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<!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta http-equiv="X-UA-Compatible" content="IE=edge"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>G.e.M Registration</title> <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/css/bootstrap.min.css"> <link rel="stylesheet" href="/assets/css/main.css"> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script> <script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.min.js"></script> <script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/js/bootstrap.min.js"></script> <?php include('header.php');?> <!-- <?php echo $userIp = $_SERVER['REMOTE_ADDR']; ;?> --> </head> <body> <div class="container-fluid"> <div class="row"> <div class="col-12 col-lg-6"> <div class="container-fluid fchd text-center pt-2 mt-5"><h2 class="font-weight-bold"> Registration Form For (G.e.M)</h2></div> <form id="main-form" action="/submit.php" method="post" enctype="multipart/form-data"> <div class="form-group txt"> <label>Name Of Authorized Person<span class="required"> </span></label> <input type="text" class="form-control" name="applicant_name" value=""required> </div> <div class="form-group txt"> <label>E-Mail ID<span class="required"> </span></label> <input type="email" class="form-control" name="email_id"value=""required> </div> <div class="form-group txt"> <label>Mobile Number<span class="required"> </span></label> <input type="tel" maxlength="10" minlength="10" class="form-control" name="mobile_number" value="" required=""> </div> <div class="form-group txt"> <label>Date Of Birth<span class="required"> </span></label> <input type="date" class="form-control" name="dob" value=""> </div> <!-- <div class="form-group txt"> <label>PAN CARD NUMBER<span class="required"> </span></label> <input type="tel"id="mobile" maxlength="10" minlength="10"class="form-control" name="mobile_number"value=""required> </div> --> <div class="form-group txt"> <label>Business / Organization Name<span class="required"> </span></label> <input type="text" class="form-control" name="business_name" value=""> </div> <div class="form-group txt"> <label>Business / Organization Type<span class="required"> </span></label> <select class="form-control" name="type_of_organisation"> <option value="">Select Type</option> <option value="Proprietorship">Sole Proprietor</option> <option value="Partnership Firm">Partnership Firm</option> <option value="Private Limited">Private Limited</option> <option value="Public Limited">Public Limited</option> <option value="One Person Company">One Person Company</option> <option value="Limited Liability Partnership">Limited Liability Partnership</option> <option value="Others">Others</option> </select> </div> <div class="form-group txt"> <label>INCORPORATION DATE<span class="required"> </span></label> <input type="text" name="incorporation_date" class="form-control" placeholder="dd/mm/yyyy" size="10" maxlength="10" onkeyup="this.value=this.value.replace(/^(\d\d)(\d)$/g,'$1/$2').replace(/^(\d\d\/\d\d)(\d+)$/g,'$1/$2').replace(/[^\d\/]/g,'')" value=""> </div> <div class="form-group txt"> <label>Business Pan Number(Not applicable for Proprietor)<span class="required"> </span></label> <input type="text" class="form-control" name="pan_card_number" pattern="(^([a-zA-Z]{5})([0-9]{4})([a-zA-Z]{1})$)" oninvalid="this.setCustomValidity('invalid pan number!')" oninput="this.setCustomValidity('')" value="" required=""> </div> <div class="form-group txt"> <label>BUSINESS OFFICE ADDRESS <span class="required"> </span></label> <input type="text" class="form-control" name="office_address" value="" required=""> </div> <div class="form-group txt"> <label>State <span class="required"> </span></label> <select id="office-state" size="1" class="form-control" name="office_state" onchange="makeSubmenuOffice(this.value)"required> <option value="">Select State</option> <option value="Andaman_And_Nicobar_Island">1. ANDAMAN AND NICOBAR ISLANDS / <code>अंदमान और निकोबार द्वीपसमूह</code></option> <option value="Andhra_Pradesh">2. ANDHRA PRADESH / आन्ध्र प्रदेश </option> <option value="Arunachal_Pradesh">3. ARUNACHAL PRADESH / अरुणाचल प्रदेश</option> <option value="Assam">4. ASSAM / असम</option> <option value="Bihar">5. BIHAR / बिहार</option> <option value="Chhattisgarh">6. CHHATTISGARH / छत्तीसगढ़</option> <option value="Chandigarh">7. CHANDIGARH / चंडीगढ़ </option> <option value="Dadara">8.DADAR AND NAGAR HAVELI / दादरा और नगर हवेली</option> <option value="Daman">9. DAMAN AND DIU / दमन और दीव</option> <option value="Delhi">10. DELHI / दिल्ली</option> <option value="Goa">11. GOA / गोवा</option> <option value="Gujarat">12. GUJARAT / गुजरात</option> <option value="Haryana">13. HARYANA / हरियाणा</option> <option value="Himachal_Pradesh">14. HIMACHAL PRADESH / हिमाचल प्रदेश</option> <option value="Jammu_and_Kashmir">15. JAMMU AND KASHMIR / जम्मू और कश्मीर</option> <option value="Jharkhand">16. JHARKHAND / झारखण्ड</option> <option value="Karnataka">17. KARNATAKA / कर्णाटक</option> <option value="Kerala">18. KERALA / केरल</option> <option value="Ladakh">19. LADAKH / लद्दाख</option> <option value="Lakshadweep">20. LAKSHADWEEP / लक्षद्वीप</option> <option value="Madhya_Pradesh">21. MADHYA PRADESH / मध्य प्रदेश</option> <option value="Maharashtra">22. MAHARASHTRA / महाराष्ट्र</option> <option value="Manipur">23. MANIPUR / मणिपुर</option> <option value="Meghalaya">24. MEGHALAYA / मेघालय</option> <option value="Mizoram">25. MIZORAM / मिज़ोरम</option> <option value="Nagaland">26. NAGALAND / नागालैण्ड</option> <option value="Odisha">27. ODISHA / ओड़िशा</option> <option value="Puducherry">28. PUDUCHERRY / पुडुचेरी</option> <option value="Punjab">29. PUNJAB / पंजाब</option> <option value="Rajasthan">30. RAJASTHAN / राजस्थान</option> <option value="Sikkim">31. SIKKIM / सिक्किम</option> <option value="Tamil_Nadu">32. TAMIL NADU / तमिलनाडु</option> <option value="Telangana">33. TELANGANA / तेलंगाना</option> <option value="Tripura">34. TRIPURA / त्रिपुरा</option> <option value="Uttar_Pradesh">35. UTTAR PRADESH / उत्तर प्रदेश</option> <option value="Uttarakhand">36. UTTARAKHAND / उत्तराखण्ड</option> <option value="West_Bengal">37. WEST BENGAL / पश्चिम बंगाल</option> </select> </div> <div class="form-group txt"> <label>District / जिला <span class="required"> </span></label> <select class="form-control" name="office_district" id="office-district"required> <option value="" selected="selected">Select District</option> </select> </div> <div class="form-group txt"> <label>Pin Code <span class="required"> </span></label> <input type="text" maxlength="6" class="form-control" name="office_pincode" value="" required=""> </div> <div class="form-group txt"> <label>AADHAAR NUMBER<span class="required"> </span></label> <input type="text" class="form-control" maxlength="12" minlength="12" name="aadhaar_number" value="" required=""> </div> <!-- <div class="form-group"> <label>Do you Have MSME?</label> <input type="radio"name="sel-msme"value="yes"> Yes <input type="radio"name="sel-msme"value="yes"checked> No </div> <hr> <div class="form-group"> <label>Do you Have GST Number?</label> <input type="radio"name="sel-msme"value="yes"onclick="turnovers(0)"> Yes <input type="radio"name="sel-msme"value="no"onclick="turnovers(1)" checked> No </div> <div id="turnover1"style="display:none"> <div class="form-group txt"> <label>GST Number <span class="required"> </span></label> <input type="email" class="form-control" name="email_id"value=""required> </div> </div> --> <div class="form-group txt"> <label>BANK Name <span class="required"> </span></label> <input type="text" class="form-control" name="bank_name" value=""> </div> <div class="form-group txt"> <label>BANK A/C Number <span class="required"> </span></label> <input type="text" class="form-control" name="bank_account_number" value=""> </div> <div class="form-group txt"> <label>BANK IFSC CODE <span class="required"> </span></label> <input type="text" class="form-control" name="ifsc_code" value=""> </div> <div class="form-group txt"> <label>Bank Address <span class="required"> *</span></label> <input type="text" class="form-control" name="bank_address" value=""> </div> <div class="form-group form-check"> <input type="checkbox" class="form-check-input" name="terms_of_service"required> <label class="form-check-label">I AGREE TO THE <a href="./terms-of-service.php">TERMS OF SERVICE</a> <span class=" txt">[UPDATED]</span></label> </div> <input type="hidden" class="form-control" name="form_name" value="GEM Registration"> <input type="hidden" class="form-control" name="form_id" value="gem_registration"> <button type="submit" class="btn btn-custom text-white">Submit Application</button> </form> </div> <div class="col-12 col-lg-6 instruc"> <div class="container fchd text-center pt-2"><h2>Guidelines to Apply on G.e.M Portal</h2></div> <div class="form-instructions"> <div class="form-group" style="margin-top: 10px;"> <label class="fcs-text-dark"><strong>Name of Authorized Person :</strong> Enter the Name of Owner/ Director/ Authorized Person, strictly as per Aadhaar Card or Pan Card</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>PAN / Aadhaar Number of Authorized Person :</strong> Enter Pan / Aadhaar Card Number of Authorized Person or Company (If Available). </label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Email ID :</strong> Enter a valid email address of Authorized Person, Our Executive will call to verify Email OTP</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Mobile Number :</strong> Enter valid 10 Digit mobile number of Authorized Person, Our Executive will call to verify mobile OTP.</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Date Of Birth :</strong> Select Date of Birth as per your Pan card record (Company Formation date for company having Pan Card). </label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Name of Organization :</strong> Enter the Name of the Organization/Business, As per Pan Card. </label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Type Of Organization :</strong> Select type of Organization of your Business </label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Date of Incorporation :</strong> Select date of Registration of your Business </label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>BUSINESS PAN NUMBER :</strong> Enter BUSINESS PAN NUMBER</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>BUSINESS OFFICE ADDRESS :</strong> Applicants must have to provide valid details according to their registration proof provided in the address of the business firm. </label> </div> <!-- <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Street :</strong> Enter Street Of Organization </label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Area :</strong> Enter Area Of Organization </label> </div> --> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Select State :</strong>Select state of your Business.</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Select District :</strong> Select district of your Business. </label> </div> <div class="form-group" style="margin-top: 15px; display: none"> <label class="fcs-text-dark"><strong>Enter City :</strong> Enter city of your Business.</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Enter Pin Code :</strong> Enter Pin Code of your Business</label> </div> <!-- <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>GST :</strong> Select Whether you have GST or Not, If Yes Enter GST Number.</label> </div> --> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Account Holder Name :</strong> Enter Name as per Bank records (Current or Savings).</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>Account Number :</strong> Enter valid account Number of Bank.</label> </div> <div class="form-group" style="margin-top: 15px;"> <label class="fcs-text-dark"><strong>IFSC Code :</strong> Enter valid IFS Code of your Bank.</label> </div> </div> </div> <div class="container-fluid"> <br> <div class="fchd p-3">Steps to Register on G.e.M Portal</div> <br> <div class="card-columns"> <div class="card bg-primary"> <div class="card-body"> <p class="card-text"> <span class="step">1</span> Fill Application Form with Details</p> </div> </div> <div class="card bg-warning"> <div class="card-body"> <p class="card-text"> <span class="step">2</span> Make Online Payment</p> </div> </div> <div class="card bg-light"> <div class="card-body"> <p class="card-text"> <span class="step">3</span> Get Call for Profile & OTP verification </p> </div> </div> <div class="card bg-light"> <div class="card-body"> <p class="card-text"> <span class="step">4</span> Profile & Seller ID Creation</p> </div> </div> </div> </div> <?php include('footer.php');?> <script> function turnovers(vals){ if(vals==0){ // document.getElementById('turnover2').style.display='none'; document.getElementById('turnover1').style.display='block'; } else if(vals==1){ document.getElementById('turnover1').style.display='none'; } return; } </script> </body> <script src="/state.js"></script> </html>

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