ProjectPrisha/inspl.html at master · ayushi-universe/ProjectPrisha · GitHub

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<!DOCTYPE html>
<html>
<head>
	<title>NEW POLICY</title>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
<link href="https://fonts.googleapis.com/css?family=Nunito:600|Open+Sans:600|Quicksand|Ubuntu" rel="stylesheet">
<link rel="stylesheet" type="text/css" href="form.css">
</head>
<body>
<div class="container">
    <div class="row">
        <div class="col-md-offset-3 col-md-6">
        	<img src="C:\WORK\git\prishapolicy\ASSET\prisha_png.png" alt="prishapolicy.com" class="img-responsive" style="margin: auto;">
        </div>
    </div>
    <div class="row mainform">
        <div class="col-md-offset-1 col-md-10" style="align-content: center; align-items: center;">
		<h1 style="text-align: center;">New Policy Form</h1>
		<h3 style="text-align: center;">Please fill in the following details</h3>
		<form>
			<div class="form-group">
				<label for="email">Email address</label>
				<input type="email" class="form-control" id="email">
			</div>
			<div class="form-group">
				<label for="ptype">Select list:</label>
				<select class="form-control" id="ptype" onchange="selection()">
					<option value="" class="types">Choose Type</option>
            		<option value="Car Insurance" class="types">Car Insurance</option>
            		<option value="Travel Insurance" class="types">Travel Insurance </option>
            		<option value="Term Life" class="types">Term Life</option>
            		<option value="Home Insurance" class="types">Home Insurance</option>
				</select>
			</div>
			<div class="form-group carins">
				<label for="carno">Car Registration Number</label>
				<input type="text" class="form-control" id="carno">
			</div>
			<div class="form-group carins">
				<label for="carno">Date of Purchase</label>
				<input type="Date" name="DOP">
			</div>
			<div class="form-group travelins">
				<label for="cover">Travel Cover value</label>
				<input type="text" class="form-control" id="cover">
			</div>
			<div class="form-group travelins">
				<label for="destination">Destination</label>
				<label class="radio-inline"><input type="radio" name="usa">USA or Canada</label>
				<label class="radio-inline"><input type="radio" name="nousa">Other countries</label>
			</div>
			<div class="form-group travelins">
				<label for="destination">Period</label>
				<label class="radio-inline"><input type="radio" name="30days">30 days or less</label>
				<label class="radio-inline"><input type="radio" name="60days">60 days</label>
				<label class="radio-inline"><input type="radio" name="90days">90 days</label>
				<label class="radio-inline"><input type="radio" name="90+days">more than 90 days</label>
			</div>
			<div class="form-group travelins">
				<label for="cover">Passport Number</label>
				<input type="text" class="form-control" id="Passportno">
			</div>
			<div class="form-group termlife">
				<label for="cover">Cover Value</label>
				<input type="text" class="form-control" id="Covervalue">
			</div>
			<div class="form-group termlife">
				<label for="cover">Date of birth</label>
				<input type="Date" name="DOB">
			</div>
			<div class="form-group termlife">
				<label for="smoke">Do you smoke</label>
				<label class="radio-inline"><input type="radio" name="SmokeYes">Yes</label>
				<label class="radio-inline"><input type="radio" name="SmokeNO">No</label>
			</div>
			<div class="form-group termlife">
				<label for="income">Annual Income</label>
				<label class="radio-inline"><input type="radio" name="upto10">upto 10 lac</label>
				<label class="radio-inline"><input type="radio" name="10-20">10-20 lac</label>
				<label class="radio-inline"><input type="radio" name="20-30">20-30 lac</label>
				<label class="radio-inline"><input type="radio" name="30+">more than 30 lac</label>
			</div>
			<div class="form-group homeins">
				<label for="is house rented"></label>
				<label class="radio-inline"><input type="radio" name="HomeYes">Yes</label>
				<label class="radio-inline"><input type="radio" name="HomeNo">No</label>
			</div>
			<div class="form-group homeins">
				<label for="ptype">Age of Property</label>
				<select class="form-control" id="ptype">
					<option value="">Age in years</option>
            		<option value="upto 20">upto 20</option>
            		<option value="20-40">20-40</option>
            		<option value="40+">40+</option>
				</select>
			</div>
			<div class="form-group homeins">
				<label for="Type of Property"></label>
				<label class="radio-inline"><input type="radio" name="Indi">Individual</label>
				<label class="radio-inline"><input type="radio" name="Flat">Flat/Appartment</label>
			</div>
			<div class="form-group homeins">
				<label for="coveragetype"></label>
				<label class="checkbox-inline"><input type="checkbox" value="Structure">Structure</label>
				<label class="checkbox-inline"><input type="checkbox" value="Interior">Interior</label>
			</div>
			<button type="submit" class="btn btn-default">Submit Form</button>
		</form>
        </div>
    </div>
</div>
<script type="text/javascript">
	function selection()
	{
		var sel=document.getElementById('ptype');
		var type=document.getElementsByClassName('types');

		if (type==Car Insurance){
			document.getElementsByClassName('carins').style.display="";
		}
		if (type==Travel Insurance){
			document.getElementsByClassName('travelins').style.display="";
		}
		if (type==Home Insurance){
			document.getElementsByClassName('homeins').style.display="";
		}
		if (type==Term Life){
			document.getElementsByClassName('termlife').style.display="";
		}
	}
</script>
</body>
</html>