<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Application Form</title>

    <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.3/dist/css/bootstrap.min.css" rel="stylesheet">

    <style>
        body {
            background: #f2f2f2;
            font-family: Arial, sans-serif;
        }

        .form-wrapper {
            max-width: 900px;
            margin: 30px auto;
            background: #fff;
            border: 2px solid #444;
            padding: 20px;
        }

        .logo-box {
            width: 90px;
            height: 90px;
            border: 1px solid #ccc;
            text-align: center;
            padding-top: 10px;
            font-size: 13px;
            line-height: 1.2;
        }

        .company-title {
            font-size: 42px;
            font-weight: 700;
            color: #002060;
            line-height: 1;
        }

        .company-sub {
            font-size: 24px;
            font-weight: 700;
            color: #002060;
        }

        .red-text {
            color: #d40000;
            font-size: 14px;
            font-weight: 600;
        }

        .small-text {
            font-size: 13px;
            font-weight: 600;
        }

        .section-title {
            text-align: center;
            font-size: 24px;
            font-weight: 700;
            text-decoration: underline;
            margin: 15px 0;
        }

        .blue-table td,
        .blue-table th {
            border: 2px solid #00aaff !important;
            padding: 6px;
            vertical-align: middle;
        }

        .blue-table input,
        .blue-table textarea,
        .blue-table select {
            border: none;
            outline: none;
            width: 100%;
            background: transparent;
        }

        .signature-line {
            border-bottom: 1px solid #000;
            min-width: 220px;
            display: inline-block;
        }

        @media print {

            @page {
                size: A4 portrait;
                margin: 8mm;
            }

            html,
            body {
                width: 210mm;
                height: 297mm;
                background: white !important;
                margin: 0;
                padding: 0;
                font-size: 11px;
            }

            body * {
                visibility: hidden;
            }

            .form-wrapper,
            .form-wrapper * {
                visibility: visible;
            }

            .form-wrapper {
                position: absolute;
                left: 0;
                top: 0;
                width: 100%;
                margin: 0;
                padding: 8px;
                border: none !important;
                box-shadow: none !important;
            }

            .no-print {
                display: none !important;
            }

            table {
                width: 100% !important;
                border-collapse: collapse !important;
                page-break-inside: avoid;
            }

            tr,
            td,
            th {
                page-break-inside: avoid !important;
                break-inside: avoid;
                padding: 3px !important;
                font-size: 10px;
            }

            input,
            textarea {
                border: none !important;
                font-size: 10px;
                padding: 0 !important;
                margin: 0 !important;
            }

            .company-title {
                font-size: 28px !important;
            }

            .company-sub {
                font-size: 16px !important;
            }

            .section-title {
                font-size: 18px !important;
                margin: 8px 0 !important;
            }

            hr {
                margin: 5px 0;
            }

            textarea {
                resize: none;
                height: auto !important;
            }

        }
    </style>
</head>

<body>

    <div class="container">
        <div class="form-wrapper">

            <form id="appForm">

                <!-- HEADER SECTION (JUSTIFIED TEXT) -->
                <style>
                    .header-table {
                        width: 100%;
                        border-collapse: collapse;
                        margin-bottom: 10px;
                    }

                    .header-table td {
                        vertical-align: top;
                    }

                    .logo-cell {
                        width: 18%;
                        text-align: center;
                    }

                    .text-cell {
                        width: 82%;
                        text-align: center;
                        padding-left: 10px;
                    }

                    .logo-box {
                        width: 80px;
                        height: 80px;
                        border: 1px solid #dcdcdc;
                        margin: auto;
                        padding: 6px;
                        font-size: 12px;
                        line-height: 1.1;
                    }

                    .logo-icon {
                        font-size: 38px;
                        line-height: 1;
                    }

                    .company-title {
                        font-size: 42px;
                        font-weight: 700;
                        color: #002060;
                        line-height: 1;
                        margin: 0;
                    }

                    .company-sub {
                        font-size: 24px;
                        font-weight: 700;
                        color: #002060;
                        margin: 0;
                    }

                    .red-text {
                        color: #d90000;
                        font-size: 15px;
                        font-weight: 700;
                        margin: 2px 0;
                    }

                    .small-text {
                        font-size: 13px;
                        font-weight: 600;
                        margin: 2px 0;
                        text-align: justify;
                        text-justify: inter-word;
                    }

                    .center-line {
                        font-size: 13px;
                        font-weight: 600;
                        margin: 2px 0;
                        text-align: center;
                    }

                    .divider {
                        border: 0;
                        border-top: 1px solid #555;
                        margin: 10px 0;
                    }

                    @media print {

                        .logo-box {
                            width: 70px;
                            height: 70px;
                        }

                        .company-title {
                            font-size: 30px;
                        }

                        .company-sub {
                            font-size: 18px;
                        }

                        .red-text {
                            font-size: 12px;
                        }

                        .small-text,
                        .center-line {
                            font-size: 11px;
                        }
                    }
                </style>

                <table class="header-table">
                    <tr>

                        <td class="logo-cell">
                            <div class="logo-box">
                                <div class="logo-icon"><img src="<?php echo e(asset('assets/image')); ?>/logo.png" height="45px"
                                        alt="logo"></div>
                                OMiGa
                            </div>
                        </td>

                        <td class="text-cell">

                            <h1 class="company-title">OMIGA</h1>
                            <div class="company-sub">INTERNATIONAL PVT LTD</div>

                            <div class="red-text">
                                SUPPORTING : MG INTERNATIONAL PRIVATE LTD
                            </div>

                            <div class="small-text">
                                Corporate Office: No.28/12, 2nd Flr, 1st Floor, Old Sub Registrar Office Building,
                                Kidigekal Main Road, Sahakara Nagar Post, Bengaluru |

                                TC 28/627/6, Ram Tower, Sreekanteswaram, Fort P.O,
                                Thiruvananthapuram, Kerala
                            </div>

                            <div class="center-line">
                                Phone : 0471-3511006 &nbsp;&nbsp;|&nbsp;
                                Mob : 9533189883&nbsp;|

                                Email : omigaii@gmail.com &nbsp;&nbsp;|&nbsp;
                                Web : www.omigaii.com
                            </div>

                        </td>

                    </tr>
                </table>

                <hr class="divider">

                <div class="section-title">APPLICATION FORM</div>

                <!-- MAIN DETAILS -->
                <table class="table blue-table">
                    <tr>
                        <td width="50%">Name of Applicant</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Address with Pin Code</td>
                        <td><textarea rows="2" required></textarea></td>
                    </tr>

                    <tr>
                        <td>Email ID</td>
                        <td><input type="email" required></td>
                    </tr>

                    <tr>
                        <td>Phone No</td>
                        <td>
                            <div class="row">
                                <div class="col-md-6"><input type="text" required></div>
                                <!-- <div class="col-md-6"><b>Mob:</b> <input type="text" required></div> -->
                            </div>
                        </td>
                    </tr>

                    <tr>
                        <td>Bank Name and Branch</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Bank Account No.</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>IFSC Code</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>PAN No.</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Nominee Name</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Relation with the Applicant</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Nominee Address</td>
                        <td><textarea rows="2" required></textarea></td>
                    </tr>

                    <tr>
                        <td>Nominee Phone No.</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Introducer ID</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Introducer Name</td>
                        <td><input type="text" required></td>
                    </tr>
                </table>

                <!-- FUND TRANSFER -->
                <div class="text-center fw-bold mt-3 mb-2">Fund Transfer Details</div>

                <table class="table blue-table">
                    <tr>
                        <td width="60%">Advance Amount (in words and figures) Refundable</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Name of Fund Transferer</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>Specify Bank & Account No of the Sender</td>
                        <td><input type="text" required></td>
                    </tr>

                    <tr>
                        <td>
                            Mode of Payment (Cash / Cheque / NEFT / RTGS / etc):<br>

                            <label><input type="checkbox"> Cash</label>
                            <label><input type="checkbox"> Cheque</label>
                            <label><input type="checkbox"> NEFT/RTGS</label>
                            <label><input type="checkbox"> Bank Transfer</label>
                            <label><input type="checkbox"> Others</label>

                        </td>

                        <td>
                            Specify Transaction ID details
                            <input type="text" required>
                        </td>
                    </tr>
                </table>

                <!-- DECLARATION -->
                <div class="text-center fw-bold mt-3">DECLARATION</div>
                <div class="text-center small mb-4">
                    I agree and accept the terms and condition of Omiga International Private Limited
                </div>

                <div class="row mb-4">
                    <div class="col-md-6">
                        Place: <span class="signature-line"></span><br>
                        DATE: <span class="signature-line"></span>
                    </div>

                    <div class="col-md-6 text-end">
                        Signature: <span class="signature-line"></span><br>
                        NAME: <span class="signature-line"></span>
                    </div>
                </div>

                <!-- OFFICE USE -->
                <table class="table blue-table">
                    <tr>
                        <th colspan="2" class="text-center">For Office Use Only</th>
                    </tr>

                    <tr>
                        <td>Name of Business Head:</td>
                        <td>Name of Team Head:</td>
                    </tr>
                </table>

                <!-- BUTTONS -->
                <div class="text-center mt-4 no-print">
                    <button type="submit" class="btn btn-primary px-4">Submit</button>
                    <button type="button" onclick="window.print()" class="btn btn-dark px-4">Print</button>
                </div>

            </form>
        </div>
    </div>

    <script>
        document.getElementById("appForm").addEventListener("submit", function (e) {

            if (!this.checkValidity()) {
                e.preventDefault();
                e.stopPropagation();
                alert("Please fill all required fields before submitting.");
                this.reportValidity();
                return;
            }

            alert("All data entered successfully.");
        });
    </script>

</body>

</html><?php /**PATH /var/www/html/omiga_ipl/resources/views/Admin/view_application.blade.php ENDPATH**/ ?>