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<!DOCTYPE html><html xmlns:th="http://www.thymeleaf.org"><head> <title>Document Form</title> <!-- Include Bootstrap CSS for styling (optional) --> <link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" integrity="sha384-Gn5384xqQ1aoWXA+058RXPxPg6fy4IWvTNh0E263XmFcJlSAwiGgFAW/dAiS6JXm" crossorigin="anonymous"></head><body>
<!-- <div class="container mt-5">
<div class="text-center"> <h2>Circular - New</h2> </div> --><div class="main-content"> <div class="container-fluid"> <div class="page-header"> <div class="row align-items-end"> <div class="col-lg-8"> <div class="page-header-title"> <i class="far fa-calendar-plus bg-blue"></i> <div class="d-inline"> <h5>Circular - New</h5> <!-- <span>1913 Tax Collection Module</span> --> </div> </div> </div> <!-- <div class="col-lg-4">
<nav class="breadcrumb-container" aria-label="breadcrumb"> <ol class="breadcrumb"> <li class="breadcrumb-item"> <a href="index"><i class="ik ik-home"></i></a> </li> <li class="breadcrumb-item" aria-current="page">1913 Tax Collection</li> <li class="breadcrumb-item active" aria-current="page">Create Request</li> </ol> </nav> </div> --> </div> </div> <hr> <div class="row" ><div class="col-md-6"> <div class="card"> <form action="/submit" method="post" enctype="multipart/form-data"> <div class="form-group"> <label for="documentCategory">Document Category:</label> <div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> <label class="form-check-label" for="inlineRadio1">Common</label></div><div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> <label class="form-check-label" for="inlineRadio2">Flood</label></div>
</div> <div class="form-group"> <label for="documentCategory">Type:</label> <div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> <label class="form-check-label" for="inlineRadio1">Circular</label></div><div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> <label class="form-check-label" for="inlineRadio2">Minutes</label></div><div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> <label class="form-check-label" for="inlineRadio1">Regular Report</label></div><div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> <label class="form-check-label" for="inlineRadio2">Rainfall Report</label></div> </div>
<div class="form-group"> <label for="department" class="col-sm-3 col-form-label">From Department:</label> <div class="col-sm-9"> <select class="form-control" id="department" name="department"> <option th:each="dep : ${departments}" th:value="${dep}" th:text="${dep}"></option> </select> </div> </div>
<div class="form-group"> <label for="date">Date:</label> <input type="date" class="form-control" id="date" name="date" required> </div> <div class="form-group"> <label for="documentCategory">SMS:</label> <div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1"> <label class="form-check-label" for="inlineRadio1">Send</label></div><div class="form-check form-check-inline"> <input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2"> <label class="form-check-label" for="inlineRadio2">Not Send</label></div> </div>
<div class="form-group"> <label for="smsSubject" class="col-sm-3 col-form-label">SMS Subject:</label> <div class="col-sm-9"> <input type="text" class="form-control" id="smsSubject" name="smsSubject" required> </div> </div> <div class="form-group"> <label for="subject" class="col-sm-3 col-form-label">Subject:</label> <div class="col-sm-9"> <input type="text" class="form-control" id="subject" name="subject" required> </div> </div>
<div class="form-group"> <label for="file">Select File:</label> <input type="file" class="form-control-file" id="file" name="file" required> </div>
<button type="submit" class="btn btn-primary">Submit</button> </form></div></div></div></div></div>
<!-- Include Bootstrap JS for button group styling (optional) --><script src="https://code.jquery.com/jquery-3.2.1.slim.min.js"></script><script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.12.9/umd/popper.min.js"></script><script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/js/bootstrap.min.js"></script>
</body></html>
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