PK
<head>
<script language="JavaScript" type="text/javascript">
<!--
function checkform ( form )
{
// ** START **
if (form.certno.value == "") {
alert( "Please enter Certificate no. here." );
form.certno.focus();
return false ;
}
// ** END **
// ** START **
if (form.invoice.value == "") {
alert( "Please enter invoice." );
form.invoice.focus();
return false ;
}
// ** END **
// ** START **
if (form.desc.value == "") {
alert( "Please enter Description of Consigenment." );
form.desc.focus();
return false ;
}
// ** END **
// ** START **
if (form.pack.value == "") {
alert( "Please enter Type and No. of Packges:." );
form.pack.focus();
return false ;
}
// ** END **
// ** START **
if (form.vessel.value == "") {
alert( "Please enter Container No. or Vessel:" );
form.vessel.focus();
return false ;
}
// ** END **
// ** START **
if (form.convey.value == "") {
alert( "Please enter Means of Conveyance:" );
form.convey.focus();
return false ;
}
// ** END **
// ** START **
if (form.destinat.value == "") {
alert( "Please enter Destination Port:" );
form.destinat.focus();
return false ;
}
// ** END **
// ** START **
if (form.chem.value == "") {
alert( "Please enter Chemical(Fumigant):" );
form.chem.focus();
return false ;
}
// ** END **
// ** START **
if (form.dosage.value == "") {
alert( "Please enter Dosage:" );
form.dosage.focus();
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}
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// ** START **
if (form.temp.value == "") {
alert( "Please enter Temperature:" );
form.temp.focus();
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}
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// ** START **
if (form.durat.value == "") {
alert( "Please enter Duration of Exposure:" );
form.durat.focus();
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}
// ** END **
// ** START **
if (form.Dfumigation.value == "") {
alert( "Please enter Date of Fumigation:" );
form.Dfumigation.focus();
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// ** START **
if (form.amount.value == "") {
alert( "Please enter Amount :" );
form.amount.focus();
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}
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}
//-->
</script>
</head>
<table cellspacing="3" align="center" width="100%" border="4" cellpadding="3">
<form action="conform.php" method="get" onsubmit="return checkform(this);">
<input type="hidden" name="clntid" value="<?php echo"$_GET[clntid]";?>">
<input type="hidden" name="dtype" value="<?php echo"$_GET[dtype]";?>">
<input type="hidden" name="sub_c" value="<?php echo"$_GET[sub_c]";?>">
<tr>
<td valign="top" colspan="4"> <center> <h3> CERTIFICATE OF FUMIGATION </h3> </center>
</td>
</tr>
<tr>
<td valign="top" colspan="4"><strong>Dte PPQS Regd.No.104/MB</strong></td></tr>
<td valign="top" colspan="2"><strong>Treatment Certificate No.</strong>:<em>Auto assigned</em></td>
<td valign="top" colspan="2"><input type="text" name="dat" value="<?php echo date('d-m-Y'); ?>" /></td>
</tr>
<tr><td colspan="4"> This is to certify that consignment has been treated as per details listed below and that
subject consigenmentis believed <br> to be substantially free from any injurious pests.</td></tr>
<tr>
<td valign="top" colspan="2"><strong>Name of Importer/Exporter</em></strong>:</td><td colspan="2"><?php echo"$_GET[clntid]";?></td>
</tr>
<td valign="top" colspan="2"><strong>Invoice No</strong>:</td><td colspan="2"><input type="text" name="invoice"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Description of Consigenment</strong>:</td><td colspan="2"><input type="text" name="desc"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Type and No. of Packges</strong>:</td><td colspan="2"><input type="text" name="pack"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Container No. or Vessel</strong>:</td><td colspan="2"><textarea name="vessel" cols="28" rows="3"></textarea></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Means of Conveyance</strong>:</td><td colspan="2"><input type="text" name="convey"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Destination Port</strong>:</td><td colspan="2"><input type="text" name="destinat"></td>
</tr>
<br>
<tr><td valign="top" colspan="4"> <center><h3> SCHEDULE OF TREATMENT <h3> </center> </td></tr>
<BR>
<tr>
<td valign="top" colspan="2 "><strong>Chemical(Fumigant)</strong>:</td>
<td colspan="2">
<select name="chem">
<option>METHYL BROMIDE</option>
<option>ALUMINIUM PHOSPHIDE</option>
</select></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Dosage</strong>:</td>
<td colspan="2">
<select name="dosage">
<option>3 LBS Per 1000 Cubic Ft.</option>
<option>9 Gms Per Ton</option>
<option>12 Gms Per Ton</option>
<option>6 Gms Per Cubic Meter</option>
<option>16 Gms Per Cubic Meter</option>
<option>24 Gms Per Cubic Meter</option>
<option>32 Gms Per Cubic Meter</option>
<option>40 Gms Per Cubic Meter</option>
<option>48 Gms Per Cubic Meter</option>
<option>56 Gms Per Cubic Meter</option>
<option>64 Gms Per Cubic Meter</option>
<option>80 Gms Per Cubic Meter</option>
<option>88 Gms Per Cubic Meter</option> </select></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Temperature</strong>:</td><td colspan="2"><input type="text" name="temp"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Duration of Exposure</strong>:</td>
<td colspan="2">
<select name="durat">
<option>24 Hour</option>
<option>48 Hour</option>
<option>72 Hour</option>
<option>7 days</option>
</select></td>
</tr>
<tr>
<td valign="top" colspan="2"> <strong>Date of Fumigation</strong>:</td><td colspan="2"><input type="text" name="Dfumigation"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Remark</strong>:</td><td colspan="2"><textarea name="remark" cols="35" rows="3"></textarea></td>
</tr>
<tr><td align="center" colspan="4"><br>
<table align="center" width="100%" border="1" cellpadding="0" cellspacing="0">
<tr><td colspan="2" align="right"><center>
<strong>MAKE INVOICE:</strong>
</center> </td><td colspan="2">For agent:-<select name="ajtname">
<option value="0">Select an agent</option>
<?php
$sql="SELECT ajcomp,ajid FROM ajent order by ajname";
$result=mysql_query($sql) or die('error in fetch');
if
(mysql_num_rows($result) == 0)
{ echo "<option value=0>no agents found</option>";
}
while($row=mysql_fetch_array($result))
{
echo"<option value='".$row['ajid']."'>{$row['ajcomp']}</option>";
}
?></select>
</td></tr>
<tr><td colspan="2" align="right"><strong>Amount</strong> :</td>
<td align="center" colspan="2"> Rs.<input type="text" name="amount">/-</td></tr>
<tr>
<td colspan="2" align="right"> Discount:<em>(in %age)</em></td>
<td colspan="2" align="center">
<input type="text" name="discount" size="4" value="0" onfocus="this.value=''">
%</td>
</tr>
<tr><td colspan="2" align="right"><input type="checkbox" name="stax" value="yes"> ServiceTax :</td><td colspan="4" align="center">
<input type="text" name="srtax" value="10.3" size="4">%</td></tr>
<tr><td colspan="2" align="center" valign="middle">Particulars</td><td colspan="2"><textarea name="particular" rows="2" cols="40"></textarea></td></tr>
<tr><td colspan="4" align="center"><br><center><input type="submit" value="» Check & Confirm »" class="amo-submit"></center></td></tr>
</form>
</table>
</td></tr>
</table>
PK 99