2@include('inc.header')
<form method="post" name="login"  action="https://www.cee.kerala.gov.in/kmatonlineS22026/forgetapplno_check" autocomplete="off">
<input type="hidden" name="_token" value="o7oxE690OGnv91R1ehJEDQNQWQLKSKRYrirDwYCT">
<div class="container" style="width:70%">


    <div class="card border-light mb-3" style="margin:5%;">
  <div class="card-header">Forgot Application Number</div>
  <div class="card-body">
  <fieldset style="margin-top:3%;">
    
         
    
    <div class="row">
      <label for="select" class="col-lg-3 control-label">Name of Candidate<span class="required">*</span></label>
      <div class="col-lg-9">
      <input type="text" class="form-control" name="Name" id="Name" value="" placeholder="Enter the Name of Candidate" >
             </div>
      </div>      
     
      
    <div class="row">
      <label for="select" class="col-lg-3 control-label">Date of Birth<span class="required">*</span></label>
      <div class="col-lg-3">
        
        
        <select name="day" id="day" class="form-control">
            <option value="">Select Day</option>
            <option  value="01">01</option><option  value="02">02</option><option  value="03">03</option><option  value="04">04</option><option  value="05">05</option><option  value="06">06</option><option  value="07">07</option><option  value="08">08</option><option  value="09">09</option><option  value="10">10</option><option  value="11">11</option><option  value="12">12</option><option  value="13">13</option><option  value="14">14</option><option  value="15">15</option><option  value="16">16</option><option  value="17">17</option><option  value="18">18</option><option  value="19">19</option><option  value="20">20</option><option  value="21">21</option><option  value="22">22</option><option  value="23">23</option><option  value="24">24</option><option  value="25">25</option><option  value="26">26</option><option  value="27">27</option><option  value="28">28</option><option  value="29">29</option><option  value="30">30</option><option  value="31">31</option>        </select>
		</div>
             
      <div class="col-lg-3">
        <select name="month" id="month" class="form-control">
    <option value="">Select Month</option>
    <option  value="01">January</option><option  value="02">February</option><option  value="03">March</option><option  value="04">April</option><option  value="05">May</option><option  value="06">June</option><option  value="07">July</option><option  value="08">August</option><option  value="09">September</option><option  value="10">October</option><option  value="11">November</option><option  value="12">December</option></select>
        
      </div>
             <div class="col-lg-3">
        
<!-- displaying the dropdown list -->
<select name="year" id="year" class="form-control">
    <option value="">Select Year</option>
    <option  value="2006">2006</option><option  value="2005">2005</option><option  value="2004">2004</option><option  value="2003">2003</option><option  value="2002">2002</option><option  value="2001">2001</option><option  value="2000">2000</option><option  value="1999">1999</option><option  value="1998">1998</option><option  value="1997">1997</option><option  value="1996">1996</option><option  value="1995">1995</option><option  value="1994">1994</option><option  value="1993">1993</option><option  value="1992">1992</option><option  value="1991">1991</option><option  value="1990">1990</option><option  value="1989">1989</option><option  value="1988">1988</option><option  value="1987">1987</option><option  value="1986">1986</option><option  value="1985">1985</option><option  value="1984">1984</option><option  value="1983">1983</option><option  value="1982">1982</option><option  value="1981">1981</option><option  value="1980">1980</option><option  value="1979">1979</option><option  value="1978">1978</option><option  value="1977">1977</option><option  value="1976">1976</option><option  value="1975">1975</option><option  value="1974">1974</option><option  value="1973">1973</option><option  value="1972">1972</option><option  value="1971">1971</option><option  value="1970">1970</option><option  value="1969">1969</option><option  value="1968">1968</option><option  value="1967">1967</option><option  value="1966">1966</option><option  value="1965">1965</option><option  value="1964">1964</option><option  value="1963">1963</option><option  value="1962">1962</option><option  value="1961">1961</option><option  value="1960">1960</option><option  value="1959">1959</option><option  value="1958">1958</option><option  value="1957">1957</option><option  value="1956">1956</option><option  value="1955">1955</option><option  value="1954">1954</option><option  value="1953">1953</option><option  value="1952">1952</option><option  value="1951">1951</option><option  value="1950">1950</option><option  value="1949">1949</option><option  value="1948">1948</option><option  value="1947">1947</option><option  value="1946">1946</option><option  value="1945">1945</option><option  value="1944">1944</option><option  value="1943">1943</option><option  value="1942">1942</option><option  value="1941">1941</option></select>
        
      </div>
            

    </div>
    
    
    
     <div class="row">
      <label for="select" class="col-lg-3 control-label">Mobile Number<span class="required">*</span></label>
      <div class="col-lg-9">
        <input type="text" class="form-control" name="Mobile" maxlength="10" id="Mobile" placeholder="Enter the Registered Mobile Number" />
              </div>
     </div>
     
      
     
     <div class="row">
     	<label for="select" class="col-lg-3 control-label">Access Code<span class="required">*</span></label>
     	<div class="col-lg-5">
      	<input type="text" class="form-control" name="captcha" id="captcha" placeholder="Type the charaters as in the image">
              	 </div>
      <div class="col-lg-4"><img src="https://www.cee.kerala.gov.in/kmatonlineS22026/captcha/image?745884299"
     alt="https://github.com/igoshev/laravel-captcha"
     style="cursor:pointer;width:180px;height:50px;"
     title="Update"
     onclick="this.setAttribute('src','https://www.cee.kerala.gov.in/kmatonlineS22026/captcha/image?745884299?_='+Math.random());var captcha=document.getElementById('captcha');if(captcha){captcha.focus()}"
>
</div>
     
    </div>
          <div class="row">
     <div class="col-lg-3"></div>
     <div class="col-lg-6">
    <button type="submit" name="submit" id="submit" class="btn btn-primary">Submit</button>
    </div></div>
   
    
  </fieldset>
  </div></div>
  </div>
</form>

<div class="row bg-light"  style="margin-top:5%;text-align:center;">
    <div class="col-lg-2"></div>
     <div class="col-lg-8" style="font-size:11px;font-style:italic;">
    Site owned by : <a href="http://www.cee-kerala.org" target="_blank" >CEE KERALA</a> 
    </div>
     <div class="col-lg-2"></div> 
  </div>
</body>
</html>

<script type="text/javascript">
$("#submit").click(function(){
							
	if($('#Name').val()=='')
	{
		alert("Please Enter Your Name");
		$('#Name').focus();
		return false;
	}
	else if($('#day').val()=='')
	{
		alert('Please Select Day');
		$('#day').focus();
		return false;
	}
	else if($('#month').val()=='')
	{
		alert('Please Select Month');
		$('#month').focus();
		return false;
	}
	else if($('#year').val()=='')
	{
		alert('Please Select the Year');
		$('#year').focus();
		return false;
	}
	else if($('#Mobile').val()=='')
	{
		alert('Please Enter Mobile Number');
		$('#Mobile').focus();
		return false;
	}
	else if($('#captcha').val()=='')
	{
		alert('Please Ener Access Code');
		$('#captcha').focus();
		return false;
	}
	

});

 $(document).ready(function() {
 $(':input').bind('copy paste cut',function(e) { 
 e.preventDefault(); //disable cut,copy,paste
 alert('This function is not allowed here..!!');
 });
});


$(document).ready(function() {
	
	// 1 Capitalize string - convert textbox user entered text to uppercase
	$('#Name').keyup(function() {
		$(this).val($(this).val().toUpperCase());
	});
});


 $(function () {
      $('#Name').keydown(function (e) {
          if (e.ctrlKey || e.altKey) {//e.shiftKey || 
              e.preventDefault();
          } else {
              var key = e.keyCode;
              if (!((key == 8) || key == 9 || (key == 222) || (key == 32)  || (key == 190) || (key == 46) || (key >= 35 && key <= 40) || (key >= 65 && key <= 90))) {
                  e.preventDefault();
              }
          }
      });
  });
  
  
  $("#Mobile").keypress(function (e) {
 //if the letter is not digit then display error and don't type anything
 if (e.which != 8 && e.which != 0 && (e.which < 48 || e.which > 57)) {
	//display error message
	//$("#errmsg").html("Please Enter Digits Only").show().fadeOut("slow");
		   return false;
}
});
history.pushState(null, null, location.href);
    window.onpopstate = function () {
        history.go(1);
    };

</script>