PK
<form action="certificate-alp-confirm.php" method="post" onsubmit="return checkform(this);">
<input type="hidden" name="formno" value="<?php echo $_POST['formno']; ?>">
<input type="hidden" name="clntid" value="<?php echo $_POST['clntid']; ?>">
<input type="hidden" name="clntid2" value="<?php echo $_POST['clntid2']; ?>">
<input type="hidden" name="dtype" value="<?php echo $_POST['dtype']; ?>">
<input type="hidden" name="sub_c" value="<?php echo"$_POST[sub_c]";?>">
<input type="hidden" name="subc_id" value="<?php echo "$subc_id"; ?>">
<table cellspacing="3" align="center" width="100%" border="0" cellpadding="3">
<tr>
<td valign="top" colspan="4"> <center> <h3> CERTIFICATE OF FUMIGATION </h3> </center>
</td>
</tr>
<tr>
<td valign="top" colspan="4"><strong>Dte PPQS Regd.No</strong>: 000 MB</td></tr>
<td valign="top" colspan="2"><strong>Treatment Certificate No.</strong>:<em>Auto assigned</em></td>
<td valign="top" colspan="2">Date of Issue: <input type="text" name="issuedate" class="datepicker" value="<?php echo date('d/m/Y'); ?>"></td>
</tr>
<tr>
<td colspan="4" class="safe">This is to certify that consignment has been treated as per details listed below and that subject consigenmentis believed to be substantially free from any injurious pests.</td>
</tr>
<tr>
<td colspan="2">
<strong>Name & Address of Consignor/Exporter</strong>:<br/>
<?php
client_details($_POST['clntid']);
?>
</td>
<td colspan="2">
<strong>Name & Address Of Consignee/Importer</strong>:<br/>
<?php
client_details($_POST['clntid2']);
?>
</td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Invoice No</strong>:</td><td colspan="2"><input type="text" name="invoice" id="invoicelist" /></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 selected="selected">ALUMINIUM PHOSPHIDE</option>
<option>METHYL BROMIDE</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 selected="selected">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>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Temperature</strong>:</td><td colspan="2"><input type="text" size="7" name="temp"></td>
</tr>
<tr>
<td valign="top" colspan="2"><strong>Duration of Exposure</strong>:</td>
<td colspan="2">
<select name="durat">
<option>24 Hours</option>
<option>48 Hours</option>
<option selected="selected">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"></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 colspan="2">Shipped Within:</td>
<td colspan="4"><input type="text" name="days" value="21" size="3"/>   days from the date of fumigation.</td>
</tr>
<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>
<tr>
<td colspan="6"> Number of Container </td>
</tr>
<tr>
<td colspan="6"> 20’ <input type="text" name="container20feet" size="5" /> <br /><br />
40’ <input type="text" name="container40feet" size="5" /> <br /><br />
40HC <input type="text" name="container40HC" size="5" /> <br /><br />
LCL <input type="text" name="containerLCL" size="5" /> <br /><br />
</td>
</tr>
<?php
if(isset($_POST['subc_id']) && $_POST['subc_id']!=''){
echo "";
}
else{
?>
<tr>
<td colspan="4"><strong>MAKE INVOICE:</strong></td>
</tr>
<tr>
<td colspan="2" align="right">For Agent:</td>
<td colspan="2"><input type="text" size="30" name="ajtname" id="agentslist" />
<!--
<select name="ajtname"id="agentslist">
<option value="0">Select an agent</option>
-->
<?php
/*
$sql="SELECT ajcomp,ajid FROM ajent order by ajcomp";
$result=mysql_query($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 colspan="2"> <input type="text" size="7" name="amount">/- INR</td></tr>
<tr>
<td colspan="2" align="right"> Discount:<em>(in %age)</em></td>
<td colspan="2"><input type="text" name="discount" size="3" 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"><input type="text" name="srtax" value="10.3" size="4">%</td>
</tr>
<!--
<tr><td colspan="2" align="right" valign="middle">Particulars</td><td colspan="2"><textarea name="particular" rows="2" cols="40"></textarea></td></tr>
-->
<?php
}
?>
<tr><td colspan="4" align="center"><br><center><input type="submit" value="» Check & Confirm »" class="amo-submit"></center></td></tr>
</td>
</tr>
</table>
</form>
PK 99