<?php  $this->load->view('master/common/header.php',$data);
$base_name = $data['base_name'];
?>

    <div class="content">
        
        <!-- Start Content-->
        <div class="container-fluid">
            
            <!-- start page title -->
            <div class="row">
                <div class="col-12">
                    <div class="page-title-box">
                        <div class="page-title-right">
                            <ol class="breadcrumb m-0">
                                <li class="breadcrumb-item"><a href="javascript: void(0);"><?= $base_name;?></a></li>
                                <li class="breadcrumb-item active text-capitalize"><?= $page;?></li>
                            </ol>
                        </div>
                        <h4 class="page-title text-uppercase"><?= $page;?></h4>
                    </div>
                </div>
            </div>     
            <!-- end page title --> 

            <div class="row">
                <div class="col-md-6 col-xl-6">
                    <div class="card-box">
                        <div class="row">
                            <div class="col-sm-12">
                                <form class="form-horizontal" action="<?= base_url('master/cibil/getCibil');?>" method="post" enctype="multipart/form-data">
                                   
                                    <div class="form-group">
                                        <label for="userName">Name <span class="text-danger">*</span></label>
                                        <input type="text" name="name" required="" class="form-control" />
                                        <input type="hidden" name="txnid" required="" class="form-control" value="<?= rand(11111111,99999999);?>"/>
                                    </div>
                                    <div class="form-group">
                                        <label for="userName">Mobile Number<span class="text-danger">*</span></label>
                                        <input type="number" id="" name="mobile" required="" class="form-control" />
                                    </div>
                                     <div class="form-group">
                                        <label for="userName">Pan Number<span class="text-danger">*</span></label>
                                        <input type="text" id="" name="pan" required="" class="form-control" />
                                    </div>
                                    
                                    <div class="form-group">
                                        <label for="userName">DOB<span class="text-danger">*</span></label>
                                        <input type="date" id="" name="dob" required="" class="form-control" />
                                    </div>
                                    
                                     <div class="form-group">
                                        <label for="userName">Address<span class="text-danger">*</span></label>
                                        <input type="text" id="" name="address" required="" class="form-control" />
                                    </div>
                                    
                                     <div class="form-group">
                                        <label for="userName">Pincode<span class="text-danger">*</span></label>
                                        <input type="text" id="" name="pincode" required="" class="form-control" />
                                    </div>
                                    
            					    
                                    
                                    <div class="form-group text-center">
                                        <button type="submit" class="btn btn-success my-3">Get Cibil</button>
                                    </div>
                                
                                </form>
					        </div>
					    </div>
					</div>
				</div>
				<!-- /.col-md-6 -->
			</div>
			<!-- /.row -->
		</div>
		<!-- /.container-fluid -->
	</div>
	<!-- /.content -->
</div>
<!-- /.content-wrapper -->
<?php $this->load->view('master/common/footer.php'); ?>