PK
<form action="certificate-ppq-up.php" method="post" onsubmit="return checkform(this);">
<input type="hidden" name="certypo" value="<?php echo $certypo; ?>" >
<table align="center" width="100%" border="0" cellpadding="0" cellspacing="0">
<tr>
<td align="center" colspan="6"><center>
<center> <h3> CERTIFICATE OF FUMIGATION </h3> </center>
</td>
</tr>
<tr>
<td align="left" colspan="6"><strong>DPPQS Registration No</strong>: 074/MB</td>
</tr>
<tr>
<td colspan="3">Treatment Certificate Number: <strong><input type="hidden" name="certificateno" value="<?php echo $certificateno; ?>" ><?php echo $certificateno; ?></strong>
</td>
<td align="center" colspan="3">Date of Issue: <strong><input type="hidden" name="issuedate" value="<?php echo $issuedate; ?>" ><?php echo $issuedate ?></strong>
</td>
</tr>
<tr>
<td colspan="6" class="safe">This is to certify that the following regulated articles have been fumigated according to the appropriate procedures to confirm to the current Phytosanitary. Requirements of the importing country.</td>
</tr>
<tr><td align="left" colspan="6"><strong><font color="#339933">PARTY DETAILS:</font> </strong></td></tr>
<tr>
<td colspan=3><b>Name & Address of Consignor/Exporter:</b></td>
<td colspan=3><b>Name & Address of Consignee/Importer:</b></td>
</tr>
<tr>
<td colspan='3'>
<input type="hidden" name="nameaddress" value="<?php echo $nameaddress ?>" >
<?php echo $nameaddress ?>
</td>
<td colspan='3'>
<input type="hidden" name="declarednameaddress" value="<?php echo $declarednameaddress ?>" >
<?php echo $declarednameaddress ?>
</td>
</tr>
<tr><td align="left" colspan="6"><strong><font color="#339933">DETAILS OF GOODS:</font> </strong></td></tr>
<tr>
<td colspan="2">Desription of goods:</td>
<td width="24%">
<input type="hidden" name="desgood" value="<?php echo $desgood; ?>" ><?php echo $desgood ?>
</td>
<td align="right" colspan="2">Quantity declared:</td>
<td width="25%">
<input type="text" name="quantitydeclared" value="<?php echo $quantitydeclared ?>">
</td>
</tr>
<tr>
<td align="left" colspan="2">Invoice No:</td>
<td>
<input type="hidden" name="distmarks" value="<?php echo $distmarks ?>">
<strong><?php echo $distmarks ?></strong>
</td>
<td align="right" colspan="2">Consignment Link/Container No.</td>
<td>
<textarea name="conslinkno" rows="3" cols="25" onkeyPress="return addP(event,this)"><?php echo $conslinkno ?></textarea>
</td>
</tr>
<tr>
<td align="left" colspan="2">Port & country of loading:</td>
<td><input type="text" name="portcountry" value="<?php echo $portcountry ?>"></td>
<td align="right" colspan="2">Name of the Vessel/Ship:</td>
<td><input type="text" name="nameship" value="<?php echo $nameship ?>"></td>
</tr>
<tr>
<td align="left" colspan="2">Country of Destination:</td>
<td><input type="text" name="countrydes" value="<?php echo $countrydes ?>"></td>
<td align="right" colspan="2">Declared point of Entry:</td>
<td><input type="text" name="declentry" value="<?php echo $declentry ?>"></td>
</tr>
<tr><td colspan="6">
<strong><font color="#339933">DETAILS OF TREATMENT:</font></strong></td>
</tr>
<tr>
<td width="33%" colspan="2">Name of fumigation:<br>
<select name="namefumigant">
<?php
if($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>
<td width="33%" colspan="2">Date of fumigation:<br>
<input type="text" name="datefumigantion" class="datepicker" value="<?php echo $datefumigantion ?>">
</td>
<td width="33%" colspan="2">Place of fumigation:<br>
<input type="text" name="placefumigantion" value="<?php echo $placefumigantion ?>">
</td>
</tr>
<tr>
<td width="33%" colspan="2">Dosage rate of fumigation:<br>
<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 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>
<option>96 Gms Per Cubic Meter</option>
<option>100 Gms Per Cubic Meter</option>
</select>
</td>
<td width="33%" colspan="2">Duration of fumigation:<br>
<select name="durationfumigantion">
<option><?php echo $durationfumigantion ?></option>
<option>24 Hours</option>
<option>48 Hours</option>
<option>72 Hours</option>
<option>7 Days</option>
<option>2 ½ Hours</option>
<option>2.30 Hours</option>
</select>
</td>
<td width="33%" colspan="2">Minimum Air temperature:<br>
<input type="text" name="airtemp" value="<?php echo $airtemp ?>">
</td>
</tr>
<tr><td colspan="4">Fumigation has been performed in
<select name="fumigation_conduct">
<option ><?=$fumigation_conduct?></option>
<option >a container under gas tight sheet.</option>
<option >a under gas tight enclosure.</option>
</select>
:</td>
<td colspan="2">
<?php
if($contype=='Yes')
{
echo'<input type="radio" name="contype" value="Yes" checked>Yes /
<input type="radio" name="contype" value="No">No /
<input type="radio" name="contype" value="N/A">N/A';
}
elseif($contype=='No')
{
echo'<input type="radio" name="contype" value="Yes">Yes /
<input type="radio" name="contype" value="No" checked>No /
<input type="radio" name="contype" value="N/A">N/A';
}
elseif($contype=='N/A')
{
echo'<input type="radio" name="contype" value="Yes">Yes /
<input type="radio" name="contype" value="No" checked>No /
<input type="radio" name="contype" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="4">In transit Fumigation-needs Ventillated at port of discharge:</td>
<td colspan="2">
<?php
if($discharge=='Yes')
{
echo'<input type="radio" name="discharge" value="Yes" checked>Yes /
<input type="radio" name="discharge" value="No">No /
<input type="radio" name="discharge" value="N/A">N/A';
}
elseif($discharge=='No')
{
echo'<input type="radio" name="discharge" value="Yes">Yes /
<input type="radio" name="discharge" value="No" checked>No /
<input type="radio" name="discharge" value="N/A">N/A';
}
elseif($discharge=='N/A')
{
echo'<input type="radio" name="discharge" value="Yes">Yes /
<input type="radio" name="discharge" value="No" checked>No /
<input type="radio" name="discharge" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="4">Container/Enclosure has been Ventilated to below 5ppm
v/v menthyl Bromide:</td>
<td colspan="2">
<?php
if($enclosure=='Yes')
{
echo'<input type="radio" name="enclosure" value="Yes" checked>Yes /
<input type="radio" name="enclosure" value="No">No /
<input type="radio" name="enclosure" value="N/A">N/A';
}
elseif($enclosure=='No')
{
echo'<input type="radio" name="enclosure" value="Yes">Yes /
<input type="radio" name="enclosure" value="No" checked>No /
<input type="radio" name="enclosure" value="N/A">N/A';
}
elseif($enclosure=='N/A')
{
echo'<input type="radio" name="enclosure" value="Yes">Yes /
<input type="radio" name="enclosure" value="No" checked>No /
<input type="radio" name="enclosure" value="N/A" checked>N/A';
}
?>
</td>
</tr
><tr>
<td colspan="6">
<strong><font color="#339933">WRAPPING AND TIMER:</font></strong></td>
</tr>
<tr>
<td colspan="4">Has the commodity has fumigated prior to lacquering,varnishing,painting
or wrapping?</td>
<td colspan="2">
<?php
if($commodity=='Yes')
{
echo'<input type="radio" name="commodity" value="Yes" checked>Yes /
<input type="radio" name="commodity" value="No">No /
<input type="radio" name="commodity" value="N/A">N/A';
}
elseif($commodity=='No')
{
echo'<input type="radio" name="commodity" value="Yes">Yes /
<input type="radio" name="commodity" value="No" checked>No /
<input type="radio" name="commodity" value="N/A">N/A';
}
elseif($commodity=='N/A')
{
echo'<input type="radio" name="commodity" value="Yes">Yes /
<input type="radio" name="commodity" value="No" checked>No /
<input type="radio" name="commodity" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="4">Has plastic wrapping been used in the consignment?:</td>
<td colspan="2">
<?php
if($consignment=='Yes')
{
echo'<input type="radio" name="consignment" value="Yes" checked>Yes /
<input type="radio" name="consignment" value="No">No /
<input type="radio" name="consignment" value="N/A">N/A';
}
elseif($consignment=='No')
{
echo'<input type="radio" name="consignment" value="Yes">Yes /
<input type="radio" name="consignment" value="No" checked>No /
<input type="radio" name="consignment" value="N/A">N/A';
}
elseif($consignment=='N/A')
{
echo'<input type="radio" name="consignment" value="Yes">Yes /
<input type="radio" name="consignment" value="No" checked>No /
<input type="radio" name="consignment" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="4">If yes,has the consignment been fumigated prior to wrapping?:</td>
<td colspan="2">
<?php
if($wrapping=='Yes')
{
echo'<input type="radio" name="wrapping" value="Yes" checked>Yes /
<input type="radio" name="wrapping" value="No">No /
<input type="radio" name="wrapping" value="N/A">N/A';
}
elseif($wrapping=='No')
{
echo'<input type="radio" name="wrapping" value="Yes">Yes /
<input type="radio" name="wrapping" value="No" checked>No /
<input type="radio" name="wrapping" value="N/A">N/A';
}
elseif($wrapping=='N/A')
{
echo'<input type="radio" name="wrapping" value="Yes">Yes /
<input type="radio" name="wrapping" value="No" checked>No /
<input type="radio" name="wrapping" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="4">Or has the plasstic wrapping been slashed,open or perforated
<br>
in accordance with the wrapping and perfortion standard?</td>
<td colspan="2">
<?php
if($perforated=='Yes')
{
echo'<input type="radio" name="perforated" value="Yes" checked>Yes /
<input type="radio" name="perforated" value="No">No /
<input type="radio" name="perforated" value="N/A">N/A';
}
elseif($perforated=='No')
{
echo'<input type="radio" name="perforated" value="Yes">Yes /
<input type="radio" name="perforated" value="No" checked>No /
<input type="radio" name="perforated" value="N/A">N/A';
}
elseif($perforated=='N/A')
{
echo'<input type="radio" name="perforated" value="Yes">Yes /
<input type="radio" name="perforated" value="No" checked>No /
<input type="radio" name="perforated" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="4">Is the timber in this consignment less than 200mm thick</td>
<td colspan="2">
<?php
if($height=='Yes')
{
echo'<input type="radio" name="height" value="Yes" checked>Yes /
<input type="radio" name="height" value="No">No /
<input type="radio" name="height" value="N/A">N/A';
}
elseif($height=='No')
{
echo'<input type="radio" name="height" value="Yes">Yes /
<input type="radio" name="height" value="No" checked>No /
<input type="radio" name="height" value="N/A">N/A';
}
elseif($height=='N/A')
{
echo'<input type="radio" name="height" value="Yes">Yes /
<input type="radio" name="height" value="No" checked>No /
<input type="radio" name="height" value="N/A" checked>N/A';
}
?>
</td>
</tr>
<tr>
<td colspan="6"><!--<input type="checkbox" name="addition">--> <strong><font color="#339933">ADDITION DECLERATION:</font></strong></td>
</tr>
<tr>
<td colspan="6"><textarea name="decla" cols="100" rows="10"><?php echo $decla; ?></textarea>
<br />
</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>
<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="6"><br><center><input type="submit" value="» Confirm details »" class="amo-submit"></center></td></tr>
</table>
</form>
PK 99