<?php

$sex_codes = array('Male','Female','Other (for company)');
$marital_codes = array('Married','Unmarried','Widow/Widower','Other (for company)');
$quota_codes = array('Scheduled Caste','Scheduled Tribe','Backward Class','Defense Persons > 50 Years',
	'Govt. Service > 50 Years','Handicapped','Freedom Fighter','MP/MLA/MLC','Employee-UP Devlopment Authority',
	'Employee-UP Municipality/City Board','Employee-UP Mahapalika/Jal Sansthan','Employee-UP Housing Board');
$occupation_codes = array('Service','Business','Agriculture','Self Employed','Department/Firm','Others');
$payplan_codes = array('Hire Purchase','Self Financed','Cash Down Payment');
$income_codes = array('EWS','LIG','MIG','HIG');
$yesno = array('No','Yes');


echo "Please fill in the form completely as all informations are mandatory for further processing at Authority.
<input type='hidden' name='id' value='$id'>
<table class='normal' width='90%'>
<tr><td align='right' nowrap>Scheme Name</td>
<td><input type='text' name='scheme_name' value='$scheme_name' size='50'></td></tr>
<tr><td align='right' nowrap>Scheme Code</td>
<td><input type='text' name='scheme_code' value='$scheme_code' size='50'></td></tr>
<tr valign='top'><td align='right' nowrap>Property Category</td>
<td><input type='text' name='property_category' value='$property_category' size='50'></td></tr>
<tr><td align='right' nowrap>Property Code</td>
<td><input type='text' name='property_code' value='$property_code' size='50'></td></tr>
<tr><td align='right' nowrap>Applicant Name</td>
<td><input type='text' name='applicant_name' value='$applicant_name' size='50'></td></tr>
<tr valign='top'><td align='right' nowrap>Present Address</td>
<td><textarea name='present_address' rows='2' cols='50'>$present_address</textarea></td></tr>
<tr><td align='right' nowrap>Age</td>
<td><input type='text' name='age' value='$age' size='5'> years</td></tr>
<tr><td align='right' nowrap>Sex</td>
<td><select name='sex' style='width:330px'>";
foreach($sex_codes as $x) {
	echo "<option value='$x'";
	if ($sex == $x) echo " selected";
	echo ">$x</option>";
}
echo "</select></td></tr>
<tr><td align='right' nowrap>Marital Status</td>
<td><select name='marital_status' style='width:330px'>"; 
foreach($marital_codes as $m) {
       	echo "<option value='$m'";
	if ($marital_status == $m) echo " selected";
	echo ">$m</option>";
}
echo "</select></td></tr>
<tr><td align='right' nowrap>Quota Status</td>
<td><select name='quota' style='width:330px'>";   
foreach($quota_codes as $q) {
       	echo "<option value='$q'";
	if ($quota == $q) echo " selected";
	echo ">$q</option>";
}
echo "</select></td></tr>
<tr><td align='right' nowrap>Occupation</td>
<td><select name='occupation' style='width:330px'>";
foreach($occupation_codes as $o) {
       	echo "<option value='$o'";
	if ($occupation == $o) echo " selected";
	echo ">$o</option>";
}
echo "</select></td></tr>
<tr><td align='right' nowrap>Pay Plan</td>
<td><select name='payplan' style='width:330px'>";
foreach($payplan_codes as $p) {
       	echo "<option value='$p'";
	if ($payplan == $p) echo " selected";
	echo ">$p</option>";
}
echo "</select></td></tr>
<tr><td align='right' nowrap>Income Code</td>
<td><select name='income_code' style='width:330px'>";
foreach($income_codes as $i) {
       	echo "<option value='$i'";
	if ($income_code == $i) echo " selected";
	echo ">$i</option>";
}
echo "</select></td></tr>
<tr><td align='right' nowrap>Annual Income</td>
<td><input type='text' name='annual_income' value='$annual_income' size='10'> in Rs.</td></tr>
<tr><td align='right' nowrap>Applicant Father/Husband Name</td>
<td><input type='text' name='applicant_fhname' value='$applicant_fhname' size='50'></td></tr>
<tr valign='top'><td align='right' nowrap>Permanent Address</td>
<td><textarea name='permanent_address' rows='2' cols='50'>$permanent_address</textarea></td></tr>
<tr><td align='right' nowrap>Phone No.</td>
<td><input type='text' name='phone_no' value='$phone_no' size='50'></td></tr>
<tr><td align='right' nowrap>Email</td>
<td><input type='text' name='email' value='$email' size='50'></td></tr>
<tr><td align='right' nowrap>Nominee Name</td>
<td><input type='text' name='nominee_name' value='$nominee_name' size='50'></td></tr>
<tr><td align='right' nowrap>Nominee Father/Husband Name</td>
<td><input type='text' name='nominee_fhname' value='$nominee_fhname' size='50'></td></tr>
<tr><td align='right' nowrap>ADA Property Owner</td>
<td><select name='adaproperty_owner' style='width:330px'>";
foreach($yesno as $y) {
       	echo "<option value='$y'";
	if ($adaproperty_owner == $y) echo " selected";
	echo ">$y</option>";
}
echo "</select></td></tr>
<tr><td></td><td><input type='submit' name='submit' value='SUBMIT' style='width:80px'></td></tr>
</table>";

?>