pithwacharitabletrust.org Open in urlscan Pro
2606:4700:3032::6815:4804  Public Scan

Form analysis
2 forms found in the DOM

POST #

<form class="form-data" action="#" method="POST" id="main-form">
  <div>
    <label for="family-head" id="family-head-label">Family Head's Name:</label>
    <input type="text" id="family-head" name="family-head" required=""><br>
    <img id="image-preview" class="avatar" src="./blank.png" alt="Avatar Placeholder">
    <label for="family-head-photo" id="family-head-photo">Upload passport size photo:</label>
    <input type="file" id="file-input" required="">
    <br><br>
  </div>
  <label for="village-name" id="village-name-label">Family's Native Village:</label>
  <input type="text" id="village-name" name="village-name" required=""><br><br>
  <div class="input-row">
    <div>
      <label for="blood-group" id="blood-group-label">Blood Group:</label>
      <input type="text" id="blood-group" name="blood-group">
    </div>
    <div>
      <label for="education" id="education-label">Education:</label>
      <input type="text" id="education" name="education">
    </div>
  </div><br>
  <div class="input-row">
    <div>
      <label for="family-members-count" id="family-members-count-label">Number of Family Members:</label>
      <input type="number" id="family-members-count" name="family-members-count"><br><br>
    </div>
    <div>
      <label for="dob" id="dob-label">Date of Birth:</label>
      <input type="date" id="dob" name="dob"><br><br>
    </div>
  </div>
  <label for="address" id="address-label">Postal Address:</label>
  <textarea id="address" name="address" rows="4" cols="50"></textarea><br><br>
  <div class="input-row">
    <div>
      <label for="phone" id="phone-label">Phone Number:</label>
      <input type="tel" id="phone" name="phone"><br><br>
    </div>
    <div>
      <label for="occupation" id="occupation-label">Occupation:</label>
      <input type="text" id="occupation" name="occupation"><br><br>
    </div>
  </div>
  <div class="input-row">
    <div>
      <label for="Matajimadh" id="mataji-label">Write the name of the village where your Mataji’s shrine and Surapura Dada are located:</label>
      <input type="text" id="mataji" name="mataji"><br><br>
    </div>
    <div>
      <label for="add-family" id="add-family-label">Add Family Members:</label><br><br>
      <input type="button" id="open-popup" value="Add family members:"><br><br>
    </div>
  </div>
  <table id="details-table">
    <thead>
      <tr>
        <th>Photo</th>
        <th id="tb-name">Name</th>
        <th id="tb-rel">Relation</th>
        <th id="tb-dob">Date of birth</th>
        <th id="tb-bg">Blood Group</th>
        <th id="tb-ms">Marital Status</th>
      </tr>
    </thead>
    <tbody>
    </tbody>
  </table>
  <label for="help" id="help-label">Would you like to help Pithwa Charitable Trust?</label><br>
  <input type="radio" id="yes" name="help" value="yes">
  <label for="yes" id="yes-label">Yes</label><br>
  <input type="radio" id="no" name="help" value="no">
  <label for="no" id="no-label">No</label><br><br>
  <label for="suggestions" id="suggestions-label">Any Suggestions/Message:</label>
  <textarea id="suggestions" name="suggestions" rows="4" cols="50"></textarea><br><br>
  <input type="submit" value="Submit" id="submit-button">
</form>

<form id="member-form">
  <label for="name" id="popup-name-label">Name:</label>
  <input type="text" id="name" name="name" required=""><br><br>
  <img id="image-preview-mem" class="avatar" src="./blank.png" alt="Avatar Placeholder">
  <label for="family-head-photo" id="family-head-photo">Upload passport size photo:</label>
  <input type="file" id="file-input-mem" required="">
  <br><br>
  <label for="relation" id="popup-relation-label">Relation:</label>
  <input type="text" id="relation" name="relation" required=""><br><br>
  <label for="bdate" id="popup-bdate-label">Birth Date:</label>
  <input type="date" id="bdate" name="bdate" required=""><br><br>
  <label for="blood-group-popup" id="popup-blood-group-label">Blood Group:</label>
  <input type="text" id="blood-group-popup" name="blood-group-popup" required=""><br><br>
  <label for="marital-status" id="popup-marital-status-label">Marital Status:</label>
  <input type="text" id="marital-status" name="marital-status" required=""><br><br>
  <input type="submit" value="Submit" id="popup-submit">
</form>

Text Content

PITHWA CHARITABLE TRUST

Change Language: English ગુજરાતી
Family Head's Name:
Upload passport size photo:


Family's Native Village:


Blood Group:
Education:

Number of Family Members:


Date of Birth:


Postal Address:


Phone Number:


Occupation:


Write the name of the village where your Mataji’s shrine and Surapura Dada are
located:


Add Family Members:





Photo Name Relation Date of birth Blood Group Marital Status

Would you like to help Pithwa Charitable Trust?
Yes
No

Any Suggestions/Message:


×


FAMILY MEMBER DETAILS

Name:

Upload passport size photo:

Relation:

Birth Date:

Blood Group:

Marital Status: