PK
<form action="certificate-ppq-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 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: <em>Auto assigned</em></td>
<td align="center" colspan="3">Date of Issue: <input type="text" name="issuedate" class="datepicker" value="<?php echo date('d/m/Y'); ?>"></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'>
<?php
client_details($_POST['clntid']);
?>
</td>
<td colspan='3'>
<?php
client_details($_POST['clntid2']);
?>
</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="text" name="desgood"></td>
<td align="right" colspan="2">Quantity declared:</td>
<td width="25%"><input type="text" name="quantitydeclared"></td>
</tr>
<tr>
<td align="left" colspan="2">Invoice No:</td>
<td><input type="text" name="distmarks" id="invoicelist"></td>
<td align="right" colspan="2">Consignment Link/Container No.</td>
<td><textarea name="conslinkno" rows="3" cols="25"></textarea></td>
</tr>
<tr>
<td align="left" colspan="2">Port & country of loading:</td>
<td><input type="text" name="portcountry"></td>
<td align="right" colspan="2">Name of the Vessel/Ship:</td>
<td><input type="text" name="nameship"></td>
</tr>
<tr>
<td align="left" colspan="2">Country of Destination:</td>
<td><input type="text" name="countrydes"></td>
<td align="right" colspan="2">Declared point of Entry:</td>
<td><input type="text" name="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">
<option>METHYL BROMIDE</option>
<option>ALUMINIUM PHOSPHIDE</option>
</select>
</td>
<td width="33%" colspan="2">Date of fumigation:<br><input type="text" name="datefumigantion" class="datepicker"></td>
<td width="33%" colspan="2">Place of fumigation:<br><input type="text" name="placefumigantion"></td>
</tr>
<tr>
<td width="33%" colspan="2">Dosage rate of fumigation:<br><select name="dosagefumigant">
<option>3 LBS Per 1000 Cubic Ft.</option>
<option>3.5 LBS Per 1000 Cubic Ft.</option>
<option>4 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 selected="selected">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>100Gms Per Cubic Meter</option>
<option>108Gms Per Cubic Meter</option>
<option>116Gms Per Cubic Meter</option>
</select>
</td>
<td width="33%" colspan="2">Duration of fumigation:<br><select name="durationfumigantion">
<option>24 Hours</option>
<option>48 Hours</option>
<option>72 Hours</option>
<option>7 Days</option>
<option>2.5 Hour</option>
</select></td>
<td width="33%" colspan="2">Minimum Air temperature:<br><input type="text" name="airtemp"></td>
</tr>
<tr><td colspan="4">Fumigation has been performed in
<select name="fumigation_conduct">
<option >a container under gas tight sheet.</option>
<option >a under gas tight sheet enclosure.</option>
</select>
:</td>
<td colspan="2"><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
</td></tr>
<tr>
<td colspan="4">In transit Fumigation-needs Ventillated at port of discharge:</td>
<td colspan="2"> <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 </td>
</tr>
<tr>
<td colspan="4">Container/Enclosure has been Ventilated to below 5ppm
v/v menthyl Bromide:</td>
<td colspan="2"> <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 </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"> <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 </td>
</tr>
<tr>
<td colspan="4">Has plastic wrapping been used in the consignment?:</td>
<td colspan="2"> <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 </td>
</tr>
<tr>
<td colspan="4">If yes,has the consignment been fumigated prior to wrapping?:</td>
<td colspan="2"> <input type="radio" name="wrapping" value="Yes">
Yes /
<input type="radio" name="wrapping" value="No">
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"> <input type="radio" name="perforated" value="Yes">
Yes /
<input type="radio" name="perforated" value="No">
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"> <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 </td>
</tr>
<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="deck" cols="100" rows="10">This Container successfully De-gas after ( ) hours
I declare that these details are true and correct and the fumigation has been carried out in accordance with NSPM-12&ISPM-15
</textarea>
<br />
</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"> 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="6"><strong>MAKE INVOICE:</strong></td></tr>
<tr>
<td colspan="3" align="right">For agent:</td>
<td colspan="3"><input type="text" size="30" name="ajtname" id="agentslist" /></td>
</tr>
<tr>
<td colspan="3" align="right"><strong>Amount</strong> :</td>
<td colspan="3"><input type="text" name="amount">/- INR</td>
</tr>
<tr>
<td colspan="3" align="right"> Discount:<em>(in %age)</em></td>
<td colspan="3"> <input type="text" name="discount" size="4" value="0" onFocus="this.value=''"> %</td>
</tr>
<tr>
<td colspan="3" align="right"><input type="checkbox" name="stax" value="yes"> ServiceTax :</td>
<td colspan="3"><input type="text" name="srtax" value="10.3" size="4">%</td>
</tr>
<?php
}
?>
<tr><td colspan="6"><br><center><input type="submit" value="» Confirm details »" class="amo-submit"></center></td></tr>
</table>
</form>
PK 99