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Form analysis
1 forms found in the DOM

POST /Identity/Account/Register

<form id="registerForm" enctype="multipart/form-data" method="post" action="/Identity/Account/Register" novalidate="novalidate">
  <fieldset>
    <legend>Personal Info</legend>
    <div class="row g-2">
      <div class="col-md">
        <label for="Input_FirstName">First Name</label>
        <input style="text-transform: uppercase" class="form-control" placeholder="First Name" type="text" data-val="true" data-val-minlength="Firstname must be atleast 2 letters" data-val-minlength-min="2"
          data-val-required="The FirstName field is required." id="Input_FirstName" name="Input.FirstName" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.FirstName" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_MidleName">Middle Name</label>
        <input style="text-transform: uppercase" class="form-control" placeholder="Middle Name" type="text" id="Input_MidleName" name="Input.MidleName" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.MidleName" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_LastName">Last Name</label>
        <input style="text-transform: uppercase" class="form-control" placeholder="Last Name" type="text" data-val="true" data-val-minlength="Lastname must be atleast 2 letters" data-val-minlength-min="2"
          data-val-required="The LastName field is required." id="Input_LastName" name="Input.LastName" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.LastName" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_NameExtension">Name Ext.</label>
        <input style="text-transform: uppercase" class="form-control" placeholder="Extension" type="text" data-val="true" data-val-maxlength="Name Extention maximum length is 3 letters" data-val-maxlength-max="3" id="Input_NameExtension"
          maxlength="3" name="Input.NameExtension" value="">
      </div>
    </div>
    <div class="row mt-2 g-2">
      <div class="col-md">
        <label for="Input_BranchId">Branch</label>
        <select class="form-control select2 select2-hidden-accessible" style="width:100%;" data-val="true" data-val-range="Please Select a branch" data-val-range-max="250" data-val-range-min="1" data-val-required="The BranchId field is required."
          id="Input_BranchId" name="Input.BranchId" data-select2-id="select2-data-Input_BranchId" tabindex="-1" aria-hidden="true">
          <option value="0" data-select2-id="select2-data-2-kshx">--Select--</option>
          <option value="29">Aglayan Branch</option>
          <option value="30">Aguinaldo Branch</option>
          <option value="7">Alubijid Branch</option>
          <option value="102">Ampayon Business Center</option>
          <option value="74">Bacoor Cavite Business Center</option>
          <option value="31">Bad-as Business Center</option>
          <option value="81">Bagontaas Business Center</option>
          <option value="8">Balingasag Branch</option>
          <option value="12">Balingoan Branch</option>
          <option value="108">Banisilan Business Center</option>
          <option value="32">Bankerohan Business Center</option>
          <option value="33">Barobo Business Center</option>
          <option value="84">Baungon Business Center</option>
          <option value="21">Bayugan Branch</option>
          <option value="107">Bislig Business Center</option>
          <option value="112">Buenavista Business Center</option>
          <option value="34">Bulua Business Center</option>
          <option value="18">Butuan Libertad Branch</option>
          <option value="35">Cabadbaran Branch</option>
          <option value="96">Calinan Business Center</option>
          <option value="16">Camiguin Mambajao Branch</option>
          <option value="2">Carmen Branch</option>
          <option value="36">Claveria Branch</option>
          <option value="9">Cogon Branch</option>
          <option value="95">Cordova Business Center</option>
          <option value="37">Damilag Branch</option>
          <option value="90">Danao Business Center</option>
          <option value="20">Davao Ponciano Branch</option>
          <option value="38">Digos Business Center</option>
          <option value="39">Dipolog Branch</option>
          <option value="17">Don Carlos Branch</option>
          <option value="40">El Salvador Business Center</option>
          <option value="15">Gingoog Branch</option>
          <option value="87">Guindulman Business Center</option>
          <option value="14">Iligan Branch</option>
          <option value="111">Indahag Business Center</option>
          <option value="41">Initao Business Center</option>
          <option value="24">Jagna Branch</option>
          <option value="93">Jasaan Business Center</option>
          <option value="42">Kadingilan Business Center</option>
          <option value="43">Kalilangan Branch</option>
          <option value="44">Kibawe Branch</option>
          <option value="45">Kisolon Branch</option>
          <option value="46">Kiwalan Business Center</option>
          <option value="47">Laguindingan Business Center</option>
          <option value="49">Langihan Business Center</option>
          <option value="101">Lantapan Business Center</option>
          <option value="3">Lapasan Branch</option>
          <option value="48">Lapu-lapu Branch</option>
          <option value="50">Linamon Business Center</option>
          <option value="51">Lugait Business Center</option>
          <option value="52">M. Calo Branch</option>
          <option value="53">Mahinog Business Center</option>
          <option value="1">Main Branch</option>
          <option value="26">Makati Branch</option>
          <option value="11">Malaybalay Branch</option>
          <option value="85">Malaybalay Market</option>
          <option value="27">Mandaue Branch</option>
          <option value="56">Manolo Branch</option>
          <option value="25">Maramag Branch</option>
          <option value="22">Maranding Branch</option>
          <option value="54">Medina Branch</option>
          <option value="55">Mintal Branch</option>
          <option value="86">Molave Business Center</option>
          <option value="10">Naawan Branch</option>
          <option value="57">Nasipit Business Center</option>
          <option value="5">Opol Branch</option>
          <option value="58">Oroquieta Branch</option>
          <option value="59">Ozamis Branch</option>
          <option value="60">Pagadian Branch</option>
          <option value="92">Panabo Business Center</option>
          <option value="83">Pangantucan Business Center</option>
          <option value="97">Pasay Business Center</option>
          <option value="4">Puerto Branch</option>
          <option value="61">Quezon Bukidnon Branch</option>
          <option value="82">Quezon City Branch</option>
          <option value="80">Ramos Cebu Branch</option>
          <option value="62">Salay Branch</option>
          <option value="100">San Fernando Business Center</option>
          <option value="64">San Franz Branch</option>
          <option value="63">San Jose Branch</option>
          <option value="89">Santiago Business Center</option>
          <option value="88">Siargao Business Center</option>
          <option value="65">Sugbongcogon Business Center</option>
          <option value="23">Surigao Branch</option>
          <option value="28">Tagbilaran Branch</option>
          <option value="109">Tagoloan Business Center</option>
          <option value="66">Tagum Branch</option>
          <option value="67">Talakag Branch</option>
          <option value="91">Talisay Business Center</option>
          <option value="68">Talisayan Business Center</option>
          <option value="69">Tandag Branch</option>
          <option value="19">Tiano-Recto Branch</option>
          <option value="70">Toril Branch</option>
          <option value="94">Trinto Business Center</option>
          <option value="99">Tubigon Business Center</option>
          <option value="71">Tubod Business Center</option>
          <option value="98">Ubay Business Center</option>
          <option value="13">Valencia Branch</option>
          <option value="110">Vamenta Business Center</option>
          <option value="6">Villanueva Branch</option>
          <option value="104">WAO BUSINESS CENTER</option>
          <option value="103">Xavier Heights Business Center</option>
        </select><span class="select2 select2-container select2-container--default" dir="ltr" data-select2-id="select2-data-1-5dry" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
              aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-Input_BranchId-container" aria-controls="select2-Input_BranchId-container"><span class="select2-selection__rendered"
                id="select2-Input_BranchId-container" role="textbox" aria-readonly="true" title="--Select--">--Select--</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span
            class="dropdown-wrapper" aria-hidden="true"></span></span>
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.BranchId" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md mt-2 g-2">
        <label for="Input_CompleteAddress">Complete Address</label>
        <input class="form-control" placeholder="Address" type="text" data-val="true" data-val-required="The CompleteAddress field is required." id="Input_CompleteAddress" name="Input.CompleteAddress" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.CompleteAddress" data-valmsg-replace="true"></span>
      </div>
    </div>
    <div class="row mt-2 g-2">
      <div class="col-md">
        <label for="Input_BirthPlace">Birth place</label>
        <input style="text-transform: uppercase" class="form-control" placeholder="Birth Place" type="text" id="Input_BirthPlace" name="Input.BirthPlace" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.BirthPlace" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <div class="row">
          <div class="col">
            <label for="Input_TinNumber">TIN Number</label>
            <input class="form-control" placeholder="TIN NUMBER" type="text" data-val="true" data-val-maxlength="Invalid Tin Number." data-val-maxlength-max="15" data-val-minlength="Invalid Tin Number." data-val-minlength-min="9"
              data-val-regex="Invalid Tin Number. Only Numbers are allowed" data-val-regex-pattern="([0-9]*)" data-val-required="Tin Number is Required" id="Input_TinNumber" maxlength="15" name="Input.TinNumber" value="">
            <span class="text-danger field-validation-valid" data-valmsg-for="Input.TinNumber" data-valmsg-replace="true"></span>
          </div>
        </div>
      </div>
    </div>
    <div class="row  mt-2 g-2">
      <div class="col-md">
        <span class="text-black">TIN # is required. In order for us to verify your TIN # please upload a photo of your TIN ID/Card here. </span>
        <input class="form-control" multiple="" accept="image/jpg, image/png, image/jpeg" placeholder="Upload your ID/Card" type="file" data-val="true" data-val-required="TIN Id is required" id="Input_formFiles" name="Input.formFiles">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.formFiles" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
      </div>
    </div>
    <div class="row mt-2 g-2">
      <div class="col-md">
        <label for="Input_Gender">Gender</label>
        <select class="form-select" data-val="true" data-val-required="The Gender field is required." id="Input_Gender" name="Input.Gender">
          <option selected="" value="Male">Male</option>
          <option value="Female">Female</option>
        </select>
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.Gender" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_CivilStatus">Civil Status</label>
        <select class="form-select" data-val="true" data-val-required="The CivilStatus field is required." id="Input_CivilStatus" name="Input.CivilStatus">
          <option selected="" value="Single">Single</option>
          <option value="Married">Married</option>
          <option value="Widowed">Widowed</option>
          <option value="Divorce">Divorce</option>
        </select>
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.CivilStatus" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_DateofBirth">Date of Birth</label>
        <input class="form-control" placeholder="Birthday" type="date" data-val="true" data-val-required="The DateofBirth field is required." id="Input_DateofBirth" name="Input.DateofBirth" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.DateofBirth" data-valmsg-replace="true"></span>
      </div>
    </div>
  </fieldset>
  <fieldset class="mt-3">
    <legend>Account Info</legend>
    <div class="row g-2">
      <div class="col-md">
        <label for="Input_MobileNumber">Mobile Number</label>
        <input class="form-control" placeholder="Mobile Number" type="tel" data-val="true" data-val-maxlength="The field MobileNumber must be a string or array type with a maximum length of '11'." data-val-maxlength-max="11"
          data-val-minlength="The field MobileNumber must be a string or array type with a minimum length of '11'." data-val-minlength-min="11" data-val-regex="Invalid Mobile Number." data-val-regex-pattern="([0-9]*)"
          data-val-required="The MobileNumber field is required." id="Input_MobileNumber" maxlength="11" name="Input.MobileNumber" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.MobileNumber" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_EmailAddress">Email Address</label>
        <input class="form-control" placeholder="Email" type="email" data-val="true" data-val-required="The EmailAddress field is required." id="Input_EmailAddress" name="Input.EmailAddress" value="">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.EmailAddress" data-valmsg-replace="true"></span>
      </div>
    </div>
    <div class="row g-2 mt-2">
      <span class="text-black">Password need to have atleast 1 capital letter,special character,number and atleast 8 characters long </span>
      <span class="text-black">Example: Ju@nDeLaCruz22 </span>
      <div class="col-md">
        <label for="Input_Password">Password</label>
        <input class="form-control" placeholder="Password" type="password" data-val="true" data-val-required="The Password field is required." id="Input_Password" name="Input.Password">
        <div class="form-check">
          <input class="form-check-input" type="checkbox" id="showpass">
          <label class="form-check-label" for="showpass"> Show Password </label>
        </div>
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.Password" data-valmsg-replace="true"></span>
      </div>
      <div class="col-md">
        <label for="Input_RePassword">Retype Password</label>
        <input class="form-control" placeholder="Re Type Password" type="password" data-val="true" data-val-equalto="The password and confirmation password do not match." data-val-equalto-other="*.Password" id="Input_RePassword"
          name="Input.RePassword">
        <span class="text-danger field-validation-valid" data-valmsg-for="Input.RePassword" data-valmsg-replace="true"></span>
      </div>
    </div>
    <div class="row mt-2">
      <div class="col-md">
        <div class="form-check">
          <input class="form-check-input" id="terms" type="checkbox" data-val="true" data-val-required="The AcceptTerms field is required." name="Input.AcceptTerms" value="true">
          <label class="form-check-label" for="terms"> I Accept our <a href="#" data-bs-toggle="modal" data-bs-target="#termsandpolicy">
                                                Terms and Policy
                                            </a>
          </label>
        </div>
      </div>
    </div>
  </fieldset>
  <div class="row mt-2 ">
    <div class="col-md-12">
    </div>
  </div>
  <div class="row mt-2 ">
    <div class="col-md-12 d-flex justify-content-center">
      <button class="btn " style="background-color: rgba(255,193,7,1);color: black;" id="submiteButton" type="submit">Register Now</button>
    </div>
  </div>
  <div class="text-center mt-5">
    <p>Already Registered? Click here to <a href="./login">Login</a></p>
  </div>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8C7UO9JB9QpBjAOXvjiQ-pPsFcMYPriAszof8e--2qYmwXKYnWsrS57LTmqepoXT2P788vXcbjOI3eTWUqnD-81461HpkBRIZkW7FCO0u3DwH8X2zFepJcQyMi3ZwMNT5uW0e_ECgz49tDWmbaBVgVs"><input
    name="Input.AcceptTerms" type="hidden" value="false">
</form>

Text Content

MEMBER REGISTRATION

Personal Info
First Name
Middle Name
Last Name
Name Ext.
Branch --Select-- Aglayan Branch Aguinaldo Branch Alubijid Branch Ampayon
Business Center Bacoor Cavite Business Center Bad-as Business Center Bagontaas
Business Center Balingasag Branch Balingoan Branch Banisilan Business Center
Bankerohan Business Center Barobo Business Center Baungon Business Center
Bayugan Branch Bislig Business Center Buenavista Business Center Bulua Business
Center Butuan Libertad Branch Cabadbaran Branch Calinan Business Center Camiguin
Mambajao Branch Carmen Branch Claveria Branch Cogon Branch Cordova Business
Center Damilag Branch Danao Business Center Davao Ponciano Branch Digos Business
Center Dipolog Branch Don Carlos Branch El Salvador Business Center Gingoog
Branch Guindulman Business Center Iligan Branch Indahag Business Center Initao
Business Center Jagna Branch Jasaan Business Center Kadingilan Business Center
Kalilangan Branch Kibawe Branch Kisolon Branch Kiwalan Business Center
Laguindingan Business Center Langihan Business Center Lantapan Business Center
Lapasan Branch Lapu-lapu Branch Linamon Business Center Lugait Business Center
M. Calo Branch Mahinog Business Center Main Branch Makati Branch Malaybalay
Branch Malaybalay Market Mandaue Branch Manolo Branch Maramag Branch Maranding
Branch Medina Branch Mintal Branch Molave Business Center Naawan Branch Nasipit
Business Center Opol Branch Oroquieta Branch Ozamis Branch Pagadian Branch
Panabo Business Center Pangantucan Business Center Pasay Business Center Puerto
Branch Quezon Bukidnon Branch Quezon City Branch Ramos Cebu Branch Salay Branch
San Fernando Business Center San Franz Branch San Jose Branch Santiago Business
Center Siargao Business Center Sugbongcogon Business Center Surigao Branch
Tagbilaran Branch Tagoloan Business Center Tagum Branch Talakag Branch Talisay
Business Center Talisayan Business Center Tandag Branch Tiano-Recto Branch Toril
Branch Trinto Business Center Tubigon Business Center Tubod Business Center Ubay
Business Center Valencia Branch Vamenta Business Center Villanueva Branch WAO
BUSINESS CENTER Xavier Heights Business Center --Select--
Complete Address
Birth place
TIN Number
TIN # is required. In order for us to verify your TIN # please upload a photo of
your TIN ID/Card here.

Gender Male Female
Civil Status Single Married Widowed Divorce
Date of Birth
Account Info
Mobile Number
Email Address
Password need to have atleast 1 capital letter,special character,number and
atleast 8 characters long Example: Ju@nDeLaCruz22
Password
Show Password
Retype Password
I Accept our Terms and Policy

Register Now

Already Registered? Click here to Login

TERMS AND POLICY

By clicking "I Agree", "I Accept", "Continue", "Sign Up", or likewise,
registering, accessing or using the PMS Website or parts of it, you agree to
enter into a legally binding contract with First Community Cooperative (FICCO)
(even if you are a minor or representing a person, company or entity). If you do
not agree on any of the Terms, do not proceed to avail the service.

The Services at the FICCO Website are available only to person, natural or
juridical, with a User Account. You will be held responsible not only for the
confidentiality of your password but also for any statements made on your
account. FICCO likewise may, without prior notice, alter, modify, restrict, or
even suspend, and stop any part of its PMS website at its sole discretion.

FICCO shall have no liability for any claim, loss or damage resulting from the
accuracy or completeness of the information at the PMS Website.

FICCO neither makes no warranty nor guarantee, expressed or implied, as to the
eligibility or qualification for the Services since it will be subjected to
validation in order to approve any request for application for the service.
While FICCO makes reasonable efforts to ensure the availability of the Services,
it does not guarantee, however, that the Services will be processed at the
designated place or time.

FICCO may change or impose additional fees for the Services at any time without
prior notice.

Unless otherwise specified, the Fee indicated in the pay order slip is the
Application Fee and does not cover the actual fees for the Services. Confirmed
payment for obligations are non-cancellable and fees paid are non-refundable.

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