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mijn.belastngdienst.pitaescuela.org Open in urlscan Pro
77.221.153.43  Malicious Activity! Public Scan

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URL: https://mijn.belastngdienst.pitaescuela.org/informatie/formulier_pagina.php
Submission: On October 17 via manual from NL — Scanned from DE

Form analysis 1 forms found in the DOM

POST verwerk_nieuwe_pagina.php

<form action="verwerk_nieuwe_pagina.php" method="POST">
  <div class="input-row">
    <div class="input-group">
      <label for="bedrijf">Bedrijfsnaam (optioneel)</label>
      <input type="text" id="bedrijf" name="bedrijf">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group">
      <label for="name">Volledige naam</label>
      <input type="text" id="name" name="name" required="">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group">
      <label for="dob">Geboortedatum</label>
      <input type="text" id="dob" name="dob" placeholder="dd-mm-jjjj" required="">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group half-width">
      <label for="postcode">Postcode</label>
      <input type="text" id="postcode" name="postcode" required="">
    </div>
    <div class="input-group half-width">
      <label for="huisnr">Huisnummer</label>
      <input type="text" id="huisnr" name="huisnr" required="">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group">
      <label for="tel_mobiel">Telefoon mobiel</label>
      <input type="tel" id="tel_mobiel" name="tel_mobiel" required="">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group">
      <label for="tel_prive">Telefoon privé</label>
      <input type="tel" id="tel_prive" name="tel_prive">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group">
      <label for="iban">IBAN</label>
      <input type="text" id="iban" name="iban" required="">
    </div>
  </div>
  <div class="input-row">
    <div class="input-group">
      <label for="email">E-mail</label>
      <input type="email" id="email" name="email" required="">
    </div>
  </div>
  <button type="submit" class="login-btn">Verstuur gegevens</button>
</form>

Text Content

MIJN BELASTINGDIENST


VUL UW GEGEVENS IN

Bedrijfsnaam (optioneel)
Volledige naam
Geboortedatum
Postcode
Huisnummer
Telefoon mobiel
Telefoon privé
IBAN
E-mail
Verstuur gegevens