PK
<form action="certificate-alp-up.php" method="post" onsubmit="return checkform(this);">
<input type="hidden" name="certypo" value="<?php echo $certypo; ?>" >
<table cellspacing="3" align="center" width="100%" border="0" cellpadding="3">
<tr>
<td valign="top" colspan="4"> <center> <h3> CERTIFICATE OF FUMIGATION </h3> </center>
</td>
</tr>
<tr>
<td valign="top" colspan="4"><strong>DPPQS Registration No.</strong>: 074/MB</td></tr>
<tr>
<td valign="top" colspan="2">
<strong>Treatment Certificate Number: </strong>
<input type="hidden" name="certificateno" value="<?php echo $certificateno; ?>" >
<em><?php echo $certificateno; ?></em>
</strong>
</td>
<td valign="top" colspan="2">Date of Issue:
<strong>
<input type="hidden" name="issuedate" value="<?php echo $issuedate; ?>" >
<?php echo $issuedate ?>
</strong>
</td>
</tr>
<tr>
<td colspan="4" class="safe">This is to certify that consignment has been treated as per details listed below and that subject consigenmentis believed to be substantially free from any injurious pests.</td>
</tr>
<tr>
<td colspan="2">
<strong>Name & Address of Consignor/Exporter</strong>:<br/>
<input type="hidden" name="nameaddress" value="<?php echo $nameaddress ?>" >
<?php echo $nameaddress ?>
</td>
<td colspan="2">
<strong>Name & Address Of Consignee/Importer</strong>:<br/>
<input type="hidden" name="declarednameaddress" value="<?php echo $declarednameaddress ?>" >
<?php echo $declarednameaddress ?>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Invoice No</strong>:</td>
<td colspan="2">
<input type="hidden" name="distmarks" value="<?php echo $distmarks ?>">
<?php echo $distmarks ?>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Description of Consigenment</strong>:</td>
<td colspan="2">
<input type="hidden" name="desgood" value="<?php echo $desgood; ?>" ><?php echo $desgood ?>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Type and No. of Packges</strong>:</td>
<td colspan="2">
<input type="text" name="quantitydeclared" value="<?php echo $quantitydeclared ?>"></td>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Container No. or Vessel</strong>:</td>
<td colspan="2">
<textarea name="conslinkno" rows="3" cols="25" onkeyPress="return addP(event,this)"><?php echo $conslinkno ?>
</textarea>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Means of Conveyance</strong>:</td>
<td colspan="2">
<input type="text" name="nameship" value="<?php echo $nameship ?>">
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Destination Port</strong>:</td>
<td colspan="2">
<input type="text" name="countrydes" value="<?php echo $countrydes ?>">
</td>
</tr>
<br>
<tr><td valign="top" colspan="4"> <center><h3> SCHEDULE OF TREATMENT <h3> </center> </td></tr>
<BR>
<tr>
<td valign="top" colspan="2 "><strong>Chemical(Fumigant)</strong>:</td>
<td colspan="2">
<select name="namefumigant">
<?php
if($namefumigant=='METHYL BROMIDE')
{
echo"<option selected>METHYL BROMIDE</option><option>ALUMINIUM PHOSPHIDE</option>";
}
if($namefumigant=='ALUMINIUM PHOSPHIDE')
{
echo"<option>METHYL BROMIDE</option><option selected>ALUMINIUM PHOSPHIDE</option>";
}
?>
</select>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Dosage</strong>:</td>
<td colspan="2">
<select name="dosagefumigant">
<option><?php echo $dosagefumigant ?></option>
<option>3 LBS Per 1000 Cubic Ft.</option>
<option >9 Gms Per Ton</option>
<option>12 Gms Per Ton</option>
<option>6 Gms Per MT</option>
<option>9 Gms Per MT</option>
<option>12 Gms Per MT</option>
<option>15 Gms Per MT</option>
<option>16 Gms Per MT</option>
<option>18 Gms Per MT</option>
<option>24 Gms Per MT</option>
<option>32 Gms Per MT</option>
<option>40 Gms Per MT</option>
<option>48 Gms Per MT</option>
<option>56 Gms Per MT</option>
<option>64 Gms Per MT</option>
<option>80 Gms Per MT</option>
<option>88 Gms Per MT</option>
<option>96 Gms Per MT</option>
<option>100 Gms Per MT</option>
</select>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Temperature</strong>:</td>
<td colspan="2">
<input type="text" name="airtemp" value="<?php echo $airtemp ?>">
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Duration of Exposure</strong>:</td>
<td colspan="2">
<select name="durationfumigantion">
<option><?php echo $durationfumigantion ?></option>
<option>24 Hours</option>
<option>48 Hours</option>
<option>72 Hours</option>
<option>7 Days</option>
</select>
</td>
</tr>
<tr>
<td valign="top" colspan="2"> <strong>Date of Fumigation</strong>:</td>
<td colspan="2">
<input class="datepicker" type="text" name="Dfumigation" value="<?php echo $datefumigantion ?>">
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Remark</strong>:</td>
<td colspan="2">
<textarea name="decla" cols="35" rows="3"><?php echo $decla; ?></textarea>
</td>
</tr>
<tr>
<td colspan="2">Shipped Within:</td>
<td colspan="4">
<input type="text" name="days" size="3" value="<?php echo $days; ?>" />   days from the date of fumigation.
</td>
</tr>
<?php
if($fum_carried=='1'){
?>
<tr>
<td colspan="6">
<input type="checkbox" name="fum_carried" value="1" checked="checked" />       FUMIGATION HAS BEEN CARRIED OUT IN DIS-INFECTION OF THE CONTAINER
</td>
</tr>
<?php
}
else {
?>
<tr>
<td colspan="6">
<input type="checkbox" name="fum_carried" value="1" />       FUMIGATION HAS BEEN CARRIED OUT IN DIS-INFECTION OF THE CONTAINER
</td>
</tr>
<?php
}
?>
<tr>
<td colspan="6"> Number of Container </td>
</tr>
<tr>
<td colspan="6"> 20’ <input type="text" name="container20feet" size="5" value="<?php echo $container20feet; ?>" /> <br /><br />
40’ <input type="text" name="container40feet" size="5" value="<?php echo $container40feet; ?>" /> <br /><br />
40HC <input type="text" name="container40HC" size="5" value="<?php echo $container40HC; ?>" /> <br /><br />
LCL <input type="text" name="containerLCL" size="5" value="<?php echo $containerLCL; ?>" /> <br /><br />
</td>
</tr>
<tr><td colspan="4" align="center"><br><center><input type="submit" value="» Check & Confirm »" class="amo-submit"></center></td></tr>
</td>
</tr>
</table>
</form>
<script>
$(".datepicker").datepicker({
dateFormat: 'yy-mm-dd'
});
</script>
PK 99