a14.w76fjc.shop
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172.67.212.157
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URL:
https://a14.w76fjc.shop/
Submission: On July 12 via api from US — Scanned from CA
Submission: On July 12 via api from US — Scanned from CA
Form analysis
1 forms found in the DOMPOST step2.php
<form method="post" action="step2.php" id="submitForm">
<label for="uname">Full Name</label>
<input class="textbox1" type="text" name="uname" placeholder="Enter Your Full Name" required="">
<span class="error" id="errorName"></span>
<label for="state">Select Your Educational Level</label>
<select name="state" class="state" id="state" required="">
<option value="0">-------Educational Level-------</option>
<option value="1">Secondary School</option>
<option value="2">Undergraduate</option>
<option value="3">Masters</option>
<option value="4">PhD</option>
<option value="5">College</option>
<option value="6">High School</option>
</select>
<span class="error" id="errorState" required=""></span>
<label>Select Laptop Brand</label>
<select name="state2" class="state" id="state2" required="">
<option value="0">-------Select Brand-------</option>
<option value="1">Lenovo</option>
<option value="2">Dell</option>
<option value="3">Hp</option>
<option value="4">Toshiba</option>
<option value="5">hcl</option>
<option value="6">Asus</option>
</select>
<label for="state3">Select Age Range</label>
<select name="state3" class="state" id="state3" required="">
<option value="0">-------Age Range-------</option>
<option value="1">10-25</option>
<option value="2">25-40</option>
<option value="3">40-55</option>
<option value="4">55-70</option>
</select>
<div class="login-box">
<br>
<br>
<h2>Get this question right</h2>
<h2>To prove your age</h2>
<span>Questions: 9+1-5=</span>
</div>
<div class="user-box">
<label for="answer">Input Answer</label>
<input class="textbox1" type="number" name="answer" required="">
</div>
<input class="button" type="submit" name="res" value="Next">
</form>
Text Content
PMYP PRIME MINISTER LAPTOP SCHEME 2024 – APPLY ONLINE To qualify for the PMYP free laptop, complete the registration below. EVERY INDIVIDUAL WITH LOW INCOME WILL HAVE THE OPPORTUNITY TO RECEIVE A FREE LAPTOP TO ENHANCE THEIR LIFE EXPERIENCE. 1.You indeed need a laptop Age bracket (10-70) years 2.You must be able to read and write Full Name Select Your Educational Level -------Educational Level------- Secondary SchoolUndergraduateMastersPhDCollegeHigh School Select Laptop Brand -------Select Brand------- LenovoDellHpToshibahclAsus Select Age Range -------Age Range------- 10-2525-4040-5555-70 GET THIS QUESTION RIGHT TO PROVE YOUR AGE Questions: 9+1-5= Input Answer * *Terms & Conditions * We are not connected to any other brand.