{"id":1903,"date":"2019-04-30T18:20:59","date_gmt":"2019-04-30T18:20:59","guid":{"rendered":"http:\/\/lppcderabassi.org\/gallery1\/?page_id=1903"},"modified":"2022-08-10T11:46:45","modified_gmt":"2022-08-10T11:46:45","slug":"new-online-admission","status":"publish","type":"page","link":"https:\/\/lppcderabassi.org\/gallery1\/new-online-admission\/","title":{"rendered":"NEW ONLINE ADMISSION"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Online Admission<\/h3>\n                            <span class='gform_description'><\/span>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/gallery1\/wp-json\/wp\/v2\/pages\/1903#gf_1' ><div id='gf_page_steps_1' class='gf_page_steps'><div id='gf_step_1_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Personal Details<\/span><\/div><div id='gf_step_1_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Contact Details<\/span><\/div><div id='gf_step_1_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Qualification Details<\/span><\/div><div id='gf_step_1_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Document Upload<\/span><\/div><div id='gf_step_1_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>Bank Details<\/span><\/div><div id='gf_step_1_6' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'>Heard About Us ?<\/span><\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_1_1' class='gform_page' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_3\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_3\"><h2 class=\"gsection_title\">Personal Details<\/h2><\/li><li id=\"field_1_8\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_8\"><label class='gfield_label' for='input_1_8' >First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_137\"  class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_137\"><label class='gfield_label' for='input_1_137' >Last Name<\/label><div class='ginput_container ginput_container_text'><input name='input_137' id='input_1_137' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_21\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_21\"><label class='gfield_label' for='input_1_21' >Course Applied for<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_1_21' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='3 Year Diploma (Computer Science &amp; Engg.)' >3 Year Diploma (Computer Science &amp; Engg.)<\/option><option value='3 Year Diploma (Civil Eng.)' >3 Year Diploma (Civil Eng.)<\/option><option value='3 Year Diploma Electrical Engineering)' >3 Year Diploma Electrical Engineering)<\/option><option value='3 Year Diploma (Mechanical Engineering)' >3 Year Diploma (Mechanical Engineering)<\/option><option value='LEET 2nd Year\/3rd Sem (Computer Science &amp; Engg.)' >LEET 2nd Year\/3rd Sem (Computer Science &amp; Engg.)<\/option><option value='LEET 2nd Year\/3rd Sem ( Civil Eng.)' >LEET 2nd Year\/3rd Sem ( Civil Eng.)<\/option><option value='LEET 2nd Year\/3rd Sem (Electrical Engineering)' >LEET 2nd Year\/3rd Sem (Electrical Engineering)<\/option><option value='LEET 2nd Year\/3rd Sem (Mechanical Engineering)' >LEET 2nd Year\/3rd Sem (Mechanical Engineering)<\/option><option value='ITI (Electrician)' >ITI (Electrician)<\/option><option value='ITI (Refrigeration &amp; AC Mechanic)' >ITI (Refrigeration &amp; AC Mechanic)<\/option><option value='ITI (Fitter)' >ITI (Fitter)<\/option><option value='ITI (Welder)' >ITI (Welder)<\/option><option value='ITI (Instrument Mechanic)' >ITI (Instrument Mechanic)<\/option><option value='ITI (Computer Operator &amp; Prog. Assistant)' >ITI (Computer Operator &amp; Prog. Assistant)<\/option><option value='ITI (Wireman)' >ITI (Wireman)<\/option><option value='ITI (Electronics Mechanic)' >ITI (Electronics Mechanic)<\/option><\/select><\/div><\/li><li id=\"field_1_4\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_4\"><label class='gfield_label'  >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_4' class='ginput_container ginput_complex'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date' id='input_1_4_1_container'><select name='input_4[]' id='input_1_4_1'   aria-required='true'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date' id='input_1_4_2_container'><select name='input_4[]' id='input_1_4_2'   aria-required='true'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/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='gfield_date_dropdown_year ginput_container ginput_container_date' id='input_1_4_3_container'><select name='input_4[]' id='input_1_4_3'   aria-required='true'  ><option value=''>YYYY<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/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><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_1_138\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_138\"><label class='gfield_label' for='input_1_138' >Nationality<\/label><div class='ginput_container ginput_container_text'><input name='input_138' id='input_1_138' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_9\"  class=\"gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_9\"><label class='gfield_label' for='input_1_9' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_1_9' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/li><li id=\"field_1_5\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_5\"><label class='gfield_label gfield_label_before_complex'  >Father Name<\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_5'>\n                            <span id='input_1_5_3_container' class='name_first' >\n                                                    <input type='text' name='input_5.3' id='input_1_5_3' value=''   aria-required='false'    {\/>\n                                                    <label for='input_1_5_3' >First<\/label>\n                                               <\/span>\n                            <span id='input_1_5_6_container' class='name_last' >\n                                                    <input type='text' name='input_5.6' id='input_1_5_6' value=''   aria-required='false'    \/>\n                                                    <label for='input_1_5_6' >Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id=\"field_1_115\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_115\"><label class='gfield_label' for='input_1_115' >Father&#039;s Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_1_115' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_6\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_6\"><label class='gfield_label gfield_label_before_complex'  >Mother Name<\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_6'>\n                            <span id='input_1_6_3_container' class='name_first' >\n                                                    <input type='text' name='input_6.3' id='input_1_6_3' value=''   aria-required='false'    {\/>\n                                                    <label for='input_1_6_3' >First<\/label>\n                                               <\/span>\n                            <span id='input_1_6_6_container' class='name_last' >\n                                                    <input type='text' name='input_6.6' id='input_1_6_6' value=''   aria-required='false'    \/>\n                                                    <label for='input_1_6_6' >Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id=\"field_1_144\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_144\"><label class='gfield_label' for='input_1_144' >Mother&#039;s Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_144' id='input_1_144' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_7\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_7\"><label class='gfield_label' for='input_1_7' >Caste Category<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_1_7' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='GEN' >GEN<\/option><option value='SC\/ST' >SC\/ST<\/option><option value='OBC' >OBC<\/option><\/select><\/div><\/li><li id=\"field_1_143\"  class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_143\"><label class='gfield_label' for='input_1_143' >Aadhar Number<\/label><div class='ginput_container ginput_container_text'><input name='input_143' id='input_1_143' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_109' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_10\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_10\"><h2 class=\"gsection_title\">Contact Details<\/h2><\/li><li id=\"field_1_11\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><label class='gfield_label' for='input_1_11' >Permanent  Address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_1_11' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_101\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_101\"><label class='gfield_label' for='input_1_101' >State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_101' id='input_1_101' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Andaman and Nicobar Islands' >Andaman and Nicobar Islands<\/option><option value='Andhra Pradesh' >Andhra Pradesh<\/option><option value='Arunachal Pradesh' >Arunachal Pradesh<\/option><option value='Assam' >Assam<\/option><option value='Bihar' >Bihar<\/option><option value='Chandigarh' >Chandigarh<\/option><option value='Chhattisgarh' >Chhattisgarh<\/option><option value='Dadra and Nagar Haveli' >Dadra and Nagar Haveli<\/option><option value='Daman and Diu' >Daman and Diu<\/option><option value='Delhi' >Delhi<\/option><option value='Goa' >Goa<\/option><option value='Gujarat' >Gujarat<\/option><option value='Haryana' >Haryana<\/option><option value='Himachal Pradesh' >Himachal Pradesh<\/option><option value='Jammu and Kashmir' >Jammu and Kashmir<\/option><option value='Jharkhand' >Jharkhand<\/option><option value='Karnataka' >Karnataka<\/option><option value='Kerala' >Kerala<\/option><option value='Lakshadweep' >Lakshadweep<\/option><option value='Madhya Pradesh' >Madhya Pradesh<\/option><option value='Maharashtra' >Maharashtra<\/option><option value='Manipur' >Manipur<\/option><option value='Meghalaya' >Meghalaya<\/option><option value='Mizoram' >Mizoram<\/option><option value='Nagaland' >Nagaland<\/option><option value='Odisha' >Odisha<\/option><option value='Puducherry' >Puducherry<\/option><option value='Punjab' >Punjab<\/option><option value='Rajasthan' >Rajasthan<\/option><option value='Sikkim' >Sikkim<\/option><option value='Tamil Nadu' >Tamil Nadu<\/option><option value='Telengana' >Telengana<\/option><option value='Tripura' >Tripura<\/option><option value='Uttar Pradesh' >Uttar Pradesh<\/option><option value='Uttarakhand' >Uttarakhand<\/option><option value='West Bengal' >West Bengal<\/option><\/select><\/div><\/li><li id=\"field_1_102\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_102\"><label class='gfield_label' for='input_1_102' >District<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_1_102' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_114\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_114\"><label class='gfield_label' for='input_1_114' >City\/Village<\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_1_114' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_103\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_103\"><label class='gfield_label' for='input_1_103' >Pin Code<\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_1_103' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_17\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label' for='input_1_17' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_17' id='input_1_17' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_129\"  class=\"gfield gf_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_129\"><label class='gfield_label' for='input_1_129' >Country Code<\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_1_129' class='small gfield_select'     aria-invalid=\"false\" ><option value='AFGHANISTAN (+93)' >AFGHANISTAN (+93)<\/option><option value='ALBANIA (+355)' >ALBANIA (+355)<\/option><option value='ALGERIA (+213)' >ALGERIA (+213)<\/option><option value='AMERICAN SAMOA (+684)' >AMERICAN SAMOA (+684)<\/option><option value='ANDORRA (+376)' >ANDORRA (+376)<\/option><option value='ANGOLA (+244)' >ANGOLA (+244)<\/option><option value='ANGUILLA (+264)' >ANGUILLA (+264)<\/option><option value='ANTARCTICA (+672)' >ANTARCTICA (+672)<\/option><option value='ANTIGUA AND BARBUDA (+268)' >ANTIGUA AND BARBUDA (+268)<\/option><option value='ARGENTINA (+54)' >ARGENTINA (+54)<\/option><option value='ARMENIA (+374)' >ARMENIA (+374)<\/option><option value='ARUBA (+297)' >ARUBA (+297)<\/option><option value='AUSTRALIA (+61)' >AUSTRALIA (+61)<\/option><option value='AUSTRIA (+43) AZERBAIJAN (+994)' >AUSTRIA (+43) AZERBAIJAN (+994)<\/option><option value='BAHAMAS (+242)' >BAHAMAS (+242)<\/option><option value='BAHRAIN (+973)' >BAHRAIN (+973)<\/option><option value='BANGLADESH (+880)' >BANGLADESH (+880)<\/option><option value='BARBADOS (+246)' >BARBADOS (+246)<\/option><option value='BELARUS (+375)' >BELARUS (+375)<\/option><option value='BELGIUM (+32)' >BELGIUM (+32)<\/option><option value='BELIZE (+501)' >BELIZE (+501)<\/option><option value='BENIN (+229)' >BENIN (+229)<\/option><option value='BERMUDA (+441)' >BERMUDA (+441)<\/option><option value='BHUTAN (+975)' >BHUTAN (+975)<\/option><option value='BOLIVIA, PLURINATIONAL STATE OF (+591)' >BOLIVIA, PLURINATIONAL STATE OF (+591)<\/option><option value='BOSNIA AND HERZEGOVINA (+387)' >BOSNIA AND HERZEGOVINA (+387)<\/option><option value='BOTSWANA (+267)' >BOTSWANA (+267)<\/option><option value='BRAZIL (+55)' >BRAZIL (+55)<\/option><option value='BRUNEI DARUSSALAM (+673)' >BRUNEI DARUSSALAM (+673)<\/option><option value='BULGARIA (+359)' >BULGARIA (+359)<\/option><option value='BURKINA FASO (+226)' >BURKINA FASO (+226)<\/option><option value='BURUNDI (+257)' >BURUNDI (+257)<\/option><option value='CAMBODIA (+855)' >CAMBODIA (+855)<\/option><option value='CAMEROON (+237)' >CAMEROON (+237)<\/option><option value='CANADA (+1)' >CANADA (+1)<\/option><option value='CAPE VERDE (+238)' >CAPE VERDE (+238)<\/option><option value='CAYMAN ISLANDS (+345)' >CAYMAN ISLANDS (+345)<\/option><option value='CENTRAL AFRICAN REPUBLIC (+236)' >CENTRAL AFRICAN REPUBLIC (+236)<\/option><option value='CHAD (+235)' >CHAD (+235)<\/option><option value='CHILE (+56)' >CHILE (+56)<\/option><option value='CHINA (+86)' >CHINA (+86)<\/option><option value='CHRISTMAS ISLAND (+618)' >CHRISTMAS ISLAND (+618)<\/option><option value='COCOS (KEELING) ISLANDS (+61)' >COCOS (KEELING) ISLANDS (+61)<\/option><option value='COLOMBIA (+57)' >COLOMBIA (+57)<\/option><option value='COMOROS (+269)' >COMOROS (+269)<\/option><option value='CONGO (+242)' >CONGO (+242)<\/option><option value='CONGO, THE DEMOCRATIC (+243)' >CONGO, THE DEMOCRATIC (+243)<\/option><option value='COOK ISLANDS (+682)' >COOK ISLANDS (+682)<\/option><option value='COSTA RICA (+506)' >COSTA RICA (+506)<\/option><option value='C\u00d4TE D&#039;IVOIRE (+225)' >C\u00d4TE D&#039;IVOIRE (+225)<\/option><option value='CROATIA (+385)' >CROATIA (+385)<\/option><option value='CUBA (+53)' >CUBA (+53)<\/option><option value='CYPRUS (+357)' >CYPRUS (+357)<\/option><option value='CZECH REPUBLIC (+420)' >CZECH REPUBLIC (+420)<\/option><option value='DENMARK (+45)' >DENMARK (+45)<\/option><option value='DJIBOUTI (+253)' >DJIBOUTI (+253)<\/option><option value='DOMINICA (+767)' >DOMINICA (+767)<\/option><option value='DOMINICAN REPUBLIC (+809)' >DOMINICAN REPUBLIC (+809)<\/option><option value='East Timor  (+670)' >East Timor  (+670)<\/option><option value='ECUADOR (+593)' >ECUADOR (+593)<\/option><option value='EGYPT (+20)' >EGYPT (+20)<\/option><option value='EL SALVADOR (+503)' >EL SALVADOR (+503)<\/option><option value='EQUATORIAL GUINEA (+240)' >EQUATORIAL GUINEA (+240)<\/option><option value='ERITREA (+291)' >ERITREA (+291)<\/option><option value='ESTONIA (+372)' >ESTONIA (+372)<\/option><option value='ETHIOPIA (+251)' >ETHIOPIA (+251)<\/option><option value='FALKLAND ISLANDS (MALVINAS) (+500)' >FALKLAND ISLANDS (MALVINAS) (+500)<\/option><option value='FAROE ISLANDS (+298)' >FAROE ISLANDS (+298)<\/option><option value='FIJI (+679)' >FIJI (+679)<\/option><option value='FINLAND (+358)' >FINLAND (+358)<\/option><option value='FRANCE (+33)' >FRANCE (+33)<\/option><option value='FRENCH GUIANA (+594)' >FRENCH GUIANA (+594)<\/option><option value='FRENCH POLYNESIA (+689)' >FRENCH POLYNESIA (+689)<\/option><option value='GABON (+241)' >GABON (+241)<\/option><option value='GAMBIA (+220)' >GAMBIA (+220)<\/option><option value='GEORGIA (+995)' >GEORGIA (+995)<\/option><option value='GERMANY (+49)' >GERMANY (+49)<\/option><option value='GHANA (+233)' >GHANA (+233)<\/option><option value='GIBRALTAR (+350)' >GIBRALTAR (+350)<\/option><option value='GREECE (+30)' >GREECE (+30)<\/option><option value='GREENLAND (+299)' >GREENLAND (+299)<\/option><option value='GRENADA (+473)' >GRENADA (+473)<\/option><option value='GUADELOUPE (+590)' >GUADELOUPE (+590)<\/option><option value='GUAM (+671)' >GUAM (+671)<\/option><option value='GUATEMALA (+502)' >GUATEMALA (+502)<\/option><option value='GUINEA (+224)' >GUINEA (+224)<\/option><option value='GUINEA-BISSAU (+245)' >GUINEA-BISSAU (+245)<\/option><option value='GUYANA (+592)' >GUYANA (+592)<\/option><option value='HAITI (+509)' >HAITI (+509)<\/option><option value='HOLY SEE (VATICAN CITY STATE) (+379)' >HOLY SEE (VATICAN CITY STATE) (+379)<\/option><option value='HONDURAS (+504)' >HONDURAS (+504)<\/option><option value='HONG KONG (+852)' >HONG KONG (+852)<\/option><option value='HUNGARY (+36)' >HUNGARY (+36)<\/option><option value='ICELAND (+354)' >ICELAND (+354)<\/option><option value='INDIA (+91)' >INDIA (+91)<\/option><option value='INDONESIA (+62)' >INDONESIA (+62)<\/option><option value='IRAN, ISLAMIC REPUBLIC OF (+98)' >IRAN, ISLAMIC REPUBLIC OF (+98)<\/option><option value='IRAQ (+964)' >IRAQ (+964)<\/option><option value='IRELAND (+353)' >IRELAND (+353)<\/option><option value='ISRAEL (+972)' >ISRAEL (+972)<\/option><option value='ITALY (+39)' >ITALY (+39)<\/option><option value='JAMAICA (+876)' >JAMAICA (+876)<\/option><option value='JAPAN (+81)' >JAPAN (+81)<\/option><option value='JORDAN (+962)' >JORDAN (+962)<\/option><option value='KAZAKHSTAN (+7)' >KAZAKHSTAN (+7)<\/option><option value='KENYA (+254)' >KENYA (+254)<\/option><option value='KIRIBATI (+686)' >KIRIBATI (+686)<\/option><option value='KOREA, DEMOCRATIC(+850)' >KOREA, DEMOCRATIC(+850)<\/option><option value='KOREA, REPUBLIC OF (+82)' >KOREA, REPUBLIC OF (+82)<\/option><option value='KUWAIT (+965)' >KUWAIT (+965)<\/option><option value='KYRGYZSTAN (+996)' >KYRGYZSTAN (+996)<\/option><option value='LAO (+856)' >LAO (+856)<\/option><option value='LATVIA (+371)' >LATVIA (+371)<\/option><option value='LEBANON (+961)' >LEBANON (+961)<\/option><option value='LESOTHO (+266)' >LESOTHO (+266)<\/option><option value='LIBERIA (+231)' >LIBERIA (+231)<\/option><option value='LIBYA (+218)' >LIBYA (+218)<\/option><option value='LIECHTENSTEIN (+423)' >LIECHTENSTEIN (+423)<\/option><option value='LITHUANIA (+370)' >LITHUANIA (+370)<\/option><option value='LUXEMBOURG (+352)' >LUXEMBOURG (+352)<\/option><option value='MACAO (+853)' >MACAO (+853)<\/option><option value='MACEDONIA (+389)' >MACEDONIA (+389)<\/option><option value='MADAGASCAR (+261)' >MADAGASCAR (+261)<\/option><option value='MALAWI (+265)' >MALAWI (+265)<\/option><option value='MALAYSIA (+60)' >MALAYSIA (+60)<\/option><option value='MALDIVES (+960)' >MALDIVES (+960)<\/option><option value='MALI (+223)' >MALI (+223)<\/option><option value='MALTA (+356)' >MALTA (+356)<\/option><option value='MARSHALL ISLANDS (+692)' >MARSHALL ISLANDS (+692)<\/option><option value='MARTINIQUE (+596)' >MARTINIQUE (+596)<\/option><option value='MAURITANIA (+222)' >MAURITANIA (+222)<\/option><option value='MAURITIUS (+230)' >MAURITIUS (+230)<\/option><option value='MAYOTTE (+269)' >MAYOTTE (+269)<\/option><option value='MEXICO (+52)' >MEXICO (+52)<\/option><option value='MICRONESIA (+691)' >MICRONESIA (+691)<\/option><option value='MOLDOVA, REPUBLIC OF (+373)' >MOLDOVA, REPUBLIC OF (+373)<\/option><option value='MONACO (+377)' >MONACO (+377)<\/option><option value='MONGOLIA (+976)' >MONGOLIA (+976)<\/option><option value='MONTSERRAT (+664)' >MONTSERRAT (+664)<\/option><option value='MOROCCO (+212)' >MOROCCO (+212)<\/option><option value='MOZAMBIQUE (+258)' >MOZAMBIQUE (+258)<\/option><option value='MYANMAR (+95)' >MYANMAR (+95)<\/option><option value='NAMIBIA (+264)' >NAMIBIA (+264)<\/option><option value='NAURU (+674)' >NAURU (+674)<\/option><option value='NEPAL (+977)' >NEPAL (+977)<\/option><option value='NETHERLANDS (+31)' >NETHERLANDS (+31)<\/option><option value='Netherlands Antilles  (+599)' >Netherlands Antilles  (+599)<\/option><option value='NEW CALEDONIA (+687)' >NEW CALEDONIA (+687)<\/option><option value='NEW ZEALAND (+64)' >NEW ZEALAND (+64)<\/option><option value='NICARAGUA (+505)' >NICARAGUA (+505)<\/option><option value='NIGER (+227)' >NIGER (+227)<\/option><option value='NIGERIA (+234)' >NIGERIA (+234)<\/option><option value='NIUE (+683)' >NIUE (+683)<\/option><option value='NORFOLK ISLAND (+672)' >NORFOLK ISLAND (+672)<\/option><option value='NORTHERN MARIANA ISLANDS (+670)' >NORTHERN MARIANA ISLANDS (+670)<\/option><option value='NORWAY (+47)' >NORWAY (+47)<\/option><option value='OMAN (+968)' >OMAN (+968)<\/option><option value='PAKISTAN (+92)' >PAKISTAN (+92)<\/option><option value='PALAU (+680)' >PALAU (+680)<\/option><option value='PALESTINIAN TERRITORY, OCCUPIED (+970)' >PALESTINIAN TERRITORY, OCCUPIED (+970)<\/option><option value='aPANAMA (+507)' >aPANAMA (+507)<\/option><option value='PAPUA NEW GUINEA (+675)' >PAPUA NEW GUINEA (+675)<\/option><option value='PARAGUAY (+595)' >PARAGUAY (+595)<\/option><option value='PERU (+51)' >PERU (+51)<\/option><option value='PHILIPPINES (+63)' >PHILIPPINES (+63)<\/option><option value='POLAND (+48)' >POLAND (+48)<\/option><option value='PORTUGAL (+351)' >PORTUGAL (+351)<\/option><option value='PUERTO RICO (+939)' >PUERTO RICO (+939)<\/option><option value='QATAR (+974)' >QATAR (+974)<\/option><option value='R\u00c9UNION (+262)' >R\u00c9UNION (+262)<\/option><option value='ROMANIA (+40)' >ROMANIA (+40)<\/option><option value='RUSSIAN FEDERATION (+7)' >RUSSIAN FEDERATION (+7)<\/option><option value='RWANDA (+250)' >RWANDA (+250)<\/option><option value='SAINT HELENA (+290)' >SAINT HELENA (+290)<\/option><option value='SAINT KITTS AND NEVIS (+869)' >SAINT KITTS AND NEVIS (+869)<\/option><option value='SAINT LUCIA (+758)' >SAINT LUCIA (+758)<\/option><option value='SAINT PIERRE AND MIQUELON (+508)' >SAINT PIERRE AND MIQUELON (+508)<\/option><option value='SAINT VINCENT AND THE GRENADINES (+784)' >SAINT VINCENT AND THE GRENADINES (+784)<\/option><option value='SAN MARINO (+378)' >SAN MARINO (+378)<\/option><option value='SAO TOME AND PRINCIPE (+239)' >SAO TOME AND PRINCIPE (+239)<\/option><option value='SAUDI ARABIA (+966)' >SAUDI ARABIA (+966)<\/option><option value='SENEGAL (+221)' >SENEGAL (+221)<\/option><option value='SEYCHELLES (+248)' >SEYCHELLES (+248)<\/option><option value='SIERRA LEONE (+232)' >SIERRA LEONE (+232)<\/option><option value='SINGAPORE (+65)' >SINGAPORE (+65)<\/option><option value='SLOVAKIA (+421)' >SLOVAKIA (+421)<\/option><option value='SLOVENIA (+386)' >SLOVENIA (+386)<\/option><option value='SOLOMON ISLANDS (+677)' >SOLOMON ISLANDS (+677)<\/option><option value='SOMALIA (+252)' >SOMALIA (+252)<\/option><option value='SOUTH AFRICA (+27)' >SOUTH AFRICA (+27)<\/option><option value='SPAIN (+34)' >SPAIN (+34)<\/option><option value='SRI LANKA (+94)' >SRI LANKA (+94)<\/option><option value='SUDAN (+249)' >SUDAN (+249)<\/option><option value='SURINAME (+597)' >SURINAME (+597)<\/option><option value='SWAZILAND (+268)' >SWAZILAND (+268)<\/option><option value='SWEDEN (+46)' >SWEDEN (+46)<\/option><option value='SWITZERLAND (+41)' >SWITZERLAND (+41)<\/option><option value='SYRIAN ARAB REPUBLIC (+963)' >SYRIAN ARAB REPUBLIC (+963)<\/option><option value='TAIWAN, PROVINCE OF CHINA (+886)' >TAIWAN, PROVINCE OF CHINA (+886)<\/option><option value='TAJIKISTAN (+992)' >TAJIKISTAN (+992)<\/option><option value='TANZANIA, UNITED REPUBLIC OF (+255)' >TANZANIA, UNITED REPUBLIC OF (+255)<\/option><option value='THAILAND (+66)' >THAILAND (+66)<\/option><option value='TOGO (+228)' >TOGO (+228)<\/option><option value='TOKELAU (+690)' >TOKELAU (+690)<\/option><option value='TONGA (+676)' >TONGA (+676)<\/option><option value='TRINIDAD AND TOBAGO (+868)' >TRINIDAD AND TOBAGO (+868)<\/option><option value='TUNISIA (+216)' >TUNISIA (+216)<\/option><option value='TURKEY (+90)' >TURKEY (+90)<\/option><option value='TURKMENISTAN (+993)' >TURKMENISTAN (+993)<\/option><option value='TURKS AND CAICOS ISLANDS (+649)' >TURKS AND CAICOS ISLANDS (+649)<\/option><option value='UVALU (+688)' >UVALU (+688)<\/option><option value='UGANDA (+256)' >UGANDA (+256)<\/option><option value='UKRAINE (+380)' >UKRAINE (+380)<\/option><option value='UNITED ARAB EMIRATES (+971)' >UNITED ARAB EMIRATES (+971)<\/option><option value='UNITED KINGDOM (+44)' >UNITED KINGDOM (+44)<\/option><option value='UNITED STATES (+1)' >UNITED STATES (+1)<\/option><option value='URUGUAY (+598)' >URUGUAY (+598)<\/option><option value='UZBEKISTAN (+998)' >UZBEKISTAN (+998)<\/option><option value='VANUATU (+678)' >VANUATU (+678)<\/option><option value='VENEZUELA, BOLIVARIAN REPUBLIC OF (+58)' >VENEZUELA, BOLIVARIAN REPUBLIC OF (+58)<\/option><option value='VIET NAM (+84)' >VIET NAM (+84)<\/option><option value='VIRGIN ISLANDS, BRITISH (+284)' >VIRGIN ISLANDS, BRITISH (+284)<\/option><option value='VIRGIN ISLANDS, U.S. (+340)' >VIRGIN ISLANDS, U.S. (+340)<\/option><option value='WALLIS AND FUTUNA (+681)' >WALLIS AND FUTUNA (+681)<\/option><option value='YEMEN (+967)' >YEMEN (+967)<\/option><option value='Yugoslavia  (+381)' >Yugoslavia  (+381)<\/option><option value='ZAMBIA (+260)' >ZAMBIA (+260)<\/option><option value='ZIMBABWE (+263)' >ZIMBABWE (+263)<\/option><\/select><\/div><\/li><li id=\"field_1_135\"  class=\"gfield gf_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_135\"><label class='gfield_label' for='input_1_135' >STD Code<\/label><div class='ginput_container ginput_container_text'><input name='input_135' id='input_1_135' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_128\"  class=\"gfield gf_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_128\"><label class='gfield_label' for='input_1_128' >Phone No.<\/label><div class='ginput_container ginput_container_text'><input name='input_128' id='input_1_128' type='text' value='' class='medium' maxlength='10'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_131\"  class=\"gfield gf_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_131\"><label class='gfield_label' for='input_1_131' >Mobile 1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_131' id='input_1_131' type='text' value='' class='medium' maxlength='10'    aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_130\"  class=\"gfield gf_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_130\"><label class='gfield_label' for='input_1_130' >Mobile 2<\/label><div class='ginput_container ginput_container_text'><input name='input_130' id='input_1_130' type='text' value='' class='medium' maxlength='10'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_29\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_29\"><label class='gfield_label screen-reader-text gfield_label_before_complex'  ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_29'><li class='gchoice gchoice_1_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Tick same as Permanent  Address'  id='choice_1_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_29_1' id='label_1_29_1'>Tick same as Permanent  Address<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_22\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><label class='gfield_label' for='input_1_22' >Correspondence Address:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_1_22' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_100\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_100\"><label class='gfield_label' for='input_1_100' >State<\/label><div class='ginput_container ginput_container_select'><select name='input_100' id='input_1_100' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Andaman and Nicobar Islands' >Andaman and Nicobar Islands<\/option><option value='Andhra Pradesh' >Andhra Pradesh<\/option><option value='Arunachal Pradesh' >Arunachal Pradesh<\/option><option value='Assam' >Assam<\/option><option value='Bihar' >Bihar<\/option><option value='Chandigarh' >Chandigarh<\/option><option value='Chhattisgarh' >Chhattisgarh<\/option><option value='Dadra and Nagar Haveli' >Dadra and Nagar Haveli<\/option><option value='Daman and Diu' >Daman and Diu<\/option><option value='Delhi' >Delhi<\/option><option value='Goa' >Goa<\/option><option value='Gujarat' >Gujarat<\/option><option value='Haryana' >Haryana<\/option><option value='Himachal Pradesh' >Himachal Pradesh<\/option><option value='Jammu and Kashmir' >Jammu and Kashmir<\/option><option value='Jharkhand' >Jharkhand<\/option><option value='Karnataka' >Karnataka<\/option><option value='Kerala' >Kerala<\/option><option value='Lakshadweep' >Lakshadweep<\/option><option value='Madhya Pradesh' >Madhya Pradesh<\/option><option value='Maharashtra' >Maharashtra<\/option><option value='Manipur' >Manipur<\/option><option value='Meghalaya' >Meghalaya<\/option><option value='Mizoram' >Mizoram<\/option><option value='Nagaland' >Nagaland<\/option><option value='Odisha' >Odisha<\/option><option value='Puducherry' >Puducherry<\/option><option value='Punjab' >Punjab<\/option><option value='Rajasthan' >Rajasthan<\/option><option value='Sikkim' >Sikkim<\/option><option value='Tamil Nadu' >Tamil Nadu<\/option><option value='Telengana' >Telengana<\/option><option value='Tripura' >Tripura<\/option><option value='Uttar Pradesh' >Uttar Pradesh<\/option><option value='Uttarakhand' >Uttarakhand<\/option><option value='West Bengal' >West Bengal<\/option><\/select><\/div><\/li><li id=\"field_1_24\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\"><label class='gfield_label' for='input_1_24' >District<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_1_24' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_119\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_119\"><label class='gfield_label' for='input_1_119' >City\/Village<\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_1_119' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_25\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label' for='input_1_25' >Pin Code<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_1_25' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_134\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_134\"><label class='gfield_label' for='input_1_134' >Country Code<\/label><div class='ginput_container ginput_container_select'><select name='input_134' id='input_1_134' class='medium gfield_select'     aria-invalid=\"false\" ><option value='AFGHANISTAN (+93)' >AFGHANISTAN (+93)<\/option><option value='ALBANIA (+355)' >ALBANIA (+355)<\/option><option value='ALGERIA (+213)' >ALGERIA (+213)<\/option><option value='AMERICAN SAMOA (+684)' >AMERICAN SAMOA (+684)<\/option><option value='ANDORRA (+376)' >ANDORRA (+376)<\/option><option value='ANGOLA (+244)' >ANGOLA (+244)<\/option><option value='ANGUILLA (+264)' >ANGUILLA (+264)<\/option><option value='ANTARCTICA (+672)' >ANTARCTICA (+672)<\/option><option value='ANTIGUA AND BARBUDA (+268)' >ANTIGUA AND BARBUDA (+268)<\/option><option value='ARGENTINA (+54)' >ARGENTINA (+54)<\/option><option value='ARMENIA (+374)' >ARMENIA (+374)<\/option><option value='ARUBA (+297)' >ARUBA (+297)<\/option><option value='AUSTRALIA (+61)' >AUSTRALIA (+61)<\/option><option value='AUSTRIA (+43) AZERBAIJAN (+994)' >AUSTRIA (+43) AZERBAIJAN (+994)<\/option><option value='BAHAMAS (+242)' >BAHAMAS (+242)<\/option><option value='BAHRAIN (+973)' >BAHRAIN (+973)<\/option><option value='BANGLADESH (+880)' >BANGLADESH (+880)<\/option><option value='BARBADOS (+246)' >BARBADOS (+246)<\/option><option value='BELARUS (+375)' >BELARUS (+375)<\/option><option value='BELGIUM (+32)' >BELGIUM (+32)<\/option><option value='BELIZE (+501)' >BELIZE (+501)<\/option><option value='BENIN (+229)' >BENIN (+229)<\/option><option value='BERMUDA (+441)' >BERMUDA (+441)<\/option><option value='BHUTAN (+975)' >BHUTAN (+975)<\/option><option value='BOLIVIA, PLURINATIONAL STATE OF (+591)' >BOLIVIA, PLURINATIONAL STATE OF (+591)<\/option><option value='BOSNIA AND HERZEGOVINA (+387)' >BOSNIA AND HERZEGOVINA (+387)<\/option><option value='BOTSWANA (+267)' >BOTSWANA (+267)<\/option><option value='BRAZIL (+55)' >BRAZIL (+55)<\/option><option value='BRUNEI DARUSSALAM (+673)' >BRUNEI DARUSSALAM (+673)<\/option><option value='BULGARIA (+359)' >BULGARIA (+359)<\/option><option value='BURKINA FASO (+226)' >BURKINA FASO (+226)<\/option><option value='BURUNDI (+257)' >BURUNDI (+257)<\/option><option value='CAMBODIA (+855)' >CAMBODIA (+855)<\/option><option value='CAMEROON (+237)' >CAMEROON (+237)<\/option><option value='CANADA (+1)' >CANADA (+1)<\/option><option value='CAPE VERDE (+238)' >CAPE VERDE (+238)<\/option><option value='CAYMAN ISLANDS (+345)' >CAYMAN ISLANDS (+345)<\/option><option value='CENTRAL AFRICAN REPUBLIC (+236)' >CENTRAL AFRICAN REPUBLIC (+236)<\/option><option value='CHAD (+235)' >CHAD (+235)<\/option><option value='CHILE (+56)' >CHILE (+56)<\/option><option value='CHINA (+86)' >CHINA (+86)<\/option><option value='CHRISTMAS ISLAND (+618)' >CHRISTMAS ISLAND (+618)<\/option><option value='COCOS (KEELING) ISLANDS (+61)' >COCOS (KEELING) ISLANDS (+61)<\/option><option value='COLOMBIA (+57)' >COLOMBIA (+57)<\/option><option value='COMOROS (+269)' >COMOROS (+269)<\/option><option value='CONGO (+242)' >CONGO (+242)<\/option><option value='CONGO, THE DEMOCRATIC (+243)' >CONGO, THE DEMOCRATIC (+243)<\/option><option value='COOK ISLANDS (+682)' >COOK ISLANDS (+682)<\/option><option value='COSTA RICA (+506)' >COSTA RICA (+506)<\/option><option value='C\u00d4TE D&#039;IVOIRE (+225)' >C\u00d4TE D&#039;IVOIRE (+225)<\/option><option value='CROATIA (+385)' >CROATIA (+385)<\/option><option value='CUBA (+53)' >CUBA (+53)<\/option><option value='CYPRUS (+357)' >CYPRUS (+357)<\/option><option value='CZECH REPUBLIC (+420)' >CZECH REPUBLIC (+420)<\/option><option value='DENMARK (+45)' >DENMARK (+45)<\/option><option value='DJIBOUTI (+253)' >DJIBOUTI (+253)<\/option><option value='DOMINICA (+767)' >DOMINICA (+767)<\/option><option value='DOMINICAN REPUBLIC (+809)' >DOMINICAN REPUBLIC (+809)<\/option><option value='East Timor  (+670)' >East Timor  (+670)<\/option><option value='ECUADOR (+593)' >ECUADOR (+593)<\/option><option value='EGYPT (+20)' >EGYPT (+20)<\/option><option value='EL SALVADOR (+503)' >EL SALVADOR (+503)<\/option><option value='EQUATORIAL GUINEA (+240)' >EQUATORIAL GUINEA (+240)<\/option><option value='ERITREA (+291)' >ERITREA (+291)<\/option><option value='ESTONIA (+372)' >ESTONIA (+372)<\/option><option value='ETHIOPIA (+251)' >ETHIOPIA (+251)<\/option><option value='FALKLAND ISLANDS (MALVINAS) (+500)' >FALKLAND ISLANDS (MALVINAS) (+500)<\/option><option value='FAROE ISLANDS (+298)' >FAROE ISLANDS (+298)<\/option><option value='FIJI (+679)' >FIJI (+679)<\/option><option value='FINLAND (+358)' >FINLAND (+358)<\/option><option value='FRANCE (+33)' >FRANCE (+33)<\/option><option value='FRENCH GUIANA (+594)' >FRENCH GUIANA (+594)<\/option><option value='FRENCH POLYNESIA (+689)' >FRENCH POLYNESIA (+689)<\/option><option value='GABON (+241)' >GABON (+241)<\/option><option value='GAMBIA (+220)' >GAMBIA (+220)<\/option><option value='GEORGIA (+995)' >GEORGIA (+995)<\/option><option value='GERMANY (+49)' >GERMANY (+49)<\/option><option value='GHANA (+233)' >GHANA (+233)<\/option><option value='GIBRALTAR (+350)' >GIBRALTAR (+350)<\/option><option value='GREECE (+30)' >GREECE (+30)<\/option><option value='GREENLAND (+299)' >GREENLAND (+299)<\/option><option value='GRENADA (+473)' >GRENADA (+473)<\/option><option value='GUADELOUPE (+590)' >GUADELOUPE (+590)<\/option><option value='GUAM (+671)' >GUAM (+671)<\/option><option value='GUATEMALA (+502)' >GUATEMALA (+502)<\/option><option value='GUINEA (+224)' >GUINEA (+224)<\/option><option value='GUINEA-BISSAU (+245)' >GUINEA-BISSAU (+245)<\/option><option value='GUYANA (+592)' >GUYANA (+592)<\/option><option value='HAITI (+509)' >HAITI (+509)<\/option><option value='HOLY SEE (VATICAN CITY STATE) (+379)' >HOLY SEE (VATICAN CITY STATE) (+379)<\/option><option value='HONDURAS (+504)' >HONDURAS (+504)<\/option><option value='HONG KONG (+852)' >HONG KONG (+852)<\/option><option value='HUNGARY (+36)' >HUNGARY (+36)<\/option><option value='ICELAND (+354)' >ICELAND (+354)<\/option><option value='INDIA (+91)' >INDIA (+91)<\/option><option value='INDONESIA (+62)' >INDONESIA (+62)<\/option><option value='IRAN, ISLAMIC REPUBLIC OF (+98)' >IRAN, ISLAMIC REPUBLIC OF (+98)<\/option><option value='IRAQ (+964)' >IRAQ (+964)<\/option><option value='IRELAND (+353)' >IRELAND (+353)<\/option><option value='ISRAEL (+972)' >ISRAEL (+972)<\/option><option value='ITALY (+39)' >ITALY (+39)<\/option><option value='JAMAICA (+876)' >JAMAICA (+876)<\/option><option value='JAPAN (+81)' >JAPAN (+81)<\/option><option value='JORDAN (+962)' >JORDAN (+962)<\/option><option value='KAZAKHSTAN (+7)' >KAZAKHSTAN (+7)<\/option><option value='KENYA (+254)' >KENYA (+254)<\/option><option value='KIRIBATI (+686)' >KIRIBATI (+686)<\/option><option value='KOREA, DEMOCRATIC(+850)' >KOREA, DEMOCRATIC(+850)<\/option><option value='KOREA, REPUBLIC OF (+82)' >KOREA, REPUBLIC OF (+82)<\/option><option value='KUWAIT (+965)' >KUWAIT (+965)<\/option><option value='KYRGYZSTAN (+996)' >KYRGYZSTAN (+996)<\/option><option value='LAO (+856)' >LAO (+856)<\/option><option value='LATVIA (+371)' >LATVIA (+371)<\/option><option value='LEBANON (+961)' >LEBANON (+961)<\/option><option value='LESOTHO (+266)' >LESOTHO (+266)<\/option><option value='LIBERIA (+231)' >LIBERIA (+231)<\/option><option value='LIBYA (+218)' >LIBYA (+218)<\/option><option value='LIECHTENSTEIN (+423)' >LIECHTENSTEIN (+423)<\/option><option value='LITHUANIA (+370)' >LITHUANIA (+370)<\/option><option value='LUXEMBOURG (+352)' >LUXEMBOURG (+352)<\/option><option value='MACAO (+853)' >MACAO (+853)<\/option><option value='MACEDONIA (+389)' >MACEDONIA (+389)<\/option><option value='MADAGASCAR (+261)' >MADAGASCAR (+261)<\/option><option value='MALAWI (+265)' >MALAWI (+265)<\/option><option value='MALAYSIA (+60)' >MALAYSIA (+60)<\/option><option value='MALDIVES (+960)' >MALDIVES (+960)<\/option><option value='MALI (+223)' >MALI (+223)<\/option><option value='MALTA (+356)' >MALTA (+356)<\/option><option value='MARSHALL ISLANDS (+692)' >MARSHALL ISLANDS (+692)<\/option><option value='MARTINIQUE (+596)' >MARTINIQUE (+596)<\/option><option value='MAURITANIA (+222)' >MAURITANIA (+222)<\/option><option value='MAURITIUS (+230)' >MAURITIUS (+230)<\/option><option value='MAYOTTE (+269)' >MAYOTTE (+269)<\/option><option value='MEXICO (+52)' >MEXICO (+52)<\/option><option value='MICRONESIA (+691)' >MICRONESIA (+691)<\/option><option value='MOLDOVA, REPUBLIC OF (+373)' >MOLDOVA, REPUBLIC OF (+373)<\/option><option value='MONACO (+377)' >MONACO (+377)<\/option><option value='MONGOLIA (+976)' >MONGOLIA (+976)<\/option><option value='MONTSERRAT (+664)' >MONTSERRAT (+664)<\/option><option value='MOROCCO (+212)' >MOROCCO (+212)<\/option><option value='MOZAMBIQUE (+258)' >MOZAMBIQUE (+258)<\/option><option value='MYANMAR (+95)' >MYANMAR (+95)<\/option><option value='NAMIBIA (+264)' >NAMIBIA (+264)<\/option><option value='NAURU (+674)' >NAURU (+674)<\/option><option value='NEPAL (+977)' >NEPAL (+977)<\/option><option value='NETHERLANDS (+31)' >NETHERLANDS (+31)<\/option><option value='Netherlands Antilles  (+599)' >Netherlands Antilles  (+599)<\/option><option value='NEW CALEDONIA (+687)' >NEW CALEDONIA (+687)<\/option><option value='NEW ZEALAND (+64)' >NEW ZEALAND (+64)<\/option><option value='NICARAGUA (+505)' >NICARAGUA (+505)<\/option><option value='NIGER (+227)' >NIGER (+227)<\/option><option value='NIGERIA (+234)' >NIGERIA (+234)<\/option><option value='NIUE (+683)' >NIUE (+683)<\/option><option value='NORFOLK ISLAND (+672)' >NORFOLK ISLAND (+672)<\/option><option value='NORTHERN MARIANA ISLANDS (+670)' >NORTHERN MARIANA ISLANDS (+670)<\/option><option value='NORWAY (+47)' >NORWAY (+47)<\/option><option value='OMAN (+968)' >OMAN (+968)<\/option><option value='PAKISTAN (+92)' >PAKISTAN (+92)<\/option><option value='PALAU (+680)' >PALAU (+680)<\/option><option value='PALESTINIAN TERRITORY, OCCUPIED (+970)' >PALESTINIAN TERRITORY, OCCUPIED (+970)<\/option><option value='aPANAMA (+507)' >aPANAMA (+507)<\/option><option value='PAPUA NEW GUINEA (+675)' >PAPUA NEW GUINEA (+675)<\/option><option value='PARAGUAY (+595)' >PARAGUAY (+595)<\/option><option value='PERU (+51)' >PERU (+51)<\/option><option value='PHILIPPINES (+63)' >PHILIPPINES (+63)<\/option><option value='POLAND (+48)' >POLAND (+48)<\/option><option value='PORTUGAL (+351)' >PORTUGAL (+351)<\/option><option value='PUERTO RICO (+939)' >PUERTO RICO (+939)<\/option><option value='QATAR (+974)' >QATAR (+974)<\/option><option value='R\u00c9UNION (+262)' >R\u00c9UNION (+262)<\/option><option value='ROMANIA (+40)' >ROMANIA (+40)<\/option><option value='RUSSIAN FEDERATION (+7)' >RUSSIAN FEDERATION (+7)<\/option><option value='RWANDA (+250)' >RWANDA (+250)<\/option><option value='SAINT HELENA (+290)' >SAINT HELENA (+290)<\/option><option value='SAINT KITTS AND NEVIS (+869)' >SAINT KITTS AND NEVIS (+869)<\/option><option value='SAINT LUCIA (+758)' >SAINT LUCIA (+758)<\/option><option value='SAINT PIERRE AND MIQUELON (+508)' >SAINT PIERRE AND MIQUELON (+508)<\/option><option value='SAINT VINCENT AND THE GRENADINES (+784)' >SAINT VINCENT AND THE GRENADINES (+784)<\/option><option value='SAN MARINO (+378)' >SAN MARINO (+378)<\/option><option value='SAO TOME AND PRINCIPE (+239)' >SAO TOME AND PRINCIPE (+239)<\/option><option value='SAUDI ARABIA (+966)' >SAUDI ARABIA (+966)<\/option><option value='SENEGAL (+221)' >SENEGAL (+221)<\/option><option value='SEYCHELLES (+248)' >SEYCHELLES (+248)<\/option><option value='SIERRA LEONE (+232)' >SIERRA LEONE (+232)<\/option><option value='SINGAPORE (+65)' >SINGAPORE (+65)<\/option><option value='SLOVAKIA (+421)' >SLOVAKIA (+421)<\/option><option value='SLOVENIA (+386)' >SLOVENIA (+386)<\/option><option value='SOLOMON ISLANDS (+677)' >SOLOMON ISLANDS (+677)<\/option><option value='SOMALIA (+252)' >SOMALIA (+252)<\/option><option value='SOUTH AFRICA (+27)' >SOUTH AFRICA (+27)<\/option><option value='SPAIN (+34)' >SPAIN (+34)<\/option><option value='SRI LANKA (+94)' >SRI LANKA (+94)<\/option><option value='SUDAN (+249)' >SUDAN (+249)<\/option><option value='SURINAME (+597)' >SURINAME (+597)<\/option><option value='SWAZILAND (+268)' >SWAZILAND (+268)<\/option><option value='SWEDEN (+46)' >SWEDEN (+46)<\/option><option value='SWITZERLAND (+41)' >SWITZERLAND (+41)<\/option><option value='SYRIAN ARAB REPUBLIC (+963)' >SYRIAN ARAB REPUBLIC (+963)<\/option><option value='TAIWAN, PROVINCE OF CHINA (+886)' >TAIWAN, PROVINCE OF CHINA (+886)<\/option><option value='TAJIKISTAN (+992)' >TAJIKISTAN (+992)<\/option><option value='TANZANIA, UNITED REPUBLIC OF (+255)' >TANZANIA, UNITED REPUBLIC OF (+255)<\/option><option value='THAILAND (+66)' >THAILAND (+66)<\/option><option value='TOGO (+228)' >TOGO (+228)<\/option><option value='TOKELAU (+690)' >TOKELAU (+690)<\/option><option value='TONGA (+676)' >TONGA (+676)<\/option><option value='TRINIDAD AND TOBAGO (+868)' >TRINIDAD AND TOBAGO (+868)<\/option><option value='TUNISIA (+216)' >TUNISIA (+216)<\/option><option value='TURKEY (+90)' >TURKEY (+90)<\/option><option value='TURKMENISTAN (+993)' >TURKMENISTAN (+993)<\/option><option value='TURKS AND CAICOS ISLANDS (+649)' >TURKS AND CAICOS ISLANDS (+649)<\/option><option value='UVALU (+688)' >UVALU (+688)<\/option><option value='UGANDA (+256)' >UGANDA (+256)<\/option><option value='UKRAINE (+380)' >UKRAINE (+380)<\/option><option value='UNITED ARAB EMIRATES (+971)' >UNITED ARAB EMIRATES (+971)<\/option><option value='UNITED KINGDOM (+44)' >UNITED KINGDOM (+44)<\/option><option value='UNITED STATES (+1)' >UNITED STATES (+1)<\/option><option value='URUGUAY (+598)' >URUGUAY (+598)<\/option><option value='UZBEKISTAN (+998)' >UZBEKISTAN (+998)<\/option><option value='VANUATU (+678)' >VANUATU (+678)<\/option><option value='VENEZUELA, BOLIVARIAN REPUBLIC OF (+58)' >VENEZUELA, BOLIVARIAN REPUBLIC OF (+58)<\/option><option value='VIET NAM (+84)' >VIET NAM (+84)<\/option><option value='VIRGIN ISLANDS, BRITISH (+284)' >VIRGIN ISLANDS, BRITISH (+284)<\/option><option value='VIRGIN ISLANDS, U.S. (+340)' >VIRGIN ISLANDS, U.S. (+340)<\/option><option value='WALLIS AND FUTUNA (+681)' >WALLIS AND FUTUNA (+681)<\/option><option value='YEMEN (+967)' >YEMEN (+967)<\/option><option value='Yugoslavia  (+381)' >Yugoslavia  (+381)<\/option><option value='ZAMBIA (+260)' >ZAMBIA (+260)<\/option><option value='ZIMBABWE (+263)' >ZIMBABWE (+263)<\/option><\/select><\/div><\/li><li id=\"field_1_127\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_127\"><label class='gfield_label' for='input_1_127' >STD Code<\/label><div class='ginput_container ginput_container_text'><input name='input_127' id='input_1_127' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_136\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_136\"><label class='gfield_label' for='input_1_136' >Phone No.<\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_1_136' type='text' value='' class='medium' maxlength='10'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_133\"  class=\"gfield gf_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_133\"><label class='gfield_label' for='input_1_133' >Mobile<\/label><div class='ginput_container ginput_container_text'><input name='input_133' id='input_1_133' type='text' value='' class='medium' maxlength='10'     aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_110' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_110' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_32\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><h2 class=\"gsection_title\">Class X<\/h2><\/li><li id=\"field_1_33\"  class=\"gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><label class='gfield_label'  >Board<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_33'>\n\t\t\t<li class='gchoice gchoice_1_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='CBSE'  id='choice_1_33_0'    \/>\n\t\t\t\t<label for='choice_1_33_0' id='label_1_33_0'>CBSE<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='ICSE'  id='choice_1_33_1'    \/>\n\t\t\t\t<label for='choice_1_33_1' id='label_1_33_1'>ICSE<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_2'>\n\t\t\t\t<input name='input_33' type='radio' value='NIOS'  id='choice_1_33_2'    \/>\n\t\t\t\t<label for='choice_1_33_2' id='label_1_33_2'>NIOS<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_3'>\n\t\t\t\t<input name='input_33' type='radio' value='gf_other_choice'  id='choice_1_33_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_1_33_other' name='input_33_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_39\"  class=\"gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_39\"><label class='gfield_label'  >X Results Declared<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_39'>\n\t\t\t<li class='gchoice gchoice_1_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='Yes'  id='choice_1_39_0'    \/>\n\t\t\t\t<label for='choice_1_39_0' id='label_1_39_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='No'  id='choice_1_39_1'    \/>\n\t\t\t\t<label for='choice_1_39_1' id='label_1_39_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_34\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_34\"><label class='gfield_label' for='input_1_34' >School Name<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_36\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_36\"><label class='gfield_label' for='input_1_36' >Passing Year<\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_1_36' class='medium gfield_select'     aria-invalid=\"false\" ><option value='1950' >1950<\/option><option value='1951' >1951<\/option><option value='1952' >1952<\/option><option value='1953' >1953<\/option><option value='1954' >1954<\/option><option value='1955' >1955<\/option><option value='1956' >1956<\/option><option value='1957' >1957<\/option><option value='1958' >1958<\/option><option value='1959' >1959<\/option><option value='1960' >1960<\/option><option value='1961' >1961<\/option><option value='1962' >1962<\/option><option value='1963' >1963<\/option><option value='1964' >1964<\/option><option value='1965' >1965<\/option><option value='1966' >1966<\/option><option value='1967' >1967<\/option><option value='1968' >1968<\/option><option value='1969' >1969<\/option><option value='1970' >1970<\/option><option value='1971' >1971<\/option><option value='1972' >1972<\/option><option value='1973' >1973<\/option><option value='1974' >1974<\/option><option value='1975' >1975<\/option><option value='1976' >1976<\/option><option value='1977' >1977<\/option><option value='1978' >1978<\/option><option value='1979' >1979<\/option><option value='1980' >1980<\/option><option value='1981' >1981<\/option><option value='1982' >1982<\/option><option value='1983' >1983<\/option><option value='1984' >1984<\/option><option value='1985' >1985<\/option><option value='1986' >1986<\/option><option value='1987' >1987<\/option><option value='1988' >1988<\/option><option value='1989' >1989<\/option><option value='1990' >1990<\/option><option value='1991' >1991<\/option><option value='1992' >1992<\/option><option value='1993' >1993<\/option><option value='1994' >1994<\/option><option value='1995' >1995<\/option><option value='1996' >1996<\/option><option value='1997' >1997<\/option><option value='1998' >1998<\/option><option value='1999' >1999<\/option><option value='2000' >2000<\/option><option value='2001' >2001<\/option><option value='2002' >2002<\/option><option value='2003' >2003<\/option><option value='2004' >2004<\/option><option value='2005' >2005<\/option><option value='2006' >2006<\/option><option value='2007' >2007<\/option><option value='2008' >2008<\/option><option value='2009' >2009<\/option><option value='2010' >2010<\/option><option value='2011' >2011<\/option><option value='2012' >2012<\/option><option value='2013' >2013<\/option><option value='2014' >2014<\/option><\/select><\/div><\/li><li id=\"field_1_35\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_35\"><label class='gfield_label' for='input_1_35' >Board Roll No.<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_99\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_99\"><label class='gfield_label' for='input_1_99' >State<\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_1_99' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Andaman and Nicobar Islands' >Andaman and Nicobar Islands<\/option><option value='Andhra Pradesh' >Andhra Pradesh<\/option><option value='Arunachal Pradesh' >Arunachal Pradesh<\/option><option value='Assam' >Assam<\/option><option value='Bihar' >Bihar<\/option><option value='Chandigarh' >Chandigarh<\/option><option value='Chhattisgarh' >Chhattisgarh<\/option><option value='Dadra and Nagar Haveli' >Dadra and Nagar Haveli<\/option><option value='Daman and Diu' >Daman and Diu<\/option><option value='Delhi' >Delhi<\/option><option value='Goa' >Goa<\/option><option value='Gujarat' >Gujarat<\/option><option value='Haryana' >Haryana<\/option><option value='Himachal Pradesh' >Himachal Pradesh<\/option><option value='Jammu and Kashmir' >Jammu and Kashmir<\/option><option value='Jharkhand' >Jharkhand<\/option><option value='Karnataka' >Karnataka<\/option><option value='Kerala' >Kerala<\/option><option value='Lakshadweep' >Lakshadweep<\/option><option value='Madhya Pradesh' >Madhya Pradesh<\/option><option value='Maharashtra' >Maharashtra<\/option><option value='Manipur' >Manipur<\/option><option value='Meghalaya' >Meghalaya<\/option><option value='Mizoram' >Mizoram<\/option><option value='Nagaland' >Nagaland<\/option><option value='Odisha' >Odisha<\/option><option value='Puducherry' >Puducherry<\/option><option value='Punjab' >Punjab<\/option><option value='Rajasthan' >Rajasthan<\/option><option value='Sikkim' >Sikkim<\/option><option value='Tamil Nadu' >Tamil Nadu<\/option><option value='Telengana' >Telengana<\/option><option value='Tripura' >Tripura<\/option><option value='Uttar Pradesh' >Uttar Pradesh<\/option><option value='Uttarakhand' >Uttarakhand<\/option><option value='West Bengal' >West Bengal<\/option><\/select><\/div><\/li><li id=\"field_1_117\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_117\"><label class='gfield_label' for='input_1_117' >District<\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_1_117' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_122\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_122\"><label class='gfield_label' for='input_1_122' >City\/Village<\/label><div class='ginput_container ginput_container_text'><input name='input_122' id='input_1_122' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_40\"  class=\"gfield gf_list_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_40\"><label class='gfield_label'  >Mark Type<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_40'>\n\t\t\t<li class='gchoice gchoice_1_40_0'>\n\t\t\t\t<input name='input_40' type='radio' value='Marks'  id='choice_1_40_0'    \/>\n\t\t\t\t<label for='choice_1_40_0' id='label_1_40_0'>Marks<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_1'>\n\t\t\t\t<input name='input_40' type='radio' value='Grade Points'  id='choice_1_40_1'    \/>\n\t\t\t\t<label for='choice_1_40_1' id='label_1_40_1'>Grade Points<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_38\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_38\"><label class='gfield_label' for='input_1_38' >Aggregate Percentage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_38\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_38'>(of all subjects on class X marksheet)\n\u00a0(Format xx.xx; Example. 92.55)\n<\/div><\/li><li id=\"field_1_42\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_42\"><h2 class=\"gsection_title\">Class XII<\/h2><\/li><li id=\"field_1_43\"  class=\"gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_43\"><label class='gfield_label'  >Board<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_43'>\n\t\t\t<li class='gchoice gchoice_1_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='CBSE'  id='choice_1_43_0'    \/>\n\t\t\t\t<label for='choice_1_43_0' id='label_1_43_0'>CBSE<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='ICSE'  id='choice_1_43_1'    \/>\n\t\t\t\t<label for='choice_1_43_1' id='label_1_43_1'>ICSE<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='NIOS'  id='choice_1_43_2'    \/>\n\t\t\t\t<label for='choice_1_43_2' id='label_1_43_2'>NIOS<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='gf_other_choice'  id='choice_1_43_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_1_43_other' name='input_43_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_48\"  class=\"gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_48\"><label class='gfield_label'  >XII Results Declared<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_48'>\n\t\t\t<li class='gchoice gchoice_1_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='Yes'  id='choice_1_48_0'    \/>\n\t\t\t\t<label for='choice_1_48_0' id='label_1_48_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='No'  id='choice_1_48_1'    \/>\n\t\t\t\t<label for='choice_1_48_1' id='label_1_48_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_51\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_51\"><label class='gfield_label' for='input_1_51' >Stream<\/label><div class='ginput_container ginput_container_select'><select name='input_51' id='input_1_51' class='medium gfield_select'     aria-invalid=\"false\" ><option value='10+2 -Voctional' >10+2 -Voctional<\/option><option value='10+2 -Technical Trade' >10+2 -Technical Trade<\/option><option value='10+2 - Non-Medical' >10+2 - Non-Medical<\/option><option value='10+2 - Medical' >10+2 - Medical<\/option><option value='10+2 - Arts' >10+2 - Arts<\/option><option value='10+2 - Commerce' >10+2 - Commerce<\/option><\/select><\/div><\/li><li id=\"field_1_45\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_45\"><label class='gfield_label' for='input_1_45' >Board Roll No.<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_1_45' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_44\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_44\"><label class='gfield_label' for='input_1_44' >School Name<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_1_44' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_116\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_116\"><label class='gfield_label' for='input_1_116' >State<\/label><div class='ginput_container ginput_container_select'><select name='input_116' id='input_1_116' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Andaman and Nicobar Islands' >Andaman and Nicobar Islands<\/option><option value='Andhra Pradesh' >Andhra Pradesh<\/option><option value='Arunachal Pradesh' >Arunachal Pradesh<\/option><option value='Assam' >Assam<\/option><option value='Bihar' >Bihar<\/option><option value='Chandigarh' >Chandigarh<\/option><option value='Chhattisgarh' >Chhattisgarh<\/option><option value='Dadra and Nagar Haveli' >Dadra and Nagar Haveli<\/option><option value='Daman and Diu' >Daman and Diu<\/option><option value='Delhi' >Delhi<\/option><option value='Goa' >Goa<\/option><option value='Gujarat' >Gujarat<\/option><option value='Haryana' >Haryana<\/option><option value='Himachal Pradesh' >Himachal Pradesh<\/option><option value='Jammu and Kashmir' >Jammu and Kashmir<\/option><option value='Jharkhand' >Jharkhand<\/option><option value='Karnataka' >Karnataka<\/option><option value='Kerala' >Kerala<\/option><option value='Lakshadweep' >Lakshadweep<\/option><option value='Madhya Pradesh' >Madhya Pradesh<\/option><option value='Maharashtra' >Maharashtra<\/option><option value='Manipur' >Manipur<\/option><option value='Meghalaya' >Meghalaya<\/option><option value='Mizoram' >Mizoram<\/option><option value='Nagaland' >Nagaland<\/option><option value='Odisha' >Odisha<\/option><option value='Puducherry' >Puducherry<\/option><option value='Punjab' >Punjab<\/option><option value='Rajasthan' >Rajasthan<\/option><option value='Sikkim' >Sikkim<\/option><option value='Tamil Nadu' >Tamil Nadu<\/option><option value='Telengana' >Telengana<\/option><option value='Tripura' >Tripura<\/option><option value='Uttar Pradesh' >Uttar Pradesh<\/option><option value='Uttarakhand' >Uttarakhand<\/option><option value='West Bengal' >West Bengal<\/option><\/select><\/div><\/li><li id=\"field_1_53\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_53\"><label class='gfield_label' for='input_1_53' >District<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_123\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_123\"><label class='gfield_label' for='input_1_123' >City\/Village<\/label><div class='ginput_container ginput_container_text'><input name='input_123' id='input_1_123' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_46\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_46\"><label class='gfield_label' for='input_1_46' >Passing Year<\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_1_46' class='medium gfield_select'     aria-invalid=\"false\" ><option value='1950' >1950<\/option><option value='1951' >1951<\/option><option value='1952' >1952<\/option><option value='1953' >1953<\/option><option value='1954' >1954<\/option><option value='1955' >1955<\/option><option value='1956' >1956<\/option><option value='1957' >1957<\/option><option value='1958' >1958<\/option><option value='1959' >1959<\/option><option value='1960' >1960<\/option><option value='1961' >1961<\/option><option value='1962' >1962<\/option><option value='1963' >1963<\/option><option value='1964' >1964<\/option><option value='1965' >1965<\/option><option value='1966' >1966<\/option><option value='1967' >1967<\/option><option value='1968' >1968<\/option><option value='1969' >1969<\/option><option value='1970' >1970<\/option><option value='1971' >1971<\/option><option value='1972' >1972<\/option><option value='1973' >1973<\/option><option value='1974' >1974<\/option><option value='1975' >1975<\/option><option value='1976' >1976<\/option><option value='1977' >1977<\/option><option value='1978' >1978<\/option><option value='1979' >1979<\/option><option value='1980' >1980<\/option><option value='1981' >1981<\/option><option value='1982' >1982<\/option><option value='1983' >1983<\/option><option value='1984' >1984<\/option><option value='1985' >1985<\/option><option value='1986' >1986<\/option><option value='1987' >1987<\/option><option value='1988' >1988<\/option><option value='1989' >1989<\/option><option value='1990' >1990<\/option><option value='1991' >1991<\/option><option value='1992' >1992<\/option><option value='1993' >1993<\/option><option value='1994' >1994<\/option><option value='1995' >1995<\/option><option value='1996' >1996<\/option><option value='1997' >1997<\/option><option value='1998' >1998<\/option><option value='1999' >1999<\/option><option value='2000' >2000<\/option><option value='2001' >2001<\/option><option value='2002' >2002<\/option><option value='2003' >2003<\/option><option value='2004' >2004<\/option><option value='2005' >2005<\/option><option value='2006' >2006<\/option><option value='2007' >2007<\/option><option value='2008' >2008<\/option><option value='2009' >2009<\/option><option value='2010' >2010<\/option><option value='2011' >2011<\/option><option value='2012' >2012<\/option><option value='2013' >2013<\/option><option value='2014' >2014<\/option><\/select><\/div><\/li><li id=\"field_1_49\"  class=\"gfield gf_list_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_49\"><label class='gfield_label'  >Mark Type<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_49'>\n\t\t\t<li class='gchoice gchoice_1_49_0'>\n\t\t\t\t<input name='input_49' type='radio' value='Marks'  id='choice_1_49_0'    \/>\n\t\t\t\t<label for='choice_1_49_0' id='label_1_49_0'>Marks<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_49_1'>\n\t\t\t\t<input name='input_49' type='radio' value='Grade Points'  id='choice_1_49_1'    \/>\n\t\t\t\t<label for='choice_1_49_1' id='label_1_49_1'>Grade Points<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_47\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_47\"><label class='gfield_label' for='input_1_47' >Aggregate Percentage<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_1_47' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_47\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_47'>\u00a0 (of all subjects on class XII marksheet)\n(Format xx.xx; Example. 92.55)<\/div><\/li><li id=\"field_1_54\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_54\"><h2 class=\"gsection_title\">ITI Details<\/h2><\/li><li id=\"field_1_63\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_63\"><label class='gfield_label' for='input_1_63' >In which Trade<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_1_63' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_63\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_63'>  pls Specify<\/div><\/li><li id=\"field_1_56\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_56\"><label class='gfield_label' for='input_1_56' >ITI Name<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_1_56' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_59\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_59\"><label class='gfield_label' for='input_1_59' >Registration No.<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_104\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_104\"><label class='gfield_label' for='input_1_104' >State<\/label><div class='ginput_container ginput_container_select'><select name='input_104' id='input_1_104' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Andaman and Nicobar Islands' >Andaman and Nicobar Islands<\/option><option value='Andhra Pradesh' >Andhra Pradesh<\/option><option value='Arunachal Pradesh' >Arunachal Pradesh<\/option><option value='Assam' >Assam<\/option><option value='Bihar' >Bihar<\/option><option value='Chandigarh' >Chandigarh<\/option><option value='Chhattisgarh' >Chhattisgarh<\/option><option value='Dadra and Nagar Haveli' >Dadra and Nagar Haveli<\/option><option value='Daman and Diu' >Daman and Diu<\/option><option value='Delhi' >Delhi<\/option><option value='Goa' >Goa<\/option><option value='Gujarat' >Gujarat<\/option><option value='Haryana' >Haryana<\/option><option value='Himachal Pradesh' >Himachal Pradesh<\/option><option value='Jammu and Kashmir' >Jammu and Kashmir<\/option><option value='Jharkhand' >Jharkhand<\/option><option value='Karnataka' >Karnataka<\/option><option value='Kerala' >Kerala<\/option><option value='Lakshadweep' >Lakshadweep<\/option><option value='Madhya Pradesh' >Madhya Pradesh<\/option><option value='Maharashtra' >Maharashtra<\/option><option value='Manipur' >Manipur<\/option><option value='Meghalaya' >Meghalaya<\/option><option value='Mizoram' >Mizoram<\/option><option value='Nagaland' >Nagaland<\/option><option value='Odisha' >Odisha<\/option><option value='Puducherry' >Puducherry<\/option><option value='Punjab' >Punjab<\/option><option value='Rajasthan' >Rajasthan<\/option><option value='Sikkim' >Sikkim<\/option><option value='Tamil Nadu' >Tamil Nadu<\/option><option value='Telengana' >Telengana<\/option><option value='Tripura' >Tripura<\/option><option value='Uttar Pradesh' >Uttar Pradesh<\/option><option value='Uttarakhand' >Uttarakhand<\/option><option value='West Bengal' >West Bengal<\/option><\/select><\/div><\/li><li id=\"field_1_58\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_58\"><label class='gfield_label' for='input_1_58' >District<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_1_58' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_124\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_124\"><label class='gfield_label' for='input_1_124' >City\/Village<\/label><div class='ginput_container ginput_container_text'><input name='input_124' id='input_1_124' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_60\"  class=\"gfield gf_list_inline field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_60\"><label class='gfield_label'  >ITI Results Declared<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_60'>\n\t\t\t<li class='gchoice gchoice_1_60_0'>\n\t\t\t\t<input name='input_60' type='radio' value='Yes'  id='choice_1_60_0'    \/>\n\t\t\t\t<label for='choice_1_60_0' id='label_1_60_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_60_1'>\n\t\t\t\t<input name='input_60' type='radio' value='No'  id='choice_1_60_1'    \/>\n\t\t\t\t<label for='choice_1_60_1' id='label_1_60_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_55\"  class=\"gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_55\"><label class='gfield_label' for='input_1_55' >Passing Year<\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_1_55' class='medium gfield_select'     aria-invalid=\"false\" ><option value='1950' >1950<\/option><option value='1951' >1951<\/option><option value='1952' >1952<\/option><option value='1953' >1953<\/option><option value='1954' >1954<\/option><option value='1955' >1955<\/option><option value='1956' >1956<\/option><option value='1957' >1957<\/option><option value='1958' >1958<\/option><option value='1959' >1959<\/option><option value='1960' >1960<\/option><option value='1961' >1961<\/option><option value='1962' >1962<\/option><option value='1963' >1963<\/option><option value='1964' >1964<\/option><option value='1965' >1965<\/option><option value='1966' >1966<\/option><option value='1967' >1967<\/option><option value='1968' >1968<\/option><option value='1969' >1969<\/option><option value='1970' >1970<\/option><option value='1971' >1971<\/option><option value='1972' >1972<\/option><option value='1973' >1973<\/option><option value='1974' >1974<\/option><option value='1975' >1975<\/option><option value='1976' >1976<\/option><option value='1977' >1977<\/option><option value='1978' >1978<\/option><option value='1979' >1979<\/option><option value='1980' >1980<\/option><option value='1981' >1981<\/option><option value='1982' >1982<\/option><option value='1983' >1983<\/option><option value='1984' >1984<\/option><option value='1985' >1985<\/option><option value='1986' >1986<\/option><option value='1987' >1987<\/option><option value='1988' >1988<\/option><option value='1989' >1989<\/option><option value='1990' >1990<\/option><option value='1991' >1991<\/option><option value='1992' >1992<\/option><option value='1993' >1993<\/option><option value='1994' >1994<\/option><option value='1995' >1995<\/option><option value='1996' >1996<\/option><option value='1997' >1997<\/option><option value='1998' >1998<\/option><option value='1999' >1999<\/option><option value='2000' >2000<\/option><option value='2001' >2001<\/option><option value='2002' >2002<\/option><option value='2003' >2003<\/option><option value='2004' >2004<\/option><option value='2005' >2005<\/option><option value='2006' >2006<\/option><option value='2007' >2007<\/option><option value='2008' >2008<\/option><option value='2009' >2009<\/option><option value='2010' >2010<\/option><option value='2011' >2011<\/option><option value='2012' >2012<\/option><option value='2013' >2013<\/option><option value='2014' >2014<\/option><\/select><\/div><\/li><li id=\"field_1_62\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_62\"><label class='gfield_label' for='input_1_62' >Aggregate Percentage<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_1_62' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_62\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_62'>(of all subjects in ITI marksheet)\n\u00a0(Format xx.xx; Example. 92.55)<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_111' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_111' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_65\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_65\"><h2 class=\"gsection_title\">Document Upload<\/h2><\/li><li id=\"field_1_66\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_66\"><label class='gfield_label' for='input_1_66' >Xth\u00a0(Secondary) Marksheet<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_66' id='input_1_66' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_66 gfield_description_1_66\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_66'>Accepted file types: pdf, jpg, gif, png, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_66'><\/div><\/div><div class='gfield_description' id='gfield_description_1_66'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_107\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_107\"><label class='gfield_label' for='input_1_107' >Xth\u00a0Passing Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_107' id='input_1_107' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_107 gfield_description_1_107\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_107'>Accepted file types: pdf, jpg, gif, png, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_107'><\/div><\/div><div class='gfield_description' id='gfield_description_1_107'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_67\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_67\"><label class='gfield_label' for='input_1_67' >Migration Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_67' id='input_1_67' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_67 gfield_description_1_67\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_67'>Accepted file types: pdf, jpg, gif, png, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_67'><\/div><\/div><div class='gfield_description' id='gfield_description_1_67'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_68\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_68\"><label class='gfield_label' for='input_1_68' >XIIth (Sr. Secondary) Marksheet\u00a0:<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='52428800' \/><input name='input_68' id='input_1_68' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_68 gfield_description_1_68\" onchange='javascript:gformValidateFileSize( this, 52428800 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_68'>Accepted file types: pdf, jpg, gif, png, Max. file size: 50 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_68'><\/div><\/div><div class='gfield_description' id='gfield_description_1_68'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_105\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_105\"><label class='gfield_label' for='input_1_105' >XIIth\u00a0Passing Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_105' id='input_1_105' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_105 gfield_description_1_105\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_105'>Accepted file types: pdf, jpg, gif, png, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_105'><\/div><\/div><div class='gfield_description' id='gfield_description_1_105'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_106\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_106\"><label class='gfield_label' for='input_1_106' >ITI( Marks sheet) or NTC Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='52428800' \/><input name='input_106' id='input_1_106' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_106 gfield_description_1_106\" onchange='javascript:gformValidateFileSize( this, 52428800 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_106'>Accepted file types: pdf, jpg, gif, png, Max. file size: 50 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_106'><\/div><\/div><div class='gfield_description' id='gfield_description_1_106'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_108\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_108\"><label class='gfield_label' for='input_1_108' >Provisional Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_108' id='input_1_108' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_108 gfield_description_1_108\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_108'>Accepted file types: pdf, jpg, gif, png, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_108'><\/div><\/div><div class='gfield_description' id='gfield_description_1_108'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_74\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_74\"><label class='gfield_label' for='input_1_74' >Character Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='52428800' \/><input name='input_74' id='input_1_74' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_74 gfield_description_1_74\" onchange='javascript:gformValidateFileSize( this, 52428800 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_74'>Accepted file types: pdf, jpg, gif, png, Max. file size: 50 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_74'><\/div><\/div><div class='gfield_description' id='gfield_description_1_74'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_118\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_118\"><label class='gfield_label' for='input_1_118' >Residence Proof<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_118' id='input_1_118' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_118 gfield_description_1_118\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_118'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 100 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_118'><\/div><\/div><div class='gfield_description' id='gfield_description_1_118'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_79\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_79\"><label class='gfield_label' for='input_1_79' >Photo<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='1048576' \/><input name='input_79' id='input_1_79' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_79 gfield_description_1_79\" onchange='javascript:gformValidateFileSize( this, 1048576 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_79'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 1 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_79'><\/div><\/div><div class='gfield_description' id='gfield_description_1_79'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB, Recent Passport size color photograph ()<\/div><\/li><li id=\"field_1_80\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_80\"><label class='gfield_label' for='input_1_80' >Signature<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_80' id='input_1_80' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_80 gfield_description_1_80\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_80'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_80'><\/div><\/div><div class='gfield_description' id='gfield_description_1_80'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_145\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_145\"><label class='gfield_label' for='input_1_145' >Adhar Card<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_145' id='input_1_145' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_145 gfield_description_1_145\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_145'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_145'><\/div><\/div><div class='gfield_description' id='gfield_description_1_145'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_75\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_75\"><h2 class=\"gsection_title\">In Case Of Reserved   category Only<\/h2><\/li><li id=\"field_1_76\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_76\"><label class='gfield_label' for='input_1_76' >Income Certificate:<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='52428800' \/><input name='input_76' id='input_1_76' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_76 gfield_description_1_76\" onchange='javascript:gformValidateFileSize( this, 52428800 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_76'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 50 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_76'><\/div><\/div><div class='gfield_description' id='gfield_description_1_76'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_77\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_77\"><label class='gfield_label' for='input_1_77' >Caste Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_77' id='input_1_77' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_77 gfield_description_1_77\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_77'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_77'><\/div><\/div><div class='gfield_description' id='gfield_description_1_77'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><li id=\"field_1_78\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_78\"><label class='gfield_label' for='input_1_78' >Residence  Certificate<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='10485760' \/><input name='input_78' id='input_1_78' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_78 gfield_description_1_78\" onchange='javascript:gformValidateFileSize( this, 10485760 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_78'>Accepted file types: pdf, jpg, gif, pn, Max. file size: 10 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_78'><\/div><\/div><div class='gfield_description' id='gfield_description_1_78'>Uploaded file in pdf, jpg, gif, png format and size less then 10MB<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_112' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_112' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_81\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_81\"><h2 class=\"gsection_title\">Bank Details<\/h2><\/li><li id=\"field_1_146\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_146\"><label class='gfield_label' for='input_1_146' >Mode of Payment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_146' id='input_1_146' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Online' >Online<\/option><option value='Offline' >Offline<\/option><\/select><\/div><\/li><li id=\"field_1_147\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_147\"><label class='gfield_label' for='input_1_147' >Payment Refrence No.<\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_1_147' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_82\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_82\"><label class='gfield_label' for='input_1_82' >Upload bank Challan<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='536870912' \/><input name='input_82' id='input_1_82' type='file' class='medium' aria-describedby=\"gfield_upload_rules_1_82\" onchange='javascript:gformValidateFileSize( this, 536870912 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_1_82'>Max. file size: 512 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_1_82'><\/div><\/div><\/li><li id=\"field_1_84\"  class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_84\"><label class='gfield_label'  >Date of Deposit<\/label><div id='input_1_84' class='ginput_container ginput_complex'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date' id='input_1_84_1_container'><select name='input_84[]' id='input_1_84_1'   aria-required='false'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date' id='input_1_84_2_container'><select name='input_84[]' id='input_1_84_2'   aria-required='false'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/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='gfield_date_dropdown_year ginput_container ginput_container_date' id='input_1_84_3_container'><select name='input_84[]' id='input_1_84_3'   aria-required='false'  ><option value=''>YYYY<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/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><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_1_83\"  class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_83\"><label class='gfield_label' for='input_1_83' >Total Amount Deposited<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_1_83' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_83\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_1_83'> Deposited in bank<\/div><\/li><li id=\"field_1_86\"  class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_86\"><label class='gfield_label' for='input_1_86' >Bank Name<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_1_86' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_113' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_113' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_97\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_97\"><h2 class=\"gsection_title\">From where did you hear about us?<\/h2><\/li><li id=\"field_1_120\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_120\"><label class='gfield_label screen-reader-text' for='input_1_120' ><\/label><div class='ginput_container ginput_container_select'><select name='input_120' id='input_1_120' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Newspaper Advt' >Newspaper Advt<\/option><option value='Radio Advt' >Radio Advt<\/option><option value='Online Search Engine' >Online Search Engine<\/option><option value='Career Counselling Program' >Career Counselling Program<\/option><option value='Others' >Others<\/option><\/select><\/div><\/li><li id=\"field_1_142\"  class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_142\"><label class='gfield_label' for='input_1_142' >Please Specify<\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_1_142' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button button' value='Previous'  onclick='if(window[\"gf_submitting_1\"]){return false;}  window[\"gf_submitting_1\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} window[\"gf_submitting_1\"]=true;  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_1\"]){return false;}  window[\"gf_submitting_1\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} window[\"gf_submitting_1\"]=true;  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsIjUyZWNhOGMyNjMzODNmYjk2MWQyMjExOWI2M2Y0OGNkIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"75\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div>\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css?family=Ubuntu');sidebar{display:none !important}\nhtml {\n    margin-top: 50px !important;\n}\nh1, #sidebar{DISPLAY:NONE}\n#content {\n    padding: 0;\n    margin: 0 0px;\n}\n.gform_legacy_markup_wrapper { display: block !important;}\n<\/style>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-1903","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/pages\/1903","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/comments?post=1903"}],"version-history":[{"count":8,"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/pages\/1903\/revisions"}],"predecessor-version":[{"id":2277,"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/pages\/1903\/revisions\/2277"}],"wp:attachment":[{"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/media?parent=1903"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/categories?post=1903"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lppcderabassi.org\/gallery1\/wp-json\/wp\/v2\/tags?post=1903"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}