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1 forms found in the DOM

POST

<form method="POST" class="p-1 payment-form"><input type="hidden" name="form.order_amount">
  <div>
    <div class="form-group row mb-2"><label class="col-4 col-form-label" for="participant_name">Nama Penuh <span class="text-red"> *</span></label>
      <div class="col-8"><input type="text" id="participant_name" name="participant_name" required="" class="form-control"><!----></div>
    </div>
    <div class="form-group row mb-2"><label class="col-4 col-form-label" for="participant_id">Nombor ID <span class="text-red"> *</span></label>
      <div class="col-8">
        <div class="input-group">
          <div class="input-group-prepend"><select id="participant_id_type" name="participant_id_type" class="form-control" style="background: rgb(233, 236, 239);">
              <option value="1">New IC Number</option>
              <option value="2">Old IC Number</option>
              <option value="3">Passport Number</option>
              <option value="4">Business Registration</option>
            </select></div><input type="text" id="participant_id" name="participant_id" class="form-control" required="">
        </div><!---->
      </div>
    </div><!---->
    <div class="form-group row mb-2" id="hp_no_iti_wrapper"><label class="col-4 col-form-label" for="participant_tel_no">Nombor Telefon (H/P) <span class="text-red"> *</span></label>
      <div class="col-8">
        <div class="vue-tel-input form-control">
          <div aria-label="Country Code Selector" aria-haspopup="listbox" aria-expanded="false" role="button" class="vti__dropdown"><span class="vti__selection"><span class="vti__flag my"></span><span class="vti__country-code"> +60</span><span
                class="vti__dropdown-arrow">▼</span></span><!----></div><input type="tel" class="vti__input" id="participant_tel_no" maxlength="16" placeholder="169164454">
        </div><!---->
      </div>
    </div>
    <div class="form-group row mb-2"><label class="col-4 col-form-label" for="participant_email">Alamat Emel <span class="text-red"> *</span></label>
      <div class="col-8"><input type="email" inputmode="email" id="participant_email" name="participant_email" required="" class="form-control" placeholder="Maksimum 27 karakter" maxlength="27"><!----></div>
    </div><!----><!---->
  </div><!---->
  <div class="border-top pt-4 mt-3">
    <div class="row mb-3" payment_gatewaymodifiers="[object Object]">
      <div class="col-12">
        <h4 class="mb-3">
          <div class="badge badge-danger step">Langkah 3 </div> Kaedah Bayaran
        </h4>
      </div><!---->
      <div class="col-12"><img class="w-100 mt-2 mb-2" src="/images/payments/directdebit-participating-bank.png"></div>
    </div>
  </div>
  <div class="border-top pt-4">
    <div class="mb-2">
      <div class="alert alert-warning">
        <div class="custom-control custom-checkbox pl-3" value="1"><input type="checkbox" class="custom-control-input" id="checkbox-participant_sms_email_marketing_consent" value="true"><label
            class="custom-control-label mb-0 checkbox-participant_sms_email_marketing_consent" for="checkbox-participant_sms_email_marketing_consent">
            <p class="mb-0">Sila tandakan kotak pilihan ini jika anda tidak mahu menerima sebarang kemaskini daripada kami menerusi SMS dan e-mel.</p>
          </label></div>
      </div>
    </div><!---->
  </div>
  <div class="pt-4">
    <div class="text-center align-items-baseline justify-content-center mb-3"><button type="button" class="btn btn-lg btn-success btn-block-modified">Teruskan Pendaftaran<i class="fad fa-angle-double-right ml-1"></i></button><!----></div>
  </div>
</form>

Text Content

PEMBERITAHUAN

Untuk proses pendafataran Direct Debit bayaran RM 1 akan dikenakan. Bayaran
setiap bulan akan di tolak terus dari bank yang anda daftarkan samaada awal atau
akhir bulan bergantung pada tarikh pengaktifan direct debit dibuat.

LANGKAH 1 BUTIRAN SUMBANGAN

KeteranganKuantitiAmaunKos Operasi
Sumbangan Terkumpul
RM0.00
0%
Sasaran Kempen RM12,000.00
RM 1 SEHARI (PALING BAIK)
RM30.00

RM0.00RM 1.60 SEHARI
RM50.00

RM0.00RM 3.30 SEHARI
RM100.00

RM0.00SEIKHLAS HATI
(Minimum RM10.00)
1 x
RM
JumlahRM0.00Tambahan RM1.50 untuk cas transaksi payment gateway

KeteranganKuantitiAmaunKos OperasiRM 1 SEHARI (PALING BAIK)
RM30.00
0RM0.00RM 1.60 SEHARI
RM50.00
0RM0.00RM 3.30 SEHARI
RM100.00
0RM0.00SEIKHLAS HATI

1RM0.00JumlahRM0.00Tambahan RM1.50 untuk cas transaksi payment gateway

--------------------------------------------------------------------------------

LANGKAH 2 MAKLUMAT PENDERMA

Nama Penuh *

Nombor ID *
New IC NumberOld IC NumberPassport NumberBusiness Registration
Nombor Telefon (H/P) *
+60▼
Alamat Emel *

LANGKAH 3
KAEDAH BAYARAN



Sila tandakan kotak pilihan ini jika anda tidak mahu menerima sebarang kemaskini
daripada kami menerusi SMS dan e-mel.

Teruskan Pendaftaran

REDIRECTING TO PAYMENT GATEWAY PAGE...

Saya Nak Menyumbang
Persatuan Kebajikan Maahad Tahfiz Darul Quran
(PPM-004-14-04091985)
+601111875646
admin@perkematdq.com
Darul Quran Jakim
Jalan Hamzah, Ampang Pecah
44000, Ampang Jaya
Selangor, Malaysia

MEDIA SOSIAL

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AKAUN

 * Akaun Saya
 * Jejak Transaksi