PK
<form action="certificate-nspm-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="8"> <center> <h3> FUMIGATION CERTIFICATE </h3></center>
</td>
</tr>
<tr>
<td colspan="8" class="safe">This is to certify that the goods deseibed below were treated in accordance with the fumigation treatment requirements of importing country USA and declared that the consignment has been verified free of impervious surfaces/layers such as plastic wrapping or laminated plastic films,lacqured or painted surface,aluminium foil,tarred or waxed paper etc.that may adversely effect the penetration of the fumigant, prior to fumigation.</td>
</tr>
<tr>
<td valign="top" colspan="4">Dte PPQS Regd.No.:104/MB</td>
<td valign="top" colspan="4">Date:28-11-2005</td>
</tr>
<tr>
<td valign="top" colspan="4">Treatment Certificate No.: <em>Auto assigned</em></td>
<td colspan="4">Date:<input type="text" name="dat" class="datepicker" value="<?php echo date('d/m/Y'); ?>"> </td>
</tr>
<tr>
<td valign="top" colspan="4"><b>Name & Address Of Consignor/Exporter</b>:<br/><?php client_details($_POST['clntid']); ?></td>
<td valign="top" colspan="4"><b>Name & Address Of Consignee/Importer</b>:<br/><?php client_details($_POST['clntid2']); ?></td>
</tr>
<tr><td colspan="8" align="center">
<font color="#339933"><strong>DETAILS OF TREATMENT:</strong></font></td>
</tr>
<tr>
<td colspan="2">Name of fumigation:<br></td><td colspan="2"><select name="namefumigant">
<option>METHYL BROMIDE</option>
<option>ALUMINIUM PHOSPHIDE</option>
</select>
</td>
<td colspan="2">Dosage rate of fumigation:<br></td><td colspan="2"><select name="dosagefumigant">
<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>
</tr>
<tr>
<td colspan="2">Date and Place of Fumigation:<br></td><td colspan="2"><input type="text" name="datefumigantion"></td>
<td colspan="2">Duration of Exposure:<br></td><td colspan="2"><select name="durationfumigantion">
<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">Temparure During Fumigation:</td><td colspan="2"><input type="text" name="temp"></td>
<td valign="top" colspan="2">Volume:</td><td colspan="2"><input type="text" name="volume"></td>
</tr>
<tr>
<td valign="top" colspan="2">Fumigation Performed under Gastight Sheets:</td><td colspan="2"><input type="text" name="gsheet"></td>
<td valign="top" colspan="2">If Containers are not fumigated Under
Gas-Tight sheers,Pressure decay Value
(From 200-100 Pascal's Insecond:</td><td colspan="2"><input type="text" name="value"></td>
</tr>
<tr><td colspan="8" align="center"><strong>Descripition of Goods</strong></td></tr>
<tr>
<td valign="top" colspan="4">Container Number(or Numerical Link)./
Seal Number:</td><td colspan="4"><input type="text" name="seelno"></td>
</tr>
<tr>
<td valign="top" colspan="4">Port of Discharge:</td><td colspan="4"><input type="text" name="port"></td>
</tr>
<tr>
<td valign="top" colspan="4">Vessal Name:</td><td colspan="4"><input type="text" name="vessal"></td>
</tr>
<tr>
<td valign="top" colspan="4">Type and Description of Cargo:</td><td colspan="4"><input type="text" name="desc"></td>
</tr>
<tr>
<td valign="top" colspan="4">Quantity(MTS)/No Of Packages/No Of Pieces:</td><td colspan="4"><input type="text" name="quantity"></td>
</tr>
<tr>
<td valign="top" colspan="4">Description Of Packing Material:</td><td colspan="4"><input type="text" name="packing"></td>
</tr>
<tr>
<td valign="top" colspan="4">Skaning marks or Brand:</td><td colspan="4"><input type="text" name="brand"></td>
</tr>
<tr>
<td valign="top" colspan="4">Invoce No.& Date:</td><td colspan="4"><input type="text" name="invoice"></td>
</tr>
<tr>
<td valign="top" colspan="8" align="center">P.S.No Liability to the Certifying or Its proprietors or repersentative with Respect
to this Certificate.
</td></tr><tr>
<td colspan="8" align="center">Recognisede by:: Government of India</td>
</tr>
<tr>
<td colspan="8"> <b>Number of Containers</b> </td>
</tr>
<tr>
<td colspan="8"> 20’ <input type="text" name="container20feet" /> <br /><br />
40’ <input type="text" name="container40feet" /> <br /><br />
40HC <input type="text" name="container40HC" /> <br /><br />
LCL <input type="text" name="containerLCL" /> <br /><br />
</td>
</tr>
<?php
if(isset($_POST['subc_id']) && $_POST['subc_id']!=''){
echo "";
}
else{
?>
<tr><td colspan="8"><strong>MAKE INVOICE:</strong></td></tr>
<tr><td colspan="4" align="right">For agent:-</td><td colspan="4"><input type="text" size="30" name="ajtname" id="agentslist" /></td></tr>
<tr><td colspan="4" align="right"><strong>Amount</strong> :</td>
<td colspan="4"><input type="text" name="amount">/- INR</td></tr>
<tr>
<td colspan="4" align="right"> Discount:<em>(in %age)</em></td>
<td colspan="4"><input type="text" name="discount" size="4" value="0" onfocus="this.value=''">%</td>
</tr>
<tr><td colspan="4" 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>
<?php
}
?>
<tr><td colspan="8"><br><center><input type="submit" value="» Confirm details »" class="amo-submit"></center></td></tr>
</table>
</form>
PK 99