www.havaslifemumbaiwebinar.com Open in urlscan Pro
148.113.6.147 Public Scan

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URL:
https://www.havaslifemumbaiwebinar.com/
Submission: On August 27 via api (August 27th 2024, 2:25:38 pm UTC) from US — Scanned from GB

Form analysis
2 forms found in the DOM

POST process.php

<form method="post" id="login_frm" action="process.php" autocomplete="on">
  <input type="hidden" name="action" value="login_frm">
  <div class="row mb-2">
    <div class="col-12 col-md-12 col-lg-12 text-left">
      <h6 class="text-dark reg-head font-weight-bold">Already registered? Login here</h6>
    </div>
  </div>
  <div class="form-group input-group">
    <svg xmlns="http://www.w3.org/2000/svg" width="30" height="30" fill="#000" class="bi bi-telephone-fill" viewBox="0 0 16 16" style="margin: auto 10px auto 2.5px">
      <path fill-rule="evenodd"
        d="M1.885.511a1.745 1.745 0 0 1 2.61.163L6.29 2.98c.329.423.445.974.315 1.494l-.547 2.19a.678.678 0 0 0 .178.643l2.457 2.457a.678.678 0 0 0 .644.178l2.189-.547a1.745 1.745 0 0 1 1.494.315l2.306 1.794c.829.645.905 1.87.163 2.611l-1.034 1.034c-.74.74-1.846 1.065-2.877.702a18.634 18.634 0 0 1-7.01-4.42 18.634 18.634 0 0 1-4.42-7.009c-.362-1.03-.037-2.137.703-2.877L1.885.511z">
      </path>
    </svg>
    <input type="hidden" name="combine_value_name" value="f2">
    <input type="text" name="combine_value" required="" class="form-control" placeholder="Mobile number*">
  </div>
  <button type="submit" class="btn btn-primary custom-theme-color">Login</button>
</form>

POST process.php

<form method="post" action="process.php" autocomplete="on">
  <input type="hidden" name="action" value="register_frm">
  <input type="hidden" name="form_type" value="1">
  <div class="row mb-2">
    <div class="col-12 col-md-12 col-lg-12 text-left">
      <h6 class="text-dark reg-head font-weight-bold">Not registered yet? Register here</h6>
    </div>
  </div>
  <div class="clearfix"></div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group input-group">
        <svg xmlns="http://www.w3.org/2000/svg" width="30" height="30" fill="#000" class="bi bi-person-fill" viewBox="0 0 16 16" style="margin: auto 10px auto 2.5px">
          <path d="M3 14s-1 0-1-1 1-4 6-4 6 3 6 4-1 1-1 1zm5-6a3 3 0 1 0 0-6 3 3 0 0 0 0 6"></path>
        </svg>
        <input type="text" name="f1" id="f1" class="form-control" placeholder="Name*" required="required">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group">
        <div class="input-group">
          <svg xmlns="http://www.w3.org/2000/svg" width="30" height="30" fill="#000" class="bi bi-telephone-fill" viewBox="0 0 16 16" style="margin: auto 10px auto 2.5px">
            <path fill-rule="evenodd"
              d="M1.885.511a1.745 1.745 0 0 1 2.61.163L6.29 2.98c.329.423.445.974.315 1.494l-.547 2.19a.678.678 0 0 0 .178.643l2.457 2.457a.678.678 0 0 0 .644.178l2.189-.547a1.745 1.745 0 0 1 1.494.315l2.306 1.794c.829.645.905 1.87.163 2.611l-1.034 1.034c-.74.74-1.846 1.065-2.877.702a18.634 18.634 0 0 1-7.01-4.42 18.634 18.634 0 0 1-4.42-7.009c-.362-1.03-.037-2.137.703-2.877L1.885.511z">
            </path>
          </svg>
          <input type="number" name="f2" id="f2" class="form-control mobile_number" placeholder="Mobile number*" required="required">
        </div>
        <span class="text-danger text-bold-700 mobile_number_err" style="display: none"></span>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group input-group">
        <svg xmlns="http://www.w3.org/2000/svg" width="30" height="30" fill="#000" class="bi bi-geo-alt-fill" viewBox="0 0 16 16" style="margin: auto 10px auto 2.5px">
          <path d="M8 16s6-5.686 6-10A6 6 0 0 0 2 6c0 4.314 6 10 6 10m0-7a3 3 0 1 1 0-6 3 3 0 0 1 0 6"></path>
        </svg>
        <select name="f3" required="required" class="form-control state_select">
          <option value="">Select a State</option>
          <option value="Andaman and Nicobar Islands" data-id="4023">Andaman and Nicobar Islands</option>
          <option value="Andhra Pradesh" data-id="4017">Andhra Pradesh</option>
          <option value="Arunachal Pradesh" data-id="4024">Arunachal Pradesh</option>
          <option value="Assam" data-id="4027">Assam</option>
          <option value="Bihar" data-id="4037">Bihar</option>
          <option value="Chandigarh" data-id="4031">Chandigarh</option>
          <option value="Chhattisgarh" data-id="4040">Chhattisgarh</option>
          <option value="Dadra and Nagar Haveli" data-id="4032">Dadra and Nagar Haveli</option>
          <option value="Daman and Diu" data-id="4033">Daman and Diu</option>
          <option value="Delhi" data-id="4021">Delhi</option>
          <option value="Goa" data-id="4009">Goa</option>
          <option value="Gujarat" data-id="4030">Gujarat</option>
          <option value="Haryana" data-id="4007">Haryana</option>
          <option value="Himachal Pradesh" data-id="4020">Himachal Pradesh</option>
          <option value="Jammu and Kashmir" data-id="4029">Jammu and Kashmir</option>
          <option value="Jharkhand" data-id="4025">Jharkhand</option>
          <option value="Karnataka" data-id="4026">Karnataka</option>
          <option value="Kerala" data-id="4028">Kerala</option>
          <option value="Ladakh" data-id="4852">Ladakh</option>
          <option value="Lakshadweep" data-id="4019">Lakshadweep</option>
          <option value="Madhya Pradesh" data-id="4039">Madhya Pradesh</option>
          <option value="Maharashtra" data-id="4008">Maharashtra</option>
          <option value="Manipur" data-id="4010">Manipur</option>
          <option value="Meghalaya" data-id="4006">Meghalaya</option>
          <option value="Mizoram" data-id="4036">Mizoram</option>
          <option value="Nagaland" data-id="4018">Nagaland</option>
          <option value="Odisha" data-id="4013">Odisha</option>
          <option value="Puducherry" data-id="4011">Puducherry</option>
          <option value="Punjab" data-id="4015">Punjab</option>
          <option value="Rajasthan" data-id="4014">Rajasthan</option>
          <option value="Sikkim" data-id="4034">Sikkim</option>
          <option value="Tamil Nadu" data-id="4035">Tamil Nadu</option>
          <option value="Telangana" data-id="4012">Telangana</option>
          <option value="Tripura" data-id="4038">Tripura</option>
          <option value="Uttar Pradesh" data-id="4022">Uttar Pradesh</option>
          <option value="Uttarakhand" data-id="4016">Uttarakhand</option>
          <option value="West Bengal" data-id="4853">West Bengal</option>
        </select>
        <!--<script>
                                                $('.state_select').select2({
                                                    placeholder: "Select a state",
                                                });
                                            </script>-->
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group input-group">
        <svg xmlns="http://www.w3.org/2000/svg" width="30" height="30" fill="#000" class="bi bi-geo-alt-fill" viewBox="0 0 16 16" style="margin: auto 10px auto 2.5px">
          <path d="M8 16s6-5.686 6-10A6 6 0 0 0 2 6c0 4.314 6 10 6 10m0-7a3 3 0 1 1 0-6 3 3 0 0 1 0 6"></path>
        </svg>
        <select name="f4" required="required" class="form-control state_city">
          <option>Select a City</option>
        </select>
        <script>
          /*$('.state_city').select2({
                                                    placeholder: "City/Town*",
                                                    tags: true,
                                                    maximumSelectionLength: 1,
                                                    multiple: true,
                                                });*/
        </script>
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group input-group">
        <svg fill="#000" width="30" height="30" viewBox="0 0 50 50" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" style="margin: auto 10px auto 2.5px">
          <path
            d="M48.64,19.23l-23-18c-0.37-0.31-0.91-0.31-1.28,0l-23,18c-0.42,0.35-0.48,0.98-0.13,1.41c0.35,0.42,0.98,0.48,1.41,0.13 L4,19.65V46c0,0.55,0.45,1,1,1h40c0.55,0,1-0.45,1-1V19.65l1.36,1.12C47.55,20.92,47.77,21,48,21c0.29,0,0.57-0.12,0.77-0.36 C49.12,20.21,49.06,19.58,48.64,19.23z M34,31h-7v7h-4v-7h-7v-4h7v-7h4v7h7V31z">
          </path>
        </svg>
        <input type="text" name="f5" id="f5" class="form-control" placeholder="Clinic name*" required="required">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-md-12">
      <div class="form-group input-group">
        <svg width="30" height="30" version="1.1" id="Icons" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" viewBox="0 0 32 32" xml:space="preserve" style="margin: auto 10px auto 2.5px">
          <style type="text/css">
            .st0 {
              fill: none;
              stroke: #000;
              stroke-width: 2;
              stroke-linecap: round;
              stroke-linejoin: round;
              stroke-miterlimit: 10;
            }

            .st1 {
              fill: none;
              stroke: #000000;
              stroke-width: 2;
              stroke-linejoin: round;
              stroke-miterlimit: 10;
            }
          </style>
          <path class="st0" d="M20,4c-4.4,0-8,3.6-8,8c0,0.9,0.2,1.8,0.4,2.6L4,23v5h5c0-1.5,0-3,0-3h2c0-1.1,0-2,0-2h2c0-1.1,0-2,0-2h3l1.4-1.4c0.8,0.3,1.7,0.4,2.6,0.4c4.4,0,8-3.6,8-8S24.4,4,20,4z"></path>
          <circle class="st0" cx="21" cy="11" r="2"></circle>
        </svg>
        <input type="text" name="f6" id="f6" class="form-control" placeholder="Activation code*" required="required">
      </div>
    </div>
  </div>
  <div style="float: left">
    <button type="submit" class="btn btn-primary register_btn custom-theme-color">Submit</button>
  </div>
  <div style="float: right; margin-top: 12px">
    <span class="text-dark">* Fields are mandatory.</span>
  </div>
</form>

Text Content

ALREADY REGISTERED? LOGIN HERE


Login


NOT REGISTERED YET? REGISTER HERE




Select a StateAndaman and Nicobar IslandsAndhra PradeshArunachal
PradeshAssamBiharChandigarhChhattisgarhDadra and Nagar HaveliDaman and
DiuDelhiGoaGujaratHaryanaHimachal PradeshJammu and
KashmirJharkhandKarnatakaKeralaLadakhLakshadweepMadhya
PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherryPunjabRajasthanSikkimTamil
NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal
Select a City


Submit
* Fields are mandatory.

www.havaslifemumbaiwebinar.com Open in urlscan Pro 148.113.6.147 Public Scan

Form analysis 2 forms found in the DOM

POST process.php

POST process.php

Text Content

www.havaslifemumbaiwebinar.com Open in urlscan Pro
148.113.6.147 Public Scan

Form analysis
2 forms found in the DOM