recensements.dgtt.cg
Open in
urlscan Pro
89.117.59.239
Public Scan
URL:
https://recensements.dgtt.cg/
Submission: On June 23 via api from US — Scanned from DE
Submission: On June 23 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<div class="mt-8 lg:mt-16 mb-8 space-y-8 md:grid md:grid-cols-2 md:gap-12 md:space-y-0 text-left">
<div>
<h3 class="mb-4 text-sm font-bold dark:text-white"> Personne physique <input id="country-option-1" style="cursor:pointer;" type="radio" name="countries" value="USA"
class="w-4 h-4 ml-2 border-gray-300 focus:ring-2 focus:ring-blue-300 dark:focus:ring-blue-600 dark:focus:bg-blue-600 dark:bg-gray-700 dark:border-gray-600" checked=""></h3>
</div>
<div>
<h3 class="mb-4 text-sm font-bold dark:text-white"> Personne morale <input id="country-option-2" style="cursor:pointer;" type="radio" name="countries" value="Germany"
class="w-4 h-4 ml-2 border-gray-300 focus:ring-2 focus:ring-blue-300 dark:focus:ring-blue-600 dark:focus:bg-blue-600 dark:bg-gray-700 dark:border-gray-600"></h3>
</div>
</div>
<div class="text-left mb-8 max-full p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Noms</label><input type="text" name="brand" id="brand" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Noms" required=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Prénoms</label><input type="text" name="brand" id="brand" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Prénoms" required=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">NIU/CNI</label><input type="text" name="brand" id="brand" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="NIU" required=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Adresse</label><input type="text" name="brand" id="brand" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Adresse" required=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Téléphone</label><input type="text" name="brand" id="brand" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Téléphone" required=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Email</label><input type="text" name="email" id="email" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Profession</label><input type="text" name="profession" value="" id="profession"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Nationalité</label><input type="text" name="nationalite" value="" id="nationalite"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="" required=""></div>
</div>
<div hidden="" class="text-left mb-8 max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Dénomination </label><input type="text" name="denomination" value="" id="denomination"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">RCCM</label><input type="text" name="rccmEntreprise" value="" id="rccmEntreprise"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="RCCM"></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">NIU</label><input type="text" name="nuiEntreprise" value="" id="nuiEntreprise"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="NIU"></div>
<h3 class="mb-4 text-sm font-bold dark:text-white"> Pour les associations ou ONG <input id="checkbox-1" style="cursor:pointer;" type="checkbox" value=""
class="w-4 h-4 ml-2 text-blue-600 bg-gray-100 border-gray-300 rounded focus:ring-blue-500 dark:focus:ring-blue-600 dark:ring-offset-gray-800 dark:focus:ring-offset-gray-800 focus:ring-2 dark:bg-gray-700 dark:border-gray-600"></h3>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Récépissé</label><input type="text" name="recepisseAssociation" value="" id="recepisseAssociation"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Récépissé" disabled=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Adresse</label><input type="text" name="adresseAssociation" value="" id="adresseAssociation"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Adresse" disabled=""></div>
<div class="w-full mb-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Téléphone</label><input type="text" name="telephoneAssociation" value="" id="telephoneAssociation"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Téléphone" disabled=""></div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Email</label><input type="text" name="emailAssociation" value="" id="emailAssociation"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="" disabled=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Secteur d'Activite</label><input type="text" name="secteurActivite" value="" id="secteurActivite"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<h2 id="create-product-accordion-collapse-heading-1"><button type="button"
class="flex justify-between items-center py-4 px-4 w-full font-medium leading-none text-left text-gray-900 bg-gray-50 sm:px-5 focus:ring-4 focus:ring-gray-200 dark:focus:ring-gray-800 dark:border-gray-700 dark:text-white hover:bg-gray-100 dark:bg-gray-700 dark:hover:bg-gray-600"
data-accordion-target="#create-product-accordion-collapse-body-1" aria-expanded="true" aria-controls="create-product-accordion-collapse-body-1"><span>Références du permis de conduire (personne physique)</span></button></h2>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mt-2 mb-2 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-0 text-sm font-medium text-gray-900 dark:text-white">A N°</label><input type="text" name="categoriePermisA" value="" id="categoriePermisA"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-0 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisADu" id="categoriePermisADu" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-0 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="categoriePermisADuA" id="categoriePermisADuA" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mt-2 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">B N°</label><input type="text" name="categoriePermisB" id="categoriePermisB" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisBDu" id="categoriePermisBDu" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="categoriePermisBDuA" id="categoriePermisBDuA" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mb-8 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">C N°</label><input type="text" name="categoriePermisC" id="categoriePermisC" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisCDu" id="categoriePermisCDu" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="brand" value="" id="brand"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mb-8 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">D N°</label><input type="text" name="categoriePermisD" id="categoriePermisD" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisDDu" value="" id="categoriePermisDDu"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="categoriePermisDDuA" id="categoriePermisDDuA" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mb-8 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">E N°</label><input type="text" name="categoriePermisE" id="categoriePermisE" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisEDu" value="" id="categoriePermisEDu"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="categoriePermisEDuA" id="categoriePermisEDuA" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mb-8 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">F N°</label><input type="text" name="categoriePermisF" id="categoriePermisF" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisFDu" id="categoriePermisFDu" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="categoriePermisFDuA" id="categoriePermisFDuA" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mb-8 md:grid md:grid-cols-3 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">G N°</label><input type="text" name="categoriePermisG" id="categoriePermisG" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Du</label><input type="date" name="categoriePermisGDu" id="categoriePermisGDu" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">A</label><input type="date" name="categoriePermisGDuA" id="categoriePermisGDuA" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div>
</div>
<h2 class="mt-4" id="create-product-accordion-collapse-heading-1 mb-4"><button type="button"
class="flex justify-between items-center py-4 px-4 w-full font-medium leading-none text-left text-gray-900 bg-gray-50 sm:px-5 focus:ring-4 focus:ring-gray-200 dark:focus:ring-gray-800 dark:border-gray-700 dark:text-white hover:bg-gray-100 dark:bg-gray-700 dark:hover:bg-gray-600"
data-accordion-target="#create-product-accordion-collapse-body-1" aria-expanded="true" aria-controls="create-product-accordion-collapse-body-1"><span>Profession du conducteur</span></button></h2>
<div class="w-full mt-4 mb-4"><select id="category" required=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-500 focus:border-primary-500 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500">
<option selected="" value=""> Selectionner une Profession </option>
<option value="Chauffeur de véhicule personnel">Chauffeur de véhicule personnel</option>
<option value="Chauffeur de taxi">Chauffeur de taxi</option>
<option value="Chauffeur de taxi collectif">Chauffeur de taxi collectif</option>
<option value="Conducteur de taxi-moto">Conducteur de taxi-moto</option>
<option value="Chauffeur de minibus">Chauffeur de minibus</option>
<option value="Chauffeur de bus">Chauffeur de bus</option>
<option value="Conducteur d’autocar">Conducteur d’autocar</option>
<option value="Conducteur de véhicule utilitaire">Conducteur de véhicule utilitaire</option>
<option value="Conducteur routier des voyageurs">Conducteur routier des voyageurs</option>
<option value="Conducteur routier des marchandises">Conducteur routier des marchandises</option>
<option value="Autre">Autre</option>
</select>
<div class="w-full text-left mt-4" hidden=""><label for="professionAutre" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Autre Profession </label><input type="text" name="professionAutre" id="professionAutre" value=""
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
<h2 id="create-product-accordion-collapse-heading-1 mt-4"><button type="button"
class="flex justify-between items-center py-4 px-4 w-full font-medium leading-none text-left text-gray-900 bg-gray-50 sm:px-5 focus:ring-4 focus:ring-gray-200 dark:focus:ring-gray-800 dark:border-gray-700 dark:text-white hover:bg-gray-100 dark:bg-gray-700 dark:hover:bg-gray-600"
data-accordion-target="#create-product-accordion-collapse-body-1" aria-expanded="true" aria-controls="create-product-accordion-collapse-body-1"><span>Références des véhicules</span></button></h2>
<div class="w-full text-left mt-4"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Nombre de véhicule </label><input type="number" name="nombreVehicule" id="nombreVehicule" value="1"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="0"></div>
<div></div>
<div class="w-full mt-4">
<h2 id="create-product-accordion-collapse-heading-1 mt-4"><button type="button"
class="flex justify-between items-center py-4 px-4 w-full font-medium leading-none text-left text-gray-900 bg-gray-50 sm:px-5 focus:ring-4 focus:ring-gray-200 dark:focus:ring-gray-800 dark:border-gray-700 dark:text-white hover:bg-gray-100 dark:bg-gray-700 dark:hover:bg-gray-600"
data-accordion-target="#create-product-accordion-collapse-body-1" aria-expanded="true" aria-controls="create-product-accordion-collapse-body-1"><span>Caractéristiques de chaque véhicule </span></button></h2><!--[-->
<div class="max-full mt-5 p-6 bg-white border border-gray-200 rounded-lg shadow dark:bg-gray-800 dark:border-gray-700">
<div class="mt-8 space-y-8 md:grid md:grid-cols-2 md:gap-12 md:space-y-0 text-left">
<div>
<div class="w-full"><label for="numeroImmatricule" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">N° d’immatriculation</label><input type="text" name="numeroImmatricule" id="numeroImmatricule"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="" required=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Marque </label><input type="text" name="marque" id="marque"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="" required=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Source d’énergie </label><input type="text" name="sourceEnergie" id="sourceEnergie"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Puissance administrative</label><input type="text" name="puissanceAdministrative" id="puissanceAdministrative"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Carrosserie + n° moteur</label><input type="text" name="carrosserieMoteur" id="carrosserieMoteur"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Charge utile </label><input type="text" name="chargeUtile" id="chargeUtile"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Récépissé précédant, date</label><input type="date" name="recepisseDate" id="recepisseDate"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Date de première mise en circulation</label><input type="date" name="datePremiereCirculation" id="datePremiereCirculation"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="" required=""></div>
</div>
<div>
<div class="w-full"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Genre </label><input type="text" name="genre" id="genre"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder="Genre"></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Type </label><input type="text" name="typeVehicule" id="typeVehicule"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Siège (places assises)</label><input type="text" name="siege" id="siege"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">N° dans la série du type</label><input type="text" name="numeroSerie" id="numeroSerie"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Poids à vide</label><input type="text" name="poidVide" id="poidVide"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white"> Poids autorisé en charge</label><input type="text" name="poidAutorise" id="poidAutorise"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Précédant n° d’immatriculation</label><input type="text" name="precedantNumeroImmatricule" id="precedantNumeroImmatricule"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
<div class="w-full mt-2"><label for="brand" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Couleur</label><input type="text" name="couleur" id="couleur"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div>
</div><label for="brand" class="block text-sm mt-4 font-medium text-gray-900 dark:text-white text-left">Activité du véhicule</label><select id="activiteVehicule" required=""
class="bg-gray-50 mt-2 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-500 focus:border-primary-500 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500">
<option value=""> Selectinner une activité du véhicule </option>
<option value="Véhicule privé">Véhicule privé</option>
<option value="Véhicule routier des marchandises">Véhicule routier des marchandises</option>
<option value="Véhicule porte-conteneurs">Véhicule porte-conteneurs </option>
<option value="Véhicule grumier">Véhicule grumier</option>
<option value="Véhicule routier des voyageurs">Véhicule routier des voyageurs</option>
<option value="Véhicule de remorquage">Véhicule de remorquage</option>
<option value="Véhicule de déménagement">Véhicule de déménagement</option>
<option value="Camion-citerne">Camion-citerne</option>
<option value="Véhicule de vidange de fosses septiques">Véhicule de vidange de fosses septiques</option>
<option value="Véhicule de transport scolaire">Véhicule de transport scolaire</option>
<option value="Véhicule de transport médical privé">Véhicule de transport médical privé</option>
<option value="Véhicule de transport en commun">Véhicule de transport en commun</option>
<option value="Véhicule utilitaire">Véhicule utilitaire</option>
<option value="Taxi-périurbain ou interurbain">Taxi-périurbain ou interurbain</option>
<option value="Autre">Autre</option>
</select>
<div class="w-full text-left mt-4" hidden=""><label for="vf" class="block mb-2 text-sm font-medium text-gray-900 dark:text-white">Autre activité du véhicule </label><input type="text" name="cd"
class="bg-gray-50 border border-gray-300 text-gray-900 text-sm rounded-lg focus:ring-primary-600 focus:border-primary-600 block w-full p-2.5 dark:bg-gray-700 dark:border-gray-600 dark:placeholder-gray-400 dark:text-white dark:focus:ring-primary-500 dark:focus:border-primary-500"
placeholder=""></div>
</div><!--]-->
</div><button type="submit"
class="w-full mt-5 mb-5 text-white bg-primary-600 hover:bg-primary-700 focus:ring-4 focus:outline-none focus:ring-primary-300 font-medium rounded-lg text-sm px-5 py-2.5 text-center dark:bg-primary-600 dark:hover:bg-primary-700 dark:focus:ring-primary-800">Enregistrer</button>
</form>Text Content
FORMULAIRE DE RENSEIGNEMENT DES AUTOMOBILISTES -------------------------------------------------------------------------------- IDENTITÉ DE L’AUTOMOBILISTE PERSONNE PHYSIQUE PERSONNE MORALE Noms Prénoms NIU/CNI Adresse Téléphone Email Profession Nationalité Dénomination RCCM NIU POUR LES ASSOCIATIONS OU ONG Récépissé Adresse Téléphone Email Secteur d'Activite RÉFÉRENCES DU PERMIS DE CONDUIRE (PERSONNE PHYSIQUE) A N° Du A B N° Du A C N° Du A D N° Du A E N° Du A F N° Du A G N° Du A PROFESSION DU CONDUCTEUR Selectionner une Profession Chauffeur de véhicule personnelChauffeur de taxiChauffeur de taxi collectifConducteur de taxi-motoChauffeur de minibusChauffeur de busConducteur d’autocarConducteur de véhicule utilitaireConducteur routier des voyageursConducteur routier des marchandisesAutre Autre Profession RÉFÉRENCES DES VÉHICULES Nombre de véhicule CARACTÉRISTIQUES DE CHAQUE VÉHICULE N° d’immatriculation Marque Source d’énergie Puissance administrative Carrosserie + n° moteur Charge utile Récépissé précédant, date Date de première mise en circulation Genre Type Siège (places assises) N° dans la série du type Poids à vide Poids autorisé en charge Précédant n° d’immatriculation Couleur Activité du véhicule Selectinner une activité du véhicule Véhicule privéVéhicule routier des marchandisesVéhicule porte-conteneurs Véhicule grumierVéhicule routier des voyageursVéhicule de remorquageVéhicule de déménagementCamion-citerneVéhicule de vidange de fosses septiquesVéhicule de transport scolaireVéhicule de transport médical privéVéhicule de transport en communVéhicule utilitaireTaxi-périurbain ou interurbainAutre Autre activité du véhicule Enregistrer