<div class="body-content">
                        <div class="row">
                            <div class="col-md-12">
                                <div class="card mb-4">
                                    <div class="card-header">
                                        <div class="d-flex justify-content-between align-items-center">
                                                <h6 class="fs-17 font-weight-600 mb-0"><i class="fa fa-credit-card"></i> New Visa Application</h6>
                                        </div>
                                    </div>
                                    <div class="card-body">
                                     <form action="<?php echo base_url();?>admin/add_visa" method="post" enctype="multipart/form-data"><div class=" row">
                                     	<div class="col-md-7">
                                     	<div class="row">
                                        	<div class="form-group col-md-5">
                                            	<b class="text-warning">Select Visa Type</b>
                                                <select class="form-control" style="border:1px solid orange;font-size:16px;" name="visa_type" required>
                                                	<option value="">Select Visa Type</option>
                                                    <option value="Business/Tourist Visa">Business/Tourist Visa</option>
                                                    <option value="Work Visa">Work Visa</option>
                                                    <option value="Student Visa">Student Visa</option>
                                                    <option value="Exchange Visitor Visa">Exchange Visitor Visa</option>
                                                    <option value="Transit/Ship Crew Visa">Transit/Ship Crew Visa</option>
                                                    <option value="Religious Worker Visa">Religious Worker Visa</option>
                                                    <option value="Domestic Employee Visa">Domestic Employee Visa</option>
                                                    <option value="Journalist and Media Visa">Journalist and Media Visa</option>
                                                </select>
                                            </div>
                                            <div class="form-group col-md-7">
                                    <b class="text-warning">Visa Destination Country</b>
                                    <input type="text" style="border:1px solid orange;font-size:16px;" required class="form-control" name="visa_country" />
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Current Citizenship Country</label>
                                                <input type="text" required style="border:1px solid orange;" class="form-control" name="nationality" />
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Passport Number</label>
                                                <input type="text" required style="border:1px solid orange;" class="form-control" name="passport_number" />
                                            </div>
                                            <div class="form-group col-md-4">
                                                <label>Passport Validity</label>
                                                <input type="date" required style="border:1px solid orange;" class="form-control" name="passport_validity" />
                                            </div>
                                            </div>
                                        <h6 class="text-success">CUSTOMER DETAILS</h6>
                                        <div class="row">
                                        <div class="col-md-2">
                                            <label>Gender</label>
                                            <div class="radio">
                                                <input type="radio" name="gender" id="Male" value="Male" checked="">
                                                <label style="margin-bottom:0px;" for="Male">Male</label>
                                            </div>
                                            <div class="radio">
                                                <input type="radio" name="gender" id="Female" value="Female">
                                                <label style="margin-bottom:0px;" for="Female">Female</label>
                                            </div>
                                        </div>
                                        <div class="form-group col-md-5">
                                            <label>First Name</label>
                                            <input type="text" required class="form-control" name="firstname" />
                                        </div>
                                        <div class="form-group col-md-5">
                                            <label>Last Name</label>
                                            <input type="text" required class="form-control" name="lastname" />
                                        </div>
                                        <div class="form-group col-md-3">
                                            <label>Mobile</label>
                                            <input type="text" required class="form-control" name="mobile" />
                                        </div>
                                        <div class="form-group col-md-3">
                                            <label>Phone</label>
                                            <input type="text" class="form-control" name="phone" />
                                        </div>
                                        <div class="form-group col-md-6">
                                            <label>Email</label>
                                            <input type="email" class="form-control" name="email" />
                                        </div>
                                        <div class="form-group col-md-4">
                                            <label>Date of Birth</label>
                                            <input type="date" class="form-control" name="dob" />
                                        </div>
                                        <div class="form-group col-md-4">
                                            <label>PAN Number</label>
                                            <input type="text" class="form-control" name="pan_number" />
                                        </div>
                                        <div class="form-group col-md-4">
                                            <label>Aadhar Number</label>
                                            <input type="text" class="form-control" name="aadhar_number" />
                                        </div>
                                    </div>
                                        <div class="row">
                                        	<div class="col-md-5">
                                            	<div class="form-group">
                                                    <label>Address/Street</label>
                                                    <textarea class="form-control" name="address" rows="3"></textarea>
                                                </div>
                                                <button type="submit" class="btn btn-warning btn-block">Submit</button>
                                            </div>
                                            <div class="col-md-7">
                                            	<div class="form-group">
                                                    <label>State</label>
                                                    <input type="text" class="form-control" name="state" />
                                                </div>
                                                <div class="row">
                                                	<div class="form-group col-md-7">
                                                        <label>City</label>
                                                        <input type="text" class="form-control" name="city" />
                                                    </div>
                                                    <div class="form-group col-md-5">
                                                        <label>Pincode</label>
                                                        <input type="text" class="form-control" name="pincode" />
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        </div>
                                        <div class="col-md-5">
                                        <!--<b class="text-danger">DOCUMENTS</b>-->
                                        <div class="row">
                                        <div class="form-group col-md-6">
                                <label class="text-danger">Upload Photo</label>
                                <input type="file" class="form-control" id="fileUpload3" name="photo"  />
                                <div class="form-group" id="image-container3">
                                    <img height="120px" class="img img-responsive" src="<?php echo base_url();?>assets/images/docs/user.png" /> 
                                </div>
                            </div>
                            <div class="form-group col-md-6">
                                <label class="text-danger">Upload PAN CARD</label>
                                <input type="file" class="form-control" id="fileUpload" name="pan"  />
                                <div class="form-group" id="image-container">
                                    <img height="120px" class="img img-responsive" src="<?php echo base_url();?>assets/images/docs/pan.jpg" /> 
                                </div>
                            </div>
                            <div class="form-group  col-md-6">
                                <label class="text-danger">Upload Aadhar (Front/Back)</label>
                                <input type="file" class="form-control" id="fileUpload1" name="aadhar"  />
                                <div class="form-group" id="image-container1">
                                    <img height="120px" class="img img-responsive" src="<?php echo base_url();?>assets/images/docs/aadhar.jpg" /> 
                                </div>
                            </div>
                            <div class="form-group  col-md-6">
                                <label class="text-danger">Upload Passport</label>
                                <input type="file" class="form-control" id="fileUpload2" name="passport"  />
                                <div class="form-group" id="image-container2">
                                    <img height="120px" class="img img-responsive" src="<?php echo base_url();?>assets/images/docs/passport.jpg" /> 
                                </div>
                            </div></div>
                                        </div>
                                        </div>
                                     </form>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div><!--/.body content-->
                </div><!--/.main content-->
                
            </div><!--/.wrapper-->
        </div>
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		$("#fileUpload3").on('change', function() {
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		  } else {
			var container = $("#image-container1");
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		  }});
		$("#fileUpload2").on('change', function() {
		  if (typeof(FileReader) == "undefined") {
			alert("Your browser doesn't support HTML5, Please upgrade your browser");
		  } else {
			var container = $("#image-container2");
			container.empty();
			var reader = new FileReader();
			reader.onload = function(e) {
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			reader.readAsDataURL($(this)[0].files[0]);
		  }});
		$(document).ready(function(){
			
		});
		</script>
        <script src="<?php echo base_url();?>admin_assets/dist/js/popper.min.js"></script>
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