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<?php require_once('include/header.php') ?> <?php require_once('include/navbar.php') ?> <?php require_once('include/connection.php') ?> <!-- Section 1 starts from here --> <section class="position-1" style="background-color:#f9ed817d"> <div class="container"> <h2 align="center">TRACE LOST FSSAI CERTIFICATE ONLINE</h2> <hr style="background-color: #000 !important; margin: 30px 500px 30px 500px;"> <div class="card-deck"> <div class="card" style="border: 1px solid #00a33e !important;box-shadow: 0 4px 8px 0 rgba(0, 0, 0, 0.2), 0 6px 20px 0 rgba(0, 0, 0, 0.19); border-radius: 10px"> <div class="card-header" style="color: #fff; background-color:#00a33e !important; margin: 3px 3px 0px 3px; border-radius: 10px;" align="center"> <b style="font-size: 14px;">TRACE LOST FSSAI CERTIFICATE FORM</b> </div> <div class="card-body"> <form action="lost-fssai-certificate-submit.php" method="post"> <div class="form-row"> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label for="cus_name">Name of the applicant <span style="color: red;"></span></label> <input type="text" class="form-control" name="applicant_name" placeholder="Enter Your Name" required> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label for="cus_email">Email <span style="color: red;"></span></label> <input type="email" class="form-control" name="email_id" placeholder="Enter Your Email" required> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group m-15"> <label for="cus_phone">Phone <span style="color: red;"></span></label> <input type="number" id="numberInput" class="form-control" name="mobile_number" maxlength="10" minlength="10" placeholder="Enter Phone Number" required> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label for="busi_name">Name of Business<span style="color: red;"></span></label> <input type="text" class="form-control" name="busi_name" placeholder="Enter Your Business Name" required> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label>Complete Business Address <span style="color: red;"></span></label> <textarea type="text" class="form-control" name="busi_address" placeholder="Enter Your Business Address" required></textarea> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label>State <span style="color: red;"></span></label> <select class="form-control" name="state_id" id="state_id" required> <option value="" selected disabled>--Select State--</option> <?php $query = "SELECT * FROM `states` ORDER BY `name` ASC "; $all_states = mysqli_query($conn, $query); while ($state = mysqli_fetch_array($all_states, MYSQLI_ASSOC)) :; ?> <option value="<?php echo $state["code"]; ?>"> <?php echo $state["name"]; ?> </option> <?php endwhile; ?> </select> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label>District <span style="color: red;"></span></label> <select name="district" id="district" class="form-control" required> <option value="" selected disabled>--Select District--</option> <!-- Districts will be loaded here based on selected state --> </select> </div> </div> <div class="col-xl-6 col-lg-6 col-md-12 col-sm-12"> <div class="form-group"> <label>Pincode <span style="color: red;"></span></label> <input type="text" class="form-control" id="numberInput" name="pincode" maxlength="6" minlength="6" placeholder="Enter Your Pincode" required> </div> </div> <div class="col-xl-12 col-lg-12 col-md-12 col-sm-12"> <div class="form-group"> <label>Mention Licence Number Of The Certificate To Be Traced <span style="color: red;">*</span></label> <select name="check_licence" id="check_licence" onchange="selectFoodCategory()" class="form-control" required> <option value="" selected disabled>--Select Option--</option> <option value="Having License">I have License number with me</option> <option value="No Licesce">I don't have License number</option> </select> </div> </div> <div class="col-xl-12 col-lg-12 col-md-12 col-sm-12"> <div class="form-group txt" id="otheritem"> <label for="licence_no">Existing FSSAI License/Registration No </label> <input type="text" class="form-control" name="licence_no" placeholder="Enter License No."> </div> </div> <input type="hidden" name="form_name" value="Trace Lost FSSAI Certificate Form"> <input type="hidden" name="form_id" value="Trace_lost_fssai_certificate"> <button type="submit" type="button" class="btn btn-primary m-b-0" style="text-transform:capitalize;font-size:initial;border-radius: 10px;">Submit</button> </div> </form> </div> </div> <div class="card" style="border: 1px solid #00a33e !important;box-shadow: 0 4px 8px 0 rgba(0, 0, 0, 0.2), 0 6px 20px 0 rgba(0, 0, 0, 0.19); border-radius: 10px"> <div class="card-header" style="color: #fff; background-color:#00a33e !important; margin: 3px 3px 0px 3px; border-radius: 10px;" align="center"> <b style="font-size: 14px;">INSTRUCTION TO FILL TRACE LOST FSSAI CERTIFICATE FORM</b> </div> <div class="card-body"> <ul> <li><strong>Name Of Applicant / Company:</strong> Applicant Need To Mention His / Her Name Or Name Of Company In Application Form.</li> <li><strong>Email:</strong> Applicant Need To Mention His / Her Email Id To Receive Certificate And Acknowledgement.</li> <li><strong>Phone:</strong> Mention Correct Mobile Number In The Application Form.</li> <li><strong>Name Of Business:</strong> Candidates Are Required To Enter The Business Name For Certificate Tracing.</li> <li><strong>Business Address:</strong> Candidates Should Enter The Entire Address Of The Mentioned Business.</li> <li><strong>State:</strong> Select Correct State Of Operating Business.</li> <li><strong>District:</strong> Mention Correct District Of The Business.</li> <li><strong>Pincode:</strong> Mention Correct Pin Code Of The Business.</li> <li><strong>Mention The Licence Number Of The Certificate To Be Traced: </strong> Applicants Are Required To Mention The License Number Of The Certificate For Tracing.</li> </ul> </div> </div> </div> </div> </section> <?php require_once('include/footer.php') ?> <script> // For Other Food Category document.getElementById('otheritem').style.display = "none"; function selectFoodCategory() { var check_licence = document.querySelector('select[name="check_licence"]').value; if (check_licence === 'Having License') { document.getElementById('otheritem').style.display = "block"; } else { document.getElementById('otheritem').style.display = "none"; } } </script> <script src="https://code.jquery.com/jquery-3.6.0.min.js"></script> <script type="text/javascript"> $(document).ready(function() { $('#state_id').on('change', function() { var stateCode = $(this).val(); // alert(stateCode); if (stateCode) { $.ajax({ url: 'fetch_districts.php', type: 'POST', data: { state_code: stateCode }, success: function(data) { $('#district').html(data); } }); } else { $('#district').html('<option value="">--Select District--</option>'); } }); }); </script>

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