवा चमनिया</option>
<option value="07750400">बरवा फहीम</option>
<option value="07755400">बरवा राजा</option>
<option value="07759900">बरवा विदद्ययापती</option>
<option value="07771000">ब्रहमपुर</option>
<option value="07750500">बरहरा</option>
<option value="07747200">बरहरा रानी</option>
<option value="07763600">बैरिया</option>
<option value="07779300">बैरिया</option>
<option value="07786600">बलुआ</option>
<option value="07750100">बलुआ</option>
<option value="07777800">बेलटीकरा</option>
<option value="07753600">बेलभरिया</option>
<option value="07782400">बेलराई</option>
<option value="07759800">बल्‍लोखास</option>
<option value="07782900">बेलवा</option>
<option value="07773500">बेलवा आराजी</option>
<option value="07745100">बेलवा काजी</option>
<option value="07758200">बेलवा खुर्द</option>
<option value="07763000">बेलवा टीकर</option>
<option value="07767600">बेलवा तिवारी</option>
<option value="07786000">बेलवा बुजुर्ग</option>
<option value="07785000">बेलवा बरौली</option>
<option value="07779800">बेलासपुर</option>
<option value="07752800">बेलासपुर</option>
<option value="07774300">बसडीला</option>
<option value="07783500">बस्‍डीला ऊर्फ अमवा</option>
<option value="07764600">बसन्‍तपुर</option>
<option value="07758700">बसन्‍तपुर खुर्द</option>
<option value="07755500">बसन्‍तपुर राजा</option>
<option value="07784900">बसवार</option>
<option value="07783600">बसहिया खुर्द</option>
<option value="07783400">बसहीया बुर्जुग</option>
<option value="07776700">बहरामपुर</option>
<option value="07745300">बागापार</option>
<option value="07767100">बासपार</option>
<option value="07780100">बासपार छोटा</option>
<option value="07761000">बासपार नूतन</option>
<option value="07747700">बासपार बैजौली</option>
<option value="07779900">बासपार बारा</option>
<option value="07746200">बिशुनपुर</option>
<option value="07771300">बौरिया</option>
<option value="07757800">बौलिया राजा</option>
<option value="07759300">बौलीया बाबू</option>
<option value="07783100">भटगावा तरकुलवा</option>
<option value="07784300">भरगॉंवा ऊर्फ लक्ष्‍मीपुर</option>
<option value="07765100">भरवलिया</option>
<option value="07766000">भुवना</option>
<option value="07765900">भुवनी</option>
<option value="07776800">भवानीपुर</option>
<option value="07786400">भैसा</option>
<option value="07761800">भैसी</option>
<option value="07762000">भिटौली</option>
<option value="07752100">भिसवा</option>
<option value="07768600">भिस्‍वा ऊर्फ कोटिया</option>
<option value="07781800">मंगलपुर</option>
<option value="07767500">मंगलपुर पटखौली</option>
<option value="07769500">मुजुरी</option>
<option value="07746400">मुजहना खुर्द</option>
<option value="07758900">मुजहना बुजुर्ग</option>
<option value="07752300">मजार छपरा</option>
<option value="07760600">मझौवा</option>
<option value="07764400">मटकोपा</option>
<option value="07751400">मटिहनिया चौधरी</option>
<option value="07781200">मठईयां</option>
<option value="07748700"> ा</option>
<option value="07767400">मठीया</option>
<option value="07748800"> ाा</option>
<option value="07759100">मुडेरा खुद्र</option>
<option value="07760500">मुडेरी</option>
<option value="07773300">मुडिला चौधरी</option>
<option value="07751500">मुडीला तिवारी</option>
<option value="07757900">मुण्‍डेरा कला</option>
<option value="07759200">मथनिया</option>
<option value="07768000">मेदनीपुर</option>
<option value="07774600">मधोनगर</option>
<option value="07750200">मुरीला</option>
<option value="07785400">मलमलिया ऊर्फ सिरसिया</option>
<option value="07776600">मंसूरगंज</option>
<option value="07772000">महुअवा</option>
<option value="07747500">महुआवा</option>
<option value="07773400">महदेइया</option>
<option value="07778800">महदेवा</option>
<option value="07749700">महदेवा</option>
<option value="07765400">महराजगंज</option>
<option value="07745200">महराजगंज फारेस्‍ट रेंज</option>
<option value="07778000">महराजगंज फारेस्‍ट रेंज</option>
<option value="07781100">महराजगंज फारेस्‍ट रेंज</option>
<option value="07782600">महुवा महुई</option>
<option value="07781300">महादेवा ऊर्फ बलुहा भार</option>
<option value="07788600">महावन खोर ऊर्फ बडहरा</option>
<option value="07788300">माधोपुर</option>
<option value="07772200">मिठौरा</option>
<option value="07761300">मिर्जापुर पकडी</option>
<option value="07784100">मोददीनपुर</option>
<option value="07782100">मोहनापुर</option>
<option value="07758000">मोहनापुर</option>
<option value="07780400">मोहम्‍दा</option>
<option value="07783700">मोहम्‍मदपुर</option>
<option value="07769000">मोहीदीनपुर</option>
<option value="07770100">मौलागंज</option>
<option value="07758300">रजवल</option>
<option value="07777300">रजौडा कला</option>
<option value="07777200">रजौडा खुर्द</option>
<option value="07777700">रजौडा पंजुम</option>
<option value="07775100">रतनपुरवा</option>
<option value="07786500">रूद्रापुर</option>
<option value="07770600">रूद्रापुर</option>
<option value="07756300">रूदलापुर</option>
<option value="07748100">रूदलापुर</option>
<option value="07782700">रूदलापुर बलुही</option>
<option value="07748500">रूधौली भावचक</option>
<option value="07755700">रेहॉंव</option>
<option value="07781900">राजपुर</option>
<option value="07772700">राजमन्दिर</option>
<option value="07760800">रानीपुर</option>
<option value="07782000">रानीपुर</option>
<option value="07775400">रानीपुर</option>
<option value="07744600">राम चरनपुर</option>
<option value="07752600">रामनगर</option>
<option value="07769400">रामनगर</option>
<option value="07746700">रामपुर</option>
<option value="07776500">रामपुर</option>
<option value="07778500">रामपुर</option>
<option value="07783900">रामपुर</option>
<option value="07772600">रामपुर खुर्द</option>
<option value="07780900">रामपुर चकिया</option>
<option value="07745500">रामपुर बुर्जुग</option>
<option value="07764300">रामपुर बल्‍डीहा</option>
<option value="07772300">रामपुर बोदरहीया</option>
<option value="07758400">रामपुर महुअवा</option>
<option value="07757300">रामपुर मिर</option>
<option value="07749400">रामहौली</option>
<option value="07761200">लक्ष्‍मीपुर</option>
<option value="07762800">लक्ष्‍मीपुर</option>
<option value="07778700">लक्ष्‍मीपुर</option>
<option value="07775300">लक्ष्‍मीपुर</option>
<option value="07787500">लक्ष्‍मीपुर</option>
<option value="07759500">लक्ष्‍मीपुर एकडंगा</option>
<option value="07760900">लक्ष्‍मीपुर देउरवा</option>
<option value="07788100">लखिमा</option>
<option value="07747100">लखिमा थरूआ</option>
<option value="07757200">लेदवा</option>
<option value="07772800">ललकारपुर</option>
<option value="07784000">वनकटीयां</option>
<option value="07785600">वरियापुर</option>
<option value="07744900">विजयपुर</option>
<option value="07773100">विन्‍दवलिया</option>
<option value="07766200">विरैचा</option>
<option value="07766300">विरैची</option>
<option value="07786100">विशुनपुर खर्द</option>
<option value="07763100">विशुनपुर गबडुआ</option>
<option value="07764900">विशुनपुर घाट</option>
<option value="07760300">विशुनपुर भडेहर</option>
<option value="07771400">विशुनपुरा</option>
<option value="07766500">विश्‍वनाथपुर</option>
<option value="07758600">विश्‍वनापुर ऊर्फ पडवनीया</option>
<option value="07780800">श्‍यामदेउरवां</option>
<option value="07772500">शिकारपुर</option>
<option value="07760000">शिकारपुर</option>
<option value="07787400">शितलापुर</option>
<option value="07775500">सतगुरू</option>
<option value="07746800">सतभरिया</option>
<option value="07753800">सदहो चक</option>
<option value="07781700">सुमेरगढ</option>
<option value="07752700">सेमरा</option>
<option value="07784800">सेमरा चन्‍द्रवली</option>
<option value="07761500">सेमराही चक</option>
<option value="07747300">सरडीहा</option>
<option value="07750600">सरया खुटहा ऊर्फ लखराव</option>
<option value="07751000">सेवराजी</option>
<option value="07746500">सवाना</option>
<option selected="selected" value="07756800">सिन्‍दूरिया</option>
<option value="07763500">सिरसिया</option>
<option value="07784600">सिरसिया</option>
<option value="07749800">सिसवा</option>
<option value="07747900">सिसवा अमहवा</option>
<option value="07746600">सिसवा बाबू</option>
<option value="07785900">सिसवा मुशी</option>
<option value="07752500">सिसवा राजा</option>
<option value="07749900">सिंहपुर</option>
<option value="07745600">सीसवनीया</option>
<option value="07758800">सीसवनीया</option>
<option value="07779100">सोनकटिया</option>
<option value="07759000">सोनबरसा</option>
<option value="07745800">सोनरा</option>
<option value="07774400">सोनवरसा</option>
<option value="07756500">सोनवल</option>
<option value="07753300">सोनारीखास</option>
<option value="07785100">सोनिया उत्‍तर</option>
<option value="07785200">सोनिया दक्खिन</option>
<option value="07754300">सोहगौरा</option>
<option value="07780300">सोहनपुर ऊर्फ सोनकटीया</option>
<option value="07773000">सोहरौना तिवारी</option>
<option value="07762600">सोहरौना राजा</option>
<option value="07783000">सोहवल</option>
<option value="07770500">सोहसा खास</option>
<option value="07784700">सोहसा बासपार</option>
<option value="07776400">सौरहा</option>
<option value="07748000">हजरत पुर</option>
<option value="07777400">हेमछपरा</option>
<option value="07775800">हरखपुरा</option>
<option value="07760400">हरखपुरा</option>
<option value="07768200">हरखा</option>
<option value="07768400">हरखी</option>
<option value="07778900">हरपुर</option>
<option value="07762200">हरपुर महन्‍थ</option>
<option value="07777500">हरिरामपुर</option>
<option value="07757500">हरिहरपुर</option>
<option value="07770800">हसखोरी</option>
</select>
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>
4. जन्म तिथि* :</label>
</div>
<div class="col-md-3">
<input name="db" type="text" value="10/12/2009" maxlength="10" id="db" class="form-
control hasDatepicker" placeholder="(DD/MM/YYYY)" style="border-width:1px;border-style:solid;"
data-bv-field="db"><i class="form-control-feedback" data-bv-icon-for="db" style="display: none;"></i>
</div>
<div class="col-md-2">
<label> जन्म का स्थान: </label>
</div>
<div class="col-md-3"><input name="birthPlace" type="text" value="सिन्दुरिया "
maxlength="100" id="birthPlace" class="form-control" placeholder="Max. 100 Chars" style="border-
width:1px;border-style:solid;" data-bv-field="birthPlace"><i class="form-control-feedback" data-bv-icon-
for="birthPlace" style="display: none;"></i>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>
11 .मोबाईल नम्बर :
</label>
</div>
<div class="col-md-3">
<input name="Textmob" type="text" value="9716972795" maxlength="10" id="Textmob"
class="form-control" style="border-width:1px;border-style:solid;" data-bv-field="Textmob"><i
class="form-control-feedback" data-bv-icon-for="Textmob" style="display: none;"></i>
</div>
<div class="col-md-2">
<label>12. निवास की अवधि *:</label>
</div>
<div class="col-md-3" style="padding-left:0px;padding-right:0px;">
<div class="col-md-6">
<span id="RadioButtonList3"><input id="RadioButtonList3_0" type="radio"
name="RadioButtonList3" value="जन्म से" checked="checked"><label
for="RadioButtonList3_0"> जन्म से </label><input id="RadioButtonList3_1"
type="radio" name="RadioButtonList3" value="0"
onclick="javascript:setTimeout('__doPostBack(\'RadioButtonList3$1\',\'\')', 0)"><label
for="RadioButtonList3_1"> वर्ष भरें</label></span>
</div>
<div class="col-md-6">
</div>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>
14. प्रमाण पत्र बनवाने का कारण :</label>
</div>
<div class="col-md-8">
<input name="reason" type="text" value="छात्रवुत्रि हेतु" maxlength="100"
id="reason" placeholder="Maximum 100 chracters are allowed.." class="form-control" style="border-
width:1px;border-style:solid;" data-bv-field="reason"><i class="form-control-feedback" data-bv-icon-
for="reason" style="display: none;"></i>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-4">
<label>15. क्या इससे पूर्व निवास प्रमाण पत्र जारी हुआ है ?:</label>
</div>
<div class="col-md-3">
<select name="allready_cert"
onchange="javascript:setTimeout('__doPostBack(\'allready_cert\',\'\')', 0)" id="allready_cert"
class="form-control">
<option selected="selected" value="0">नहीं</option>
<option value="1">हां</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>16. आवेदन शुल्क का भुगतान कर दिया है ?:</label>
</div>
<div class="col-md-3">
<select name="Dropfees" id="Dropfees" disabled="disabled" class="form-control">
<option selected="selected" value="YES">हां</option>
<option value="NO">नहीं</option>
<option value="NA">N/A</option>
</select>
</div>
<div class="col-md-2"><label>17.राशन कार्ड संख्या/परिवार आई.डी. :</label>
</div>
<div class="col-md-3">
<input name="TxtUID" type="text" maxlength="12" id="TxtUID" disabled="disabled"
class="form-control" style="border-width:1px;border-style:solid;" data-bv-field="TxtUID"><i
class="form-control-feedback" data-bv-icon-for="TxtUID" style="display: none;"></i>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-4">
<label>
18. संलग्नक शीर्षक/Attachment Title *:</label>
</div>
<div class="col-md-3">
<select name="Droptitle"
onchange="javascript:setTimeout('__doPostBack(\'Droptitle\',\'\')', 0)" id="Droptitle" class="form-
control">
<option selected="selected" value="select">--चुने--</option>
<option value="फोटो">फोटो</option>
<option value="स्वप्रमाणित घोषणा पत्र">स्वप्रमाणित घोषणा पत्र</option>
<option value="पार्षद या वार्डेन या ग्राम प्रधान का जाति प्रमाण पत्र">पार्षद या
वार्डेन या ग्राम प्रधान का जाति प्रमाण पत्र</option>
<option value="राशन कार्ड की छाया प्रति">राशन कार्ड की छाया प्रति</option>
<option value="others">अन्य</option>
</select>
</div>
<div class="col-md-2">
</div>
<div class="col-md-3">
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-4">
<label style="font-size:12px;">
<b>नोट:</b>
संलग्नक: [केवल .jpg|.jpeg|.png],[फोटो :अधिकतम साइज 50 kb], [संलग्नक
:अधिकतम साइज 100 kb] ,[<b>अनिवार्य संलग्नक</b> :फोटो,घोषणा पत्र]
</label>
<span id="chkLabel" style="display:inline-block;font-size:Small;width:352px;">* संलग्नक
हटाने के लिये चेक करें!!!</span>
</div>
<div class="col-md-3">
<input type="file" name="FileUpload1" id="FileUpload1" class="form-control"
style="border-width:1px;border-style:solid;height:21px;width:100%;height: 34px; padding: 0 10;
font-size: 11px; line-height: 1.42857143; color: #555; background-color: #fff;
background-image: none;">
</div>
<div class="col-md-3">
<input type="button" name="UploadButton" value="अपलोड"
onclick="javascript:__doPostBack('UploadButton','')" id="UploadButton" class="btn-primary"
style="border-width:1px;border-style:solid;height: 34px; font-size: 14px;">
</div>
</div>
</div>
<div id="showAtt" class="row">
<div class="form-group">
<div class="col-md-4">
<label>संलग्नको की सूची/List Of attachments :</label>
</div>
<div class="col-md-5">
<table id="CheckBoxList1" class="rbl" border="0">
<tbody><tr>
<td><input id="CheckBoxList1_0" type="checkbox" name="CheckBoxList1$0"
onclick="javascript:setTimeout('__doPostBack(\'CheckBoxList1$0\',\'\')', 0)"><label
for="CheckBoxList1_0">फोटो</label></td>
</tr><tr>
<td><input id="CheckBoxList1_1" type="checkbox" name="CheckBoxList1$1"
onclick="javascript:setTimeout('__doPostBack(\'CheckBoxList1$1\',\'\')', 0)"><label
for="CheckBoxList1_1">स्वप्रमाणितघोषणापत्र</label></td>
</tr><tr>
<td><input id="CheckBoxList1_2" type="checkbox" name="CheckBoxList1$2"
onclick="javascript:setTimeout('__doPostBack(\'CheckBoxList1$2\',\'\')', 0)"><label
for="CheckBoxList1_2">पार्षदयावार्डेनयाग्रामप्रधानकाजातिप्रमाणपत्र</label></td>
</tr><tr>
<td><input id="CheckBoxList1_3" type="checkbox" name="CheckBoxList1$3"
onclick="javascript:setTimeout('__doPostBack(\'CheckBoxList1$3\',\'\')', 0)"><label
for="CheckBoxList1_3">आधारकार्ड</label></td>
</tr>
</tbody></table>
</div>
</div>
</div>
<div class="row">
<div class="form-group has-feedback">
<div class="col-md-4">
<label>Enter Security code :</label>
</div>
<div class="col-md-1">
<img id="imgCaptcha" src="../../../login/captHandler.ashx?
638581398746576687&i=NCVBDkwqrOI=" style="border-width:0px;height:34px;">
</div>
<div class="col-md-1">
<input name="txtcap" type="text" maxlength="4" id="txtcap" class="form-control"
style="border-width:1px;border-style:solid;border-width:1px;border-style:solid;padding-right:0px;"
data-bv-field="txtcap"><i class="form-control-feedback" data-bv-icon-for="txtcap" style="display:
none;"></i>
</div>
<div class="col-md-6">
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12 text-center">
<div class="text-center has-error" id="messages">
<small class="help-block" data-bv-validator="notEmpty" data-bv-for="Name" data-bv-
result="NOT_VALIDATED" style="display: none;">Applicant's name cannot be empty or
Blank!!!!</small><small class="help-block" data-bv-validator="stringLength" data-bv-for="Name" data-
bv-result="NOT_VALIDATED" style="display: none;">The Applicant's Name must be less than 50
characters long</small><small class="help-block" data-bv-validator="regexp" data-bv-for="Name" data-
bv-result="NOT_VALIDATED" style="display: none;">Please enter Applicant's name in
hindi</small><small class="help-block" data-bv-validator="callback" data-bv-for="Name" data-bv-
result="NOT_VALIDATED" style="display: none;">Special Characters or Numbers Are Not Allowed in
Applicant Name</small><small class="help-block" data-bv-validator="notEmpty" data-bv-
for="NameEng" data-bv-result="NOT_VALIDATED" style="display: none;">Applicant's name cannot be
empty or Blank!!!!</small><small class="help-block" data-bv-validator="stringLength" data-bv-
for="NameEng" data-bv-result="NOT_VALIDATED" style="display: none;">The Applicant's Name must be
less than 50 characters long</small><small class="help-block" data-bv-validator="regexp" data-bv-
for="NameEng" data-bv-result="NOT_VALIDATED" style="display: none;">Please enter Applicant's name
in English</small><small class="help-block" data-bv-validator="callback" data-bv-for="NameEng" data-
bv-result="NOT_VALIDATED" style="display: none;">Special Characters or Numbers are not allowed in
Applicant Name</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="fat_husb"
data-bv-result="NOT_VALIDATED" style="display: none;">father's / Husband's name cannot be empty or
Blank!!!!" </small><small class="help-block" data-bv-validator="stringLength" data-bv-for="fat_husb"
data-bv-result="NOT_VALIDATED" style="display: none;">The father's / Husband's name must be less
than 50 characters long</small><small class="help-block" data-bv-validator="regexp" data-bv-
for="fat_husb" data-bv-result="NOT_VALIDATED" style="display: none;">Numbers Are Not Allowed in
Name</small><small class="help-block" data-bv-validator="callback" data-bv-for="fat_husb" data-bv-
result="NOT_VALIDATED" style="display: none;">Special Characters or Numbers Are Not Allowed in
Name</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="mothername"
data-bv-result="NOT_VALIDATED" style="display: none;">Mother Name cannot be empty or Blank!!!!"
</small><small class="help-block" data-bv-validator="stringLength" data-bv-for="mothername" data-bv-
result="NOT_VALIDATED" style="display: none;">Mother Name must be less than 50 characters
long</small><small class="help-block" data-bv-validator="regexp" data-bv-for="mothername" data-bv-
result="NOT_VALIDATED" style="display: none;">Numbers Are Not Allowed In Mother's
Name</small><small class="help-block" data-bv-validator="callback" data-bv-for="mothername" data-
bv-result="NOT_VALIDATED" style="display: none;">Special Characters or Numbers Are Not Allowed In
Mother's Name</small><small class="help-block" data-bv-validator="stringLength" data-bv-
for="Address" data-bv-result="NOT_VALIDATED" style="display: none;">House Number must be less
than 10 characters</small><small class="help-block" data-bv-validator="callback" data-bv-
for="Address" data-bv-result="NOT_VALIDATED" style="display: none;">Special Characters are Not
Allowed in House Number</small><small class="help-block" data-bv-validator="stringLength" data-bv-
for="pmohalla" data-bv-result="NOT_VALIDATED" style="display: none;">Mohalla Name must be less
than 100 characters</small><small class="help-block" data-bv-validator="callback" data-bv-
for="pmohalla" data-bv-result="NOT_VALIDATED" style="display: none;">Special Characters are not
Allowed In Mohalla Name</small><small class="help-block" data-bv-validator="date" data-bv-for="db"
data-bv-result="NOT_VALIDATED" style="display: none;">The is not a valid date </small><small
class="help-block" data-bv-validator="stringLength" data-bv-for="db" data-bv-result="NOT_VALIDATED"
style="display: none;">Please enter a value with valid length</small><small class="help-block" data-bv-
validator="stringLength" data-bv-for="birthPlace" data-bv-result="NOT_VALIDATED" style="display:
none;">Birth Place must be less than 100 characters</small><small class="help-block" data-bv-
validator="callback" data-bv-for="birthPlace" data-bv-result="NOT_VALIDATED" style="display:
none;">Special Characters are not Allowed In Birth Place</small><small class="help-block" data-bv-
validator="notEmpty" data-bv-for="Textmob" data-bv-result="NOT_VALIDATED" style="display:
none;">The mobile number is required and cannot be empty</small><small class="help-block" data-bv-
validator="regexp" data-bv-for="Textmob" data-bv-result="NOT_VALIDATED" style="display: none;">
Please Enter 10 digit Mobile Number</small><small class="help-block" data-bv-validator="stringLength"
data-bv-for="Textmob" data-bv-result="NOT_VALIDATED" style="display: none;">Please enter a value
with valid length</small><small class="help-block" data-bv-validator="regexp" data-bv-for="TxtUID"
data-bv-result="NOT_VALIDATED" style="display: none;">Please Enter valid Ration Card Number/Family
ID</small><small class="help-block" data-bv-validator="stringLength" data-bv-for="TxtUID" data-bv-
result="NOT_VALIDATED" style="display: none;">Please Enter 12 digit Ration Card Number/Family
ID</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="reason" data-bv-
result="NOT_VALIDATED" style="display: none;">Reason to get Certificate is required and cannot be
empty</small><small class="help-block" data-bv-validator="stringLength" data-bv-for="reason" data-
bv-result="NOT_VALIDATED" style="display: none;">Reason to get Certificate must be less than 100
characters long</small><small class="help-block" data-bv-validator="callback" data-bv-for="reason"
data-bv-result="NOT_VALIDATED" style="display: none;">Special Characters are not
Allowed</small><small class="help-block" data-bv-validator="notEmpty" data-bv-for="txtcap" data-bv-
result="NOT_VALIDATED" style="display: none;">Enter the CAPTCHA </small><small class="help-block"
data-bv-validator="callback" data-bv-for="txtcap" data-bv-result="NOT_VALIDATED" style="display:
none;">Special Characters not Allowed In the title </small><small class="help-block" data-bv-
validator="stringLength" data-bv-for="txtcap" data-bv-result="NOT_VALIDATED" style="display:
none;">Please enter a value with valid length</small></div>
</div>
</div>
</div>
<div class="row">
<div class="form-group">
<div class="col-md-12">
<span id="Labelerror"
style="color:Red;font-family:Verdana;font-size:Small;"></span><span id="Label1"></span>
</div>
</div>
</div>
<div class="panel-footer" style="font-family: Arial Unicode MS;text-align: center;background-
color:#ff9933;padding: 11px;margin-left: -15px;margin-right: -15px;margin-bottom: -15px;">
<input type="submit" name="Submit" value="दर्ज करॆ" id="Submit" class="btn-primary"
style="border-width:1px;border-style:solid;height: 40px; width:70px; font-size:
16px;"> <input type="button" name="Back" value="वापस‌"
onclick="javascript:__doPostBack('Back','')" id="Back" class="btn-primary" style="border-
width:1px;border-style:solid;height: 40px; font-size: 16px;width:70px;">
</div>
</form>
</div>
</div>
</div>
<div id="ui-datepicker-div" class="ui-datepicker ui-widget ui-widget-content ui-helper-clearfix ui-corner-
all"></div></body></html>
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