<?php $cn=$_REQUEST["cn"]; 
include('../db_con.php');
?>

<input type="hidden" name="child[]" id="childno" value='<?php echo $cn ;?>'>
<h3 class="page-title">	Dependent Information <button type="button" class="btn btn-danger dependantremove" style="padding: 2px 4px; float: right;"><i class="fa fa-minus-circle" aria-hidden="true"></i></button></h3>
	
	
							<div class="form-group">
							  	
								<label class="col-md-2 control-label">
									Visa Category: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									<select name="mainvisatype" id="mainvisatype" class="form-control" required>
									  	<option value=""> - Select -</option>
								
								<?php    
		                            $delrs = mysqli_query($con,"select * from main_visatype_table where mvisatype_status=1 order by mvisatype_name ASC");
                            		while($delrow=mysqli_fetch_array($delrs)){ 
                                
                                 	  	echo "<option value=".$delrow["mvisatype_id"]."> ".$delrow["mvisatype_name"]." </option>";
									  	
									} 
								?>	
									</select>	
                                
								</div>

								<label class="col-md-2 control-label">
									Visa Type: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									<select name="visatype<?php echo "ch".$cn ;?>" id="visatype" class="form-control dobb" required>
										<option value=""> - Select -</option>
									</select>														
                                
								</div>
							</div>	

	<h4>Personal Details </h4>
	<div class="form-group">

								<label class="col-md-2 control-label">
									Salutation: <!-- <span class="required">* </span> -->
								</label>

								<div class="col-md-3">
									<select name="salut<?php echo "ch".$cn ;?>" class="form-control" required>							  	
									  	<option value="MR."> Mr. </option>
									  	<option value="MRS."> Mrs. </option>
									  	<option value="MS."> Ms. </option>
									  	<option value="MSTR"> Mstr </option>
									  </select>
								</div>
								

							</div>
							
                            <div class="form-group">


								<label class="col-md-2 control-label">
									Surname: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									<input type="text" class="form-control" name="surname<?php echo "ch".$cn ;?>" placeholder="" required>
								</div>

								<label class="col-md-2 control-label">
									Given Name: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									<input type="text" class="form-control" name="gname<?php echo "ch".$cn ;?>" placeholder="" required>
								</div>

							</div> 
							<?php //echo $_REQUEST["cn"];?>
							<div class="form-group">


								<label class="col-md-2 control-label">
									Date of Birth: <span class="required">* </span>
								</label>

								<div class="col-md-3">
								    <input type="text" class="form-control date" style="text-transform: lowercase;" name="dob<?php echo "ch".$cn ;?>" id="dob" required data-inputmask="'alias': 'date'" />
									
								</div>

								<label class="col-md-2 control-label">
									Place of Birth: 
								</label>

								<div class="col-md-3">
									<input type="text" class="form-control" name="pob<?php echo "ch".$cn ;?>" placeholder="" >
								</div>

							</div> 

							<div class="form-group">


								<label class="col-md-2 control-label">
									Gender: <span class="required">* </span>
								</label>

								<div class="col-md-3">									
									  <select name="gender<?php echo "ch".$cn ;?>" class="form-control" required>
									  	<option value=""> - Select -</option>
									  	<option value="Male"> Male </option>
									  	<option value="Female"> Female </option>
									  </select>	
								
								</div>	

								<label class="col-md-2 control-label">
									Nationality: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									<input type="text" class="form-control" name="nation<?php echo "ch".$cn ;?>" placeholder="" required>
								</div>

							</div> 

							<div class="form-group">

								<label class="col-md-2 control-label">
									Passport Type: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									 <select name="passtype<?php echo "ch".$cn ;?>" class="form-control" required>
									  	<option value=""> - Select -</option>
									  	<option value="1"> Normal Passport </option>
									  	<option value="2"> Govt Passport </option>
									  </select>	
								</div>

								<label class="col-md-2 control-label">
									Passport No.: <span class="required">* </span>
								</label>

								<div class="col-md-3">
									<input type="text" class="form-control" name="passport<?php echo "ch".$cn ;?>" placeholder="" required>
								</div>

							</div>


							<div class="form-group">

								<label class="col-md-2 control-label">
									Passport Issue Date: 
								</label>

								<div class="col-md-3">
								    <input type="text" class="form-control date" style="text-transform: lowercase;" name="pissue_date<?php echo "ch".$cn ;?>" id="pissue_date"  data-inputmask="'alias': 'date'" />
																	
								</div>

								<label class="col-md-2 control-label">
									Passport Expire Date: <span class="required">* </span>
								</label>

								<div class="col-md-3">
										<input type="text" class="form-control date" style="text-transform: lowercase;" name="pexp_date<?php echo "ch".$cn ;?>" id="pexp_date" required data-inputmask="'alias': 'date'" />							
									
								</div>

							</div>
							

					