Personal Information

{{ form_label(form.entry_type, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% for child in form.entry_type %} {{ form_widget(child, {'attr': { 'class': 'kt-radio' }}) }} {{ form_label(child, null, { 'label_attr': { 'class': 'non-req' }}) }} {{ form_errors(child) }} {% endfor %}

{{ form_label(form.orphan, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% for child in form.orphan %} {{ form_widget(child, {'attr': { 'class': 'kt-radio' }}) }} {{ form_label(child, null, { 'label_attr': { 'class': 'non-req' }}) }} {{ form_errors(child) }} {% endfor %}

{{ form_label(form.firstName, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% if read_only %} {{ form_widget(form.firstName, {'attr': { 'class': 'form-control', 'readOnly': 'true' }}) }} {% else %} {{ form_widget(form.firstName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}})}} {% endif %} {{ form_errors(form.firstName) }}

{{ form_label(form.middleName, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.middleName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.middleName) }}

{{ form_label(form.lastName, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% if read_only %} {{ form_widget(form.lastName, {'attr': { 'class': 'form-control', 'readOnly': 'true' }}) }} {% else %} {{ form_widget(form.lastName, {'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {% endif %} {{ form_errors(form.lastName) }}

{{ form_label(form.fatherHusbandName, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.fatherHusbandName,{'attr': { 'class': 'form-control','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.fatherHusbandName) }}

{{ form_label(form.photo, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.photo,{'attr': { 'class': 'form-control-file' }}) }} {{ form_errors(form.photo) }}

File must be .jpg,.png,.jpeg and file size less than 500 KB

{{ form_label(form.gender, '', {'label_attr': { 'class': 'col-4 col-for4-label font-weight-bold required' }}) }}

{% for child in form.gender %} {{ form_widget(child, {'attr': { 'class': 'kt-radio' }}) }} {{ form_label(child, null, { 'label_attr': { 'class': 'non-req' }}) }} {{ form_errors(child) }} {% endfor %}

{{ form_label(form.maritalStatus, '', {'label_attr': { 'class': 'col-4 col-for4-label font-weight-bold required' }}) }}

{% for child in form.maritalStatus %} {{ form_widget(child, {'attr': { 'class': 'kt-radio' }}) }} {{ form_label(child, null, { 'label_attr': { 'class': 'non-req' }}) }} {{ form_errors(child) }} {% endfor %}

{{ form_label(form.mobile, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.mobile, {'attr': { 'class': 'form-control','maxlength':'15','autocomplete':'off','minlength':'10', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')"}}) }} {{ form_errors(form.mobile) }}

{{ form_label(form.email, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.email, {'attr': { 'class': 'form-control','autocomplete':'off' }}) }} {{ form_errors(form.email) }}

{{ form_label(form.dob, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% if read_only %} {{ form_widget(form.dob, {'attr': { 'class': 'form-control dob', 'readOnly': 'true'}}) }} {% else %} {{ form_widget(form.dob, {'attr': { 'class': 'form-control dob', 'oninput':"this.value = this.value.replace(/[^]/g, '')"}}) }} {% endif %} {{ form_errors(form.dob) }}

Age

{% if read_only %} {{ form_widget(form.age, {'attr': { 'class': 'form-control age', 'readOnly': 'true' }}) }} {% else %} {{ form_widget(form.age, {'attr': { 'class': 'form-control age','min':'1','max':'150','maxlength':'3', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')"}}) }} {% endif %}

years

{{ form_label(form.occupation, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.occupation, {'attr': { 'class': 'form-control', 'maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.occupation) }}

{{ form_label(form.cast, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold required' }}) }}

{{ form_widget(form.cast, {'attr': { 'class': 'form-control select_dropdown' }}) }} {{ form_errors(form.cast) }}

{{ form_label(form.familyIncome, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

₹

{{ form_widget(form.familyIncome, {'attr': { 'class': 'form-control family_income','min':'1','maxlength':'10','oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }}

Yearly

{{ form_label(form.adharNum, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.adharNum, {'attr': { 'class': 'form-control','minlength':'12','maxlength':'12' }}) }} {{ form_errors(form.adharNum) }}

Address Information

{{ form_label(form.housePlotNo, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.housePlotNo, {'attr': { 'class': 'form-control', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)" }}) }} {{ form_errors(form.housePlotNo) }}

{{ form_label(form.address, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.address, {'attr': { 'class': 'form-control','maxlength':'255', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.address) }}

{{ form_label(form.state, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.state, {'attr': { 'class': 'form-control select_dropdown', 'data-ajax-url': path('location_district_json') }}) }} {{ form_errors(form.state) }}

{{ form_label(form.district, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.district, {'attr': { 'class': 'form-control select_dropdown', 'data-ajax-url': path('location_taluka_json') }}) }} {{ form_errors(form.district) }}

{{ form_label(form.taluka, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.taluka, {'attr': { 'class': 'form-control select_dropdown', 'data-ajax-url': path('location_village_json') }}) }} {{ form_errors(form.taluka) }}

{{ form_label(form.village, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.village, {'attr': { 'class': 'form-control select_dropdown' }}) }} {{ form_errors(form.village) }}

{{ form_label(form.pincode, '', {'label_attr': { 'class': 'col-3 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.pincode, {'attr': { 'class': 'form-control','minlength':'6','maxlength':'10', oninput:"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.pincode) }}

Other Information

{{ form_label(form.bplNum, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bplNum, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'30', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.bplNum) }}

{{ form_label(form.healthIdNumber, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% if read_only %} {{ form_widget(form.healthIdNumber, {'attr': { 'class': 'form-control', 'readOnly': 'true' }}) }} {% else %} {{ form_widget(form.healthIdNumber, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'30', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {% endif %} {{ form_errors(form.healthIdNumber) }}

{{ form_label(form.healthAddress, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{% if read_only %} {{ form_widget(form.healthAddress, {'attr': { 'class': 'form-control', 'readOnly': 'true' }}) }} {% else %} {{ form_widget(form.healthAddress, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'30', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {% endif %} {{ form_errors(form.healthAddress) }}

{{ form_label(form.abpmJay, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.abpmJay, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'30','onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.abpmJay) }}

{{ form_label(form.bankName, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bankName, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.bankName) }}

{{ form_label(form.bankAccountRepeat, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bankAccountRepeat, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'20', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.bankAccountRepeat) }}

{{ form_label(form.bankAccount, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bankAccount, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'20', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')"}}) }} {{ form_errors(form.bankAccount) }}

{{ form_label(form.bankBranch, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bankBranch, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'50', 'onkeydown':"return /[0-9a-zA-Z ]/i.test(event.key)"}}) }} {{ form_errors(form.bankBranch) }}

{{ form_label(form.bankIfsCode, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bankIfsCode, {'attr': { 'class': 'form-control','minlength':'1','maxlength':'20', 'oninput':"this.value = this.value.replace(/[^0-9]/g, '')" }}) }} {{ form_errors(form.bankIfsCode) }}

{{ form_label(form.bankBranchAddress, '', {'label_attr': { 'class': 'col-4 col-form-label font-weight-bold' }}) }}

{{ form_widget(form.bankBranchAddress, {'attr': { 'class': 'form-control','minlength':'8','maxlength':'255' }}) }} {{ form_errors(form.bankBranchAddress) }}