derma.cintasyriamalaysia.com
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68.183.236.61
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Submitted URL: http://korban4hope.com/
Effective URL: https://derma.cintasyriamalaysia.com/order/form/qmcsm11-srilanka
Submission: On April 06 via api from BE — Scanned from DE
Effective URL: https://derma.cintasyriamalaysia.com/order/form/qmcsm11-srilanka
Submission: On April 06 via api from BE — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://derma.cintasyriamalaysia.com/order/submit
<form class="form-horizontal" id="order_form" role="form" action="https://derma.cintasyriamalaysia.com/order/submit" method="post" enctype="multipart/form-data" target="_top" style="position:relative" novalidate="novalidate">
<input type="hidden" id="form_id" name="form_id" value="300">
<h2 class="section-header"> BUTIRAN PEMBELIAN</h2>
<table class="table table-condensed table-hover purchase_details">
<thead>
<tr>
<th>Produk</th>
<th>Kuantiti<span class="glyphicon glyphicon-asterisk red-asterisk"></span></th>
<th>Harga (RM)</th>
</tr>
</thead>
<tbody>
<tr class="product" data-position="0" data-id="487">
<td> Korban Lembu - Pakej Diamond (RM2800)</td>
<td class="" style="">
<input type="hidden" name="product_ids[0]" value="487">
<div class="input-group">
<select class="form-control quantity" name="product_quantities[0]">
<option value="0" selected="">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
</select>
<span class="input-group-addon quantity-display quantity-display-warning" title="Stok">3</span>
</div>
</td>
<td class="subtotal-price">0.00</td>
</tr>
<tr class="product" data-position="1" data-id="489">
<td> Korban Ansuran Bahagian Lembu (RM133.33)</td>
<td class="" style="">
<input type="hidden" name="product_ids[1]" value="489">
<div class="input-group">
<select class="form-control quantity" name="product_quantities[1]">
<option value="0" selected="">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
</select>
<span class="input-group-addon quantity-display quantity-display-warning" title="Stok">3</span>
</div>
</td>
<td class="subtotal-price">0.00</td>
</tr>
<tr class="product" data-position="2" data-id="498">
<td> Korban Bahagian Lembu - Pakej Ihsan (RM400)</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[2]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr class="product" data-position="3" data-id="488">
<td> Korban Bahagian Lembu - Pakej Rahmah (RM450)</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[3]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr class="product" data-position="4" data-id="499">
<td> Korban Bahagian Lembu - Pakej Kasih (RM500)</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[4]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr class="product" data-position="5" data-id="492">
<td> Pakej Sedekah Daging Lembu (RM50)</td>
<td class="" style="">
<input type="hidden" name="product_ids[5]" value="492">
<div class="input-group">
<select class="form-control quantity" name="product_quantities[5]">
<option value="0" selected="">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
<option value="60">60</option>
<option value="61">61</option>
<option value="62">62</option>
<option value="63">63</option>
<option value="64">64</option>
<option value="65">65</option>
<option value="66">66</option>
<option value="67">67</option>
<option value="68">68</option>
<option value="69">69</option>
<option value="70">70</option>
<option value="71">71</option>
<option value="72">72</option>
<option value="73">73</option>
<option value="74">74</option>
<option value="75">75</option>
<option value="76">76</option>
<option value="77">77</option>
<option value="78">78</option>
<option value="79">79</option>
<option value="80">80</option>
<option value="81">81</option>
<option value="82">82</option>
<option value="83">83</option>
<option value="84">84</option>
<option value="85">85</option>
<option value="86">86</option>
<option value="87">87</option>
<option value="88">88</option>
<option value="89">89</option>
<option value="90">90</option>
<option value="91">91</option>
<option value="92">92</option>
<option value="93">93</option>
<option value="94">94</option>
<option value="95">95</option>
<option value="96">96</option>
<option value="97">97</option>
<option value="98">98</option>
<option value="99">99</option>
<option value="100">100</option>
<option value="101">101</option>
<option value="102">102</option>
<option value="103">103</option>
<option value="104">104</option>
<option value="105">105</option>
<option value="106">106</option>
<option value="107">107</option>
<option value="108">108</option>
<option value="109">109</option>
<option value="110">110</option>
<option value="111">111</option>
<option value="112">112</option>
<option value="113">113</option>
<option value="114">114</option>
<option value="115">115</option>
<option value="116">116</option>
<option value="117">117</option>
<option value="118">118</option>
<option value="119">119</option>
<option value="120">120</option>
<option value="121">121</option>
<option value="122">122</option>
<option value="123">123</option>
<option value="124">124</option>
<option value="125">125</option>
<option value="126">126</option>
<option value="127">127</option>
<option value="128">128</option>
<option value="129">129</option>
<option value="130">130</option>
<option value="131">131</option>
<option value="132">132</option>
<option value="133">133</option>
<option value="134">134</option>
<option value="135">135</option>
<option value="136">136</option>
<option value="137">137</option>
<option value="138">138</option>
<option value="139">139</option>
<option value="140">140</option>
<option value="141">141</option>
<option value="142">142</option>
<option value="143">143</option>
<option value="144">144</option>
<option value="145">145</option>
<option value="146">146</option>
<option value="147">147</option>
<option value="148">148</option>
<option value="149">149</option>
<option value="150">150</option>
<option value="151">151</option>
<option value="152">152</option>
<option value="153">153</option>
<option value="154">154</option>
<option value="155">155</option>
<option value="156">156</option>
<option value="157">157</option>
<option value="158">158</option>
<option value="159">159</option>
<option value="160">160</option>
<option value="161">161</option>
<option value="162">162</option>
<option value="163">163</option>
<option value="164">164</option>
<option value="165">165</option>
<option value="166">166</option>
<option value="167">167</option>
<option value="168">168</option>
<option value="169">169</option>
<option value="170">170</option>
<option value="171">171</option>
<option value="172">172</option>
<option value="173">173</option>
<option value="174">174</option>
<option value="175">175</option>
<option value="176">176</option>
<option value="177">177</option>
<option value="178">178</option>
<option value="179">179</option>
<option value="180">180</option>
<option value="181">181</option>
<option value="182">182</option>
<option value="183">183</option>
<option value="184">184</option>
<option value="185">185</option>
<option value="186">186</option>
<option value="187">187</option>
<option value="188">188</option>
<option value="189">189</option>
<option value="190">190</option>
<option value="191">191</option>
<option value="192">192</option>
<option value="193">193</option>
<option value="194">194</option>
<option value="195">195</option>
<option value="196">196</option>
<option value="197">197</option>
<option value="198">198</option>
<option value="199">199</option>
<option value="200">200</option>
<option value="201">201</option>
<option value="202">202</option>
<option value="203">203</option>
<option value="204">204</option>
<option value="205">205</option>
<option value="206">206</option>
<option value="207">207</option>
<option value="208">208</option>
<option value="209">209</option>
<option value="210">210</option>
<option value="211">211</option>
<option value="212">212</option>
<option value="213">213</option>
<option value="214">214</option>
<option value="215">215</option>
<option value="216">216</option>
<option value="217">217</option>
<option value="218">218</option>
<option value="219">219</option>
<option value="220">220</option>
<option value="221">221</option>
<option value="222">222</option>
<option value="223">223</option>
<option value="224">224</option>
<option value="225">225</option>
<option value="226">226</option>
<option value="227">227</option>
<option value="228">228</option>
<option value="229">229</option>
<option value="230">230</option>
<option value="231">231</option>
<option value="232">232</option>
<option value="233">233</option>
<option value="234">234</option>
<option value="235">235</option>
<option value="236">236</option>
<option value="237">237</option>
<option value="238">238</option>
<option value="239">239</option>
<option value="240">240</option>
<option value="241">241</option>
<option value="242">242</option>
<option value="243">243</option>
<option value="244">244</option>
<option value="245">245</option>
<option value="246">246</option>
<option value="247">247</option>
<option value="248">248</option>
<option value="249">249</option>
<option value="250">250</option>
<option value="251">251</option>
<option value="252">252</option>
<option value="253">253</option>
<option value="254">254</option>
<option value="255">255</option>
<option value="256">256</option>
<option value="257">257</option>
<option value="258">258</option>
<option value="259">259</option>
<option value="260">260</option>
<option value="261">261</option>
<option value="262">262</option>
<option value="263">263</option>
<option value="264">264</option>
<option value="265">265</option>
<option value="266">266</option>
<option value="267">267</option>
<option value="268">268</option>
<option value="269">269</option>
<option value="270">270</option>
<option value="271">271</option>
<option value="272">272</option>
<option value="273">273</option>
<option value="274">274</option>
<option value="275">275</option>
<option value="276">276</option>
<option value="277">277</option>
<option value="278">278</option>
<option value="279">279</option>
<option value="280">280</option>
<option value="281">281</option>
<option value="282">282</option>
<option value="283">283</option>
<option value="284">284</option>
<option value="285">285</option>
<option value="286">286</option>
<option value="287">287</option>
<option value="288">288</option>
<option value="289">289</option>
<option value="290">290</option>
<option value="291">291</option>
<option value="292">292</option>
<option value="293">293</option>
<option value="294">294</option>
<option value="295">295</option>
<option value="296">296</option>
<option value="297">297</option>
<option value="298">298</option>
<option value="299">299</option>
<option value="300">300</option>
<option value="301">301</option>
<option value="302">302</option>
<option value="303">303</option>
<option value="304">304</option>
<option value="305">305</option>
<option value="306">306</option>
<option value="307">307</option>
<option value="308">308</option>
<option value="309">309</option>
<option value="310">310</option>
<option value="311">311</option>
<option value="312">312</option>
<option value="313">313</option>
<option value="314">314</option>
<option value="315">315</option>
<option value="316">316</option>
<option value="317">317</option>
<option value="318">318</option>
<option value="319">319</option>
<option value="320">320</option>
<option value="321">321</option>
<option value="322">322</option>
<option value="323">323</option>
<option value="324">324</option>
<option value="325">325</option>
<option value="326">326</option>
<option value="327">327</option>
<option value="328">328</option>
<option value="329">329</option>
<option value="330">330</option>
<option value="331">331</option>
<option value="332">332</option>
<option value="333">333</option>
<option value="334">334</option>
<option value="335">335</option>
<option value="336">336</option>
<option value="337">337</option>
<option value="338">338</option>
<option value="339">339</option>
<option value="340">340</option>
<option value="341">341</option>
<option value="342">342</option>
<option value="343">343</option>
<option value="344">344</option>
<option value="345">345</option>
<option value="346">346</option>
<option value="347">347</option>
<option value="348">348</option>
<option value="349">349</option>
<option value="350">350</option>
<option value="351">351</option>
<option value="352">352</option>
<option value="353">353</option>
<option value="354">354</option>
<option value="355">355</option>
<option value="356">356</option>
<option value="357">357</option>
<option value="358">358</option>
<option value="359">359</option>
<option value="360">360</option>
<option value="361">361</option>
<option value="362">362</option>
<option value="363">363</option>
<option value="364">364</option>
<option value="365">365</option>
<option value="366">366</option>
<option value="367">367</option>
<option value="368">368</option>
<option value="369">369</option>
<option value="370">370</option>
<option value="371">371</option>
<option value="372">372</option>
<option value="373">373</option>
<option value="374">374</option>
<option value="375">375</option>
<option value="376">376</option>
<option value="377">377</option>
<option value="378">378</option>
<option value="379">379</option>
<option value="380">380</option>
<option value="381">381</option>
<option value="382">382</option>
<option value="383">383</option>
<option value="384">384</option>
<option value="385">385</option>
<option value="386">386</option>
<option value="387">387</option>
<option value="388">388</option>
<option value="389">389</option>
<option value="390">390</option>
<option value="391">391</option>
<option value="392">392</option>
<option value="393">393</option>
<option value="394">394</option>
<option value="395">395</option>
<option value="396">396</option>
<option value="397">397</option>
<option value="398">398</option>
<option value="399">399</option>
<option value="400">400</option>
<option value="401">401</option>
<option value="402">402</option>
<option value="403">403</option>
<option value="404">404</option>
<option value="405">405</option>
<option value="406">406</option>
<option value="407">407</option>
<option value="408">408</option>
<option value="409">409</option>
<option value="410">410</option>
<option value="411">411</option>
<option value="412">412</option>
<option value="413">413</option>
<option value="414">414</option>
<option value="415">415</option>
<option value="416">416</option>
<option value="417">417</option>
<option value="418">418</option>
<option value="419">419</option>
<option value="420">420</option>
<option value="421">421</option>
<option value="422">422</option>
<option value="423">423</option>
<option value="424">424</option>
<option value="425">425</option>
<option value="426">426</option>
<option value="427">427</option>
<option value="428">428</option>
<option value="429">429</option>
<option value="430">430</option>
<option value="431">431</option>
<option value="432">432</option>
<option value="433">433</option>
<option value="434">434</option>
<option value="435">435</option>
<option value="436">436</option>
<option value="437">437</option>
<option value="438">438</option>
<option value="439">439</option>
<option value="440">440</option>
<option value="441">441</option>
<option value="442">442</option>
<option value="443">443</option>
<option value="444">444</option>
<option value="445">445</option>
<option value="446">446</option>
<option value="447">447</option>
<option value="448">448</option>
<option value="449">449</option>
<option value="450">450</option>
<option value="451">451</option>
<option value="452">452</option>
<option value="453">453</option>
<option value="454">454</option>
<option value="455">455</option>
<option value="456">456</option>
<option value="457">457</option>
<option value="458">458</option>
<option value="459">459</option>
<option value="460">460</option>
<option value="461">461</option>
<option value="462">462</option>
<option value="463">463</option>
<option value="464">464</option>
<option value="465">465</option>
<option value="466">466</option>
<option value="467">467</option>
<option value="468">468</option>
<option value="469">469</option>
<option value="470">470</option>
<option value="471">471</option>
<option value="472">472</option>
<option value="473">473</option>
<option value="474">474</option>
<option value="475">475</option>
<option value="476">476</option>
<option value="477">477</option>
<option value="478">478</option>
<option value="479">479</option>
<option value="480">480</option>
<option value="481">481</option>
<option value="482">482</option>
<option value="483">483</option>
<option value="484">484</option>
<option value="485">485</option>
<option value="486">486</option>
<option value="487">487</option>
<option value="488">488</option>
<option value="489">489</option>
<option value="490">490</option>
<option value="491">491</option>
<option value="492">492</option>
<option value="493">493</option>
<option value="494">494</option>
<option value="495">495</option>
<option value="496">496</option>
<option value="497">497</option>
<option value="498">498</option>
<option value="499">499</option>
<option value="500">500</option>
<option value="501">501</option>
<option value="502">502</option>
<option value="503">503</option>
<option value="504">504</option>
<option value="505">505</option>
<option value="506">506</option>
</select>
<span class="input-group-addon quantity-display " title="Stok">506</span>
</div>
</td>
<td class="subtotal-price">0.00</td>
</tr>
<tr class="product" data-position="6" data-id="491">
<td> Akikah Kambing - Pakej Platinum (RM1175)</td>
<td class="" style="">
<input type="hidden" name="product_ids[6]" value="491">
<div class="input-group">
<select class="form-control quantity" name="product_quantities[6]">
<option value="0" selected="">0</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
</select>
<span class="input-group-addon quantity-display " title="Stok">5</span>
</div>
</td>
<td class="subtotal-price">0.00</td>
</tr>
<tr class="product" data-position="7" data-id="483">
<td> Taja Pendidikan (RM30)</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[7]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr class="product" data-position="8" data-id="485">
<td> Taja Pendidikan (RM50)</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[8]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr class="product" data-position="9" data-id="486">
<td> Taja Pendidikan (RM100)</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[9]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr class="product" data-position="10" data-id="490">
<td> Bantuan Umum Operasi</td>
<td class="" style="">
<span class="label label-grey" name="product_quantities[10]">BELUM MULA</span>
</td>
<td class="subtotal-price"></td>
</tr>
<tr>
<td class="bold-right">JUMLAH</td>
<td class="bold total-quantity" style="">0</td>
<td class="bold total-price">0.00</td>
</tr>
</tbody>
</table>
<table class="table table-condensed purchase_details" style="margin-top:-20px">
<tbody>
<tr>
<td colspan="3">
<div class="form-group offset-0 " style="margin-bottom:0">
<input type="text" id="total_quantity" name="total_quantity" value="0" style="visibility:hidden;position:absolute" class="valid" aria-invalid="false">
</div>
<div class="form-group offset-0 " style="margin-bottom:0">
<input type="text" id="total_price" name="total_price" value="" style="visibility:hidden;position:absolute">
</div>
</td>
</tr>
<tr>
<td colspan="2" class="bold-right" style="font-size:16px">JUMLAH KESELURUHAN (RM) <input type="hidden" id="total_amount" name="total_amount" value="0.00"></td>
<td class="bold-right total-amount" style="font-size:16px">0.00</td>
</tr>
<tr style="">
<td colspan="2" class="bold-right">Caj Perkhidmatan Peniaga (RM)</td>
<td class="bold-right" id="handling-charge">1.50</td>
</tr>
</tbody>
</table>
<br>
<h2 class="section-header"> BUTIRAN PELANGGAN</h2>
<div class="form-group">
<div class="col-md-9 col-md-offset-3">
</div>
</div>
<div class="form-group ">
<label for="client_fullname" class="control-label col-md-3">Nama<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-7">
<input type="text" class="form-control" id="client_fullname" name="client_fullname" placeholder="Masukkan nama anda..." maxlength="50" value="" autocomplete="name">
</div>
</div>
<div class="form-group ">
<label for="client_email" class="control-label col-md-3">Emel<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-7">
<input type="email" class="form-control" id="client_email" name="client_email" placeholder="Masukkan emel anda..." maxlength="100" value="" autocomplete="email">
<span class="help-block" id="client_email_warning" style="display:none;margin-top:5px"></span>
</div>
</div>
<div class="form-group ">
<label for="client_phone_number" class="control-label col-md-3">Nombor HP<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-7">
<select class="form-control" id="client_phone_dial_code" name="client_phone_dial_code" style="margin-bottom:10px" autocomplete="tel-country-code">
<option value="">Pilih kod dail negara untuk nombor telefon bimbit anda...</option>
<option value="93">Afghanistan (+93)</option>
<option value="355">Albania (+355)</option>
<option value="213">Algeria (+213)</option>
<option value="1 684">American Samoa (+1 684)</option>
<option value="376">Andorra (+376)</option>
<option value="244">Angola (+244)</option>
<option value="1 264">Anguilla (+1 264)</option>
<option value="672">Antarctica (+672)</option>
<option value="1 268">Antigua and Barbuda (+1 268)</option>
<option value="54">Argentina (+54)</option>
<option value="374">Armenia (+374)</option>
<option value="297">Aruba (+297)</option>
<option value="61">Australia (+61)</option>
<option value="43">Austria (+43)</option>
<option value="994">Azerbaijan (+994)</option>
<option value="1 242">Bahamas (+1 242)</option>
<option value="973">Bahrain (+973)</option>
<option value="880">Bangladesh (+880)</option>
<option value="1 246">Barbados (+1 246)</option>
<option value="375">Belarus (+375)</option>
<option value="32">Belgium (+32)</option>
<option value="501">Belize (+501)</option>
<option value="229">Benin (+229)</option>
<option value="1 441">Bermuda (+1 441)</option>
<option value="975">Bhutan (+975)</option>
<option value="591">Bolivia (+591)</option>
<option value="387">Bosnia and Herzegovina (+387)</option>
<option value="267">Botswana (+267)</option>
<option value="55">Brazil (+55)</option>
<option value="246">British Indian Ocean Territory (+246)</option>
<option value="1 284">British Virgin Islands (+1 284)</option>
<option value="673">Brunei (+673)</option>
<option value="359">Bulgaria (+359)</option>
<option value="226">Burkina Faso (+226)</option>
<option value="95">Burma (Myanmar) (+95)</option>
<option value="257">Burundi (+257)</option>
<option value="855">Cambodia (+855)</option>
<option value="237">Cameroon (+237)</option>
<option value="1">Canada (+1)</option>
<option value="238">Cape Verde (+238)</option>
<option value="1 345">Cayman Islands (+1 345)</option>
<option value="236">Central African Republic (+236)</option>
<option value="235">Chad (+235)</option>
<option value="56">Chile (+56)</option>
<option value="86">China (+86)</option>
<option value="61">Christmas Island (+61)</option>
<option value="61">Cocos (Keeling) Islands (+61)</option>
<option value="57">Colombia (+57)</option>
<option value="269">Comoros (+269)</option>
<option value="682">Cook Islands (+682)</option>
<option value="506">Costa Rica (+506)</option>
<option value="385">Croatia (+385)</option>
<option value="53">Cuba (+53)</option>
<option value="357">Cyprus (+357)</option>
<option value="420">Czech Republic (+420)</option>
<option value="243">Democratic Republic of the Congo (+243)</option>
<option value="45">Denmark (+45)</option>
<option value="253">Djibouti (+253)</option>
<option value="1 767">Dominica (+1 767)</option>
<option value="1 809">Dominican Republic (+1 809)</option>
<option value="593">Ecuador (+593)</option>
<option value="20">Egypt (+20)</option>
<option value="503">El Salvador (+503)</option>
<option value="240">Equatorial Guinea (+240)</option>
<option value="291">Eritrea (+291)</option>
<option value="372">Estonia (+372)</option>
<option value="251">Ethiopia (+251)</option>
<option value="500">Falkland Islands (+500)</option>
<option value="298">Faroe Islands (+298)</option>
<option value="679">Fiji (+679)</option>
<option value="358">Finland (+358)</option>
<option value="33">France (+33)</option>
<option value="689">French Polynesia (+689)</option>
<option value="241">Gabon (+241)</option>
<option value="220">Gambia (+220)</option>
<option value="995">Georgia (+995)</option>
<option value="49">Germany (+49)</option>
<option value="233">Ghana (+233)</option>
<option value="350">Gibraltar (+350)</option>
<option value="30">Greece (+30)</option>
<option value="299">Greenland (+299)</option>
<option value="1 473">Grenada (+1 473)</option>
<option value="1 671">Guam (+1 671)</option>
<option value="502">Guatemala (+502)</option>
<option value="224">Guinea (+224)</option>
<option value="245">Guinea-Bissau (+245)</option>
<option value="592">Guyana (+592)</option>
<option value="509">Haiti (+509)</option>
<option value="39">Holy See (Vatican City) (+39)</option>
<option value="504">Honduras (+504)</option>
<option value="852">Hong Kong (+852)</option>
<option value="36">Hungary (+36)</option>
<option value="354">Iceland (+354)</option>
<option value="91">India (+91)</option>
<option value="62">Indonesia (+62)</option>
<option value="98">Iran (+98)</option>
<option value="964">Iraq (+964)</option>
<option value="353">Ireland (+353)</option>
<option value="44">Isle of Man (+44)</option>
<option value="972">Israel (+972)</option>
<option value="39">Italy (+39)</option>
<option value="225">Ivory Coast (+225)</option>
<option value="1 876">Jamaica (+1 876)</option>
<option value="81">Japan (+81)</option>
<option value="44">Jersey (+44)</option>
<option value="962">Jordan (+962)</option>
<option value="7">Kazakhstan (+7)</option>
<option value="254">Kenya (+254)</option>
<option value="686">Kiribati (+686)</option>
<option value="965">Kuwait (+965)</option>
<option value="996">Kyrgyzstan (+996)</option>
<option value="856">Laos (+856)</option>
<option value="371">Latvia (+371)</option>
<option value="961">Lebanon (+961)</option>
<option value="266">Lesotho (+266)</option>
<option value="231">Liberia (+231)</option>
<option value="218">Libya (+218)</option>
<option value="423">Liechtenstein (+423)</option>
<option value="370">Lithuania (+370)</option>
<option value="352">Luxembourg (+352)</option>
<option value="853">Macau (+853)</option>
<option value="389">Macedonia (+389)</option>
<option value="261">Madagascar (+261)</option>
<option value="265">Malawi (+265)</option>
<option value="60" selected="">Malaysia (+60)</option>
<option value="960">Maldives (+960)</option>
<option value="223">Mali (+223)</option>
<option value="356">Malta (+356)</option>
<option value="692">Marshall Islands (+692)</option>
<option value="222">Mauritania (+222)</option>
<option value="230">Mauritius (+230)</option>
<option value="262">Mayotte (+262)</option>
<option value="52">Mexico (+52)</option>
<option value="691">Micronesia (+691)</option>
<option value="373">Moldova (+373)</option>
<option value="377">Monaco (+377)</option>
<option value="976">Mongolia (+976)</option>
<option value="382">Montenegro (+382)</option>
<option value="1 664">Montserrat (+1 664)</option>
<option value="212">Morocco (+212)</option>
<option value="258">Mozambique (+258)</option>
<option value="264">Namibia (+264)</option>
<option value="674">Nauru (+674)</option>
<option value="977">Nepal (+977)</option>
<option value="31">Netherlands (+31)</option>
<option value="599">Netherlands Antilles (+599)</option>
<option value="687">New Caledonia (+687)</option>
<option value="64">New Zealand (+64)</option>
<option value="505">Nicaragua (+505)</option>
<option value="227">Niger (+227)</option>
<option value="234">Nigeria (+234)</option>
<option value="683">Niue (+683)</option>
<option value="672">Norfolk Island (+672)</option>
<option value="850">North Korea (+850)</option>
<option value="1 670">Northern Mariana Islands (+1 670)</option>
<option value="47">Norway (+47)</option>
<option value="968">Oman (+968)</option>
<option value="92">Pakistan (+92)</option>
<option value="680">Palau (+680)</option>
<option value="507">Panama (+507)</option>
<option value="675">Papua New Guinea (+675)</option>
<option value="595">Paraguay (+595)</option>
<option value="51">Peru (+51)</option>
<option value="63">Philippines (+63)</option>
<option value="870">Pitcairn Islands (+870)</option>
<option value="48">Poland (+48)</option>
<option value="351">Portugal (+351)</option>
<option value="1">Puerto Rico (+1)</option>
<option value="974">Qatar (+974)</option>
<option value="242">Republic of the Congo (+242)</option>
<option value="40">Romania (+40)</option>
<option value="7">Russia (+7)</option>
<option value="250">Rwanda (+250)</option>
<option value="590">Saint Barthelemy (+590)</option>
<option value="290">Saint Helena (+290)</option>
<option value="1 869">Saint Kitts and Nevis (+1 869)</option>
<option value="1 758">Saint Lucia (+1 758)</option>
<option value="1 599">Saint Martin (+1 599)</option>
<option value="508">Saint Pierre and Miquelon (+508)</option>
<option value="1 784">Saint Vincent and the Grenadines (+1 784)</option>
<option value="685">Samoa (+685)</option>
<option value="378">San Marino (+378)</option>
<option value="239">Sao Tome and Principe (+239)</option>
<option value="966">Saudi Arabia (+966)</option>
<option value="221">Senegal (+221)</option>
<option value="381">Serbia (+381)</option>
<option value="248">Seychelles (+248)</option>
<option value="232">Sierra Leone (+232)</option>
<option value="65">Singapore (+65)</option>
<option value="421">Slovakia (+421)</option>
<option value="386">Slovenia (+386)</option>
<option value="677">Solomon Islands (+677)</option>
<option value="252">Somalia (+252)</option>
<option value="27">South Africa (+27)</option>
<option value="82">South Korea (+82)</option>
<option value="34">Spain (+34)</option>
<option value="94">Sri Lanka (+94)</option>
<option value="249">Sudan (+249)</option>
<option value="597">Suriname (+597)</option>
<option value="47 79">Svalbard (+47 79)</option>
<option value="268">Swaziland (+268)</option>
<option value="46">Sweden (+46)</option>
<option value="41">Switzerland (+41)</option>
<option value="963">Syria (+963)</option>
<option value="886">Taiwan (+886)</option>
<option value="992">Tajikistan (+992)</option>
<option value="255">Tanzania (+255)</option>
<option value="66">Thailand (+66)</option>
<option value="670">Timor-Leste (+670)</option>
<option value="228">Togo (+228)</option>
<option value="690">Tokelau (+690)</option>
<option value="676">Tonga (+676)</option>
<option value="1 868">Trinidad and Tobago (+1 868)</option>
<option value="216">Tunisia (+216)</option>
<option value="90">Turkey (+90)</option>
<option value="993">Turkmenistan (+993)</option>
<option value="1 649">Turks and Caicos Islands (+1 649)</option>
<option value="688">Tuvalu (+688)</option>
<option value="256">Uganda (+256)</option>
<option value="380">Ukraine (+380)</option>
<option value="971">United Arab Emirates (+971)</option>
<option value="44">United Kingdom (+44)</option>
<option value="1">United States (+1)</option>
<option value="598">Uruguay (+598)</option>
<option value="1 340">US Virgin Islands (+1 340)</option>
<option value="998">Uzbekistan (+998)</option>
<option value="678">Vanuatu (+678)</option>
<option value="58">Venezuela (+58)</option>
<option value="84">Vietnam (+84)</option>
<option value="681">Wallis and Futuna (+681)</option>
<option value="212">Western Sahara (+212)</option>
<option value="967">Yemen (+967)</option>
<option value="260">Zambia (+260)</option>
<option value="263">Zimbabwe (+263)</option>
</select>
<input type="tel" class="form-control" id="client_phone_number" name="client_phone_number" placeholder="Masukkan nombor telefon bimbit anda..." maxlength="20" value="" autocomplete="tel-national">
</div>
</div>
<div class="form-group ">
<label for="extra_field_1" class="control-label col-md-3">Penama Korban/Akikah<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-7">
<textarea class="form-control" rows="4" id="extra_field_1" name="extra_field_1" placeholder="(1 ekor kambing untuk 1 nama sahaja)" maxlength="2000"></textarea>
<span class="field-help"></span>
</div>
</div>
<div class="form-group ">
<label for="extra_field_2" class="control-label col-md-3">Negeri<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-7">
<select class="form-control extra-field-select empty" id="extra_field_2" name="extra_field_2">
<option value="">Sila Pilih Negeri Anda...</option>
<option value="Perlis" data-custom="0">Perlis</option>
<option value="Kedah" data-custom="0">Kedah</option>
<option value="Pulau Pinang" data-custom="0">Pulau Pinang</option>
<option value="Perak" data-custom="0">Perak</option>
<option value="Kelantan" data-custom="0">Kelantan</option>
<option value="Terengganu" data-custom="0">Terengganu</option>
<option value="Pahang" data-custom="0">Pahang</option>
<option value="Selangor" data-custom="0">Selangor</option>
<option value="Negeri Sembilan" data-custom="0">Negeri Sembilan</option>
<option value="Melaka" data-custom="0">Melaka</option>
<option value="Johor" data-custom="0">Johor</option>
<option value="Sabah" data-custom="0">Sabah</option>
<option value="Sarawak" data-custom="0">Sarawak</option>
<option value="WP Kuala Lumpur" data-custom="0">WP Kuala Lumpur</option>
<option value="WP Putrajaya" data-custom="0">WP Putrajaya</option>
<option value="WP Labuan" data-custom="">WP Labuan</option>
</select>
<input type="text" class="form-control" name="extra_field_2_custom" style="display:none;margin-top:10px" value="">
<span class="field-help"></span>
</div>
</div>
<div id="payment-section">
<h2 class="section-header" style="margin-top:30px"> BUTIRAN PEMBAYARAN</h2>
<input type="hidden" name="custom_payment_methods_options" value="">
<div class="form-group offset-0 " style="margin-top:15px">
<label class="control-label col-md-12" style="text-align:left;font-size:16px">Kaedah Pembayaran<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-12">
<div class="radio">
<label class="payment_method_label">
<input type="radio" class="payment_method" name="payment_method" value="billplz" data-button_text="Teruskan ke Pembayaran">
<div class="logo billplz selected" title="Billplz"></div> Perbankan Dalam Talian (Billplz)<br><small class="text-danger semi-bold" id="billplz-handling-charge">Caj perkhidmatan peniaga akan dikenakan sebanyak <b>RM 1.50</b> untuk setiap
transaksi yang berjaya</small>
</label>
</div>
<div class="radio">
<label class="payment_method_label">
<input type="radio" class="payment_method" name="payment_method" value="toyyibpay" data-button_text="Teruskan ke Pembayaran">
<div class="logo toyyibpay" title="toyyibPay"></div> Perbankan Dalam Talian (ToyyibPay)<br><small class="text-danger semi-bold" id="toyyibpay-handling-charge">Caj perkhidmatan peniaga akan dikenakan sebanyak <b>RM 1.00</b> untuk setiap
transaksi yang berjaya</small>
</label>
</div>
<div class="radio">
<label class="payment_method_label">
<input type="radio" class="payment_method" name="payment_method" value="banks" data-button_text="Hantar">
<div class="logo banks" title="Bank"></div> Mesin Deposit Tunai
</label>
</div>
<div id="payment_bank_info">
<div style="margin-bottom:20px">
<p class="text-center" style="padding: 15px; font-size: 16px; border: 3px dashed red"> Sila lakukan bayaran berjumlah <b>RM <span class="total-amount">0.00</span></b> ke akaun bank pilihan anda di bawah. </p>
<ul style="margin-left: -10px">
<li>Anda mesti memasukkan emel <b style="color: red">admin@cintasyriamalaysia.com</b> di ruangan emel semasa melakukan transaksi menerusi <b>Perbankan Internet</b>.</li>
<li>Anda mesti mengambil dan memuat naik <b style="color: red">gambar</b> bukti pembayaran jika anda melakukan transaksi menerusi <b>Mesin Deposit Tunai</b>.</li>
</ul>
</div>
<div class="row" style="margin-top:20px;padding-left:20px">
<div class="col-sm-6 bank-info">
<div class="logo maybank" title="Maybank"></div>
<table class="details">
<tbody>
<tr>
<th>Penama</th>
<td>CINTA SYRIA MALAYSIA 05</td>
</tr>
<tr>
<th>No. Akaun</th>
<td>550511620815</td>
</tr>
</tbody>
</table>
<a href="https://www.maybank2u.com.my/home/m2u/common/login.do" class="semi-bold bank-link" target="_blank">Buka Maybank2u <span class="fa fa-external-link"></span></a>
</div>
</div>
</div>
</div>
</div>
<div id="banks_details" style="display:none;margin-left:5px">
<hr>
<div class="form-group ">
<label class="control-label col-md-3">Pilih Akaun Bank<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-9">
<div class="radio">
<label class="bank_name">
<input type="radio" class="payment_account" name="payment_account" value="Maybank">
<div class="logo maybank selected" title="Maybank"></div>
</label>
<table class="bank_details" style="display: table;">
<tbody>
<tr>
<td>Penama</td>
<td>CINTA SYRIA MALAYSIA 05</td>
</tr>
<tr>
<td>No. Akaun</td>
<td>550511620815</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="form-group ">
<label class="control-label col-md-3">Bayar Menerusi<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-9">
<label class="radio-inline"><input type="radio" class="payment_channel" name="payment_channel" value="ob" checked="">Perbankan Internet</label>
<label class="radio-inline"><input type="radio" class="payment_channel" name="payment_channel" value="cdm">Mesin Deposit Tunai</label>
</div>
</div>
<div class="form-group ">
<label for="payment_time" class="control-label col-md-3">Masa Bayaran<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-3">
<div class="input-group bootstrap-timepicker">
<input type="text" class="form-control" id="payment_time" name="payment_time" maxlength="11" value=""><span class="input-group-addon"><span class="glyphicon glyphicon-time"></span></span>
</div>
</div>
</div>
<div class="form-group ">
<label for="payment_date" class="control-label col-md-3">Tarikh Bayaran<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-3">
<div class="input-group date">
<input type="text" class="form-control" id="payment_date" name="payment_date" maxlength="10" value=""><span class="input-group-addon" style="cursor:pointer"><span class="glyphicon glyphicon-calendar"></span></span>
</div>
</div>
</div>
<div class="form-group">
<label for="payment_note" class="control-label col-md-3">Nota Bayaran</label>
<div class="col-md-7">
<textarea class="form-control" rows="4" id="payment_note" name="payment_note" placeholder="Masukkan nota bayaran..." maxlength="1000"></textarea>
</div>
</div>
<div class="form-group ">
<label for="payment_proof" class="control-label col-md-3">Bukti Bayaran<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<div class="col-md-9">
<div class="fileinput fileinput-new" data-provides="fileinput">
<span class="btn btn-default btn-file"><span class="fileinput-new"><span class="fa fa-file"></span> Pilih Fail</span><span class="fileinput-exists">Tukar Fail</span><input type="file" id="payment_proof" name="payment_proof"></span>
<span class="fileinput-filename"></span>
<a href="#" class="close fileinput-exists" data-dismiss="fileinput" style="float:none">×</a>
</div>
<span class="field-help">Tekan butang di atas untuk pilih fail.<br>Pilih fail berformat JPG, PNG, GIF, PDF atau DOC sahaja.<br>Pastikan saiz fail tidak melebihi 20000 KB.</span>
</div>
</div>
</div>
<div id="billplz_details" style="margin-left: 5px;">
<hr>
<div class="form-group offset-0 ">
<div class="col-md-12">
<label for="payment_billplz_bank_code" class="control-label" style="margin-bottom:10px">Bank<span class="glyphicon glyphicon-asterisk red-asterisk"></span></label>
<select class="form-control empty" id="payment_billplz_bank_code" name="payment_billplz_bank_code">
<option value="">Pilih bank...</option>
<option value="ABMB0212">Alliance Bank</option>
<option value="ABB0233">Affin Bank</option>
<option value="AMBB0209">AmBank</option>
<option value="BCBB0235">CIMB Clicks</option>
<option value="BIMB0340">Bank Islam</option>
<option value="BKRM0602">Bank Rakyat</option>
<option value="BMMB0341">Bank Muamalat</option>
<option value="BSN0601">BSN</option>
<option value="HLB0224">Hong Leong Bank</option>
<option value="HSBC0223">HSBC Bank</option>
<option value="KFH0346">Kuwait Finance House</option>
<option value="MB2U0227">Maybank2u</option>
<option value="OCBC0229">OCBC Bank</option>
<option value="PBB0233">Public Bank</option>
<option value="RHB0218">RHB Now</option>
<option value="SCB0216">Standard Chartered</option>
</select>
</div>
</div>
</div>
</div>
<p class="text-center" style="margin-top:30px">
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QURBAN MISSION CSM 11.0 - SRI LANKA Bersih Jiwa Bersama Sri Lanka! Qurban Mission CSM merupakan sebuah program ibadah korban yang dikendalikan oleh Cinta Syria Malaysia. Memasuki tahun ke-11 operasi, Cinta Syria Malaysia masih terus semangat untuk melaksanakan program ini demi menyalurkan bantuan kemanusiaan untuk rakyat Syria, sekaligus meraikan hari kebesaran Islam iaitu Aidiladha. Pelaksanaan ibadah korban adalah salah satu cara untuk menyempurnakan tanda kesyukuran kepada Allah SWT atas segala pinjaman, nikmat dan kurniaan-Nya yang tidak terhingga. -------------------------------------------------------------------------------- "Oleh itu, kerjakanlah sembahyang kerana Tuhanmu semata-mata, dan sembelihlah korban (sebagai bersyukur)." Al-Kauthar 108:2 -------------------------------------------------------------------------------- Objektif utama Qurban Mission CSM 11.0 adalah untuk membantu komuniti Muslim di Sri Lanka meraikan Hari Raya Aidiladha dengan lebih baik. Lokasi Agihan : Sri Lanka Tarikh Sembelihan/Agihan : 16 Jun 2024 - 22 Jun 2024 (9 - 15 Zulhijjah 1445H) Penerima Manfaat : Anggaran seramai 68,750 komuniti muslim Sri Lanka akan menerima manfaat ini. -------------------------------------------------------------------------------- Sumbangan Secara Manual / Bank Transfer / CDM Bank: Maybank Islamic Berhad Nama Akaun: Cinta Syria Malaysia 05 No. Akaun: 5505 1162 0815 Rujukan: Korban Sri Lanka Pertanyaan lebih lanjut, boleh hubungi Cik Maziah: +6011 3313 7539 -------------------------------------------------------------------------------- "Sesungguhnya orang-orang lelaki yang bersedekah dan orang-orang perempuan yang bersedekah, serta mereka memberikan pinjaman kepada Allah, sebagai pinjaman yang baik (ikhlas), akan digandakan balasannya (dengan berganda-ganda banyaknya), dan mereka pula akan beroleh pahala yang mulia." (Surah Al-Hadid: 18) Berminat untuk buat ibadah korban di Syria? Klik link korban4syria.com untuk tempahan! -------------------------------------------------------------------------------- Perhatian! Sila lengkapkan borang di bawah. Ruangan yang wajib diisi BUTIRAN PEMBELIAN Produk Kuantiti Harga (RM) Korban Lembu - Pakej Diamond (RM2800) 0123 3 0.00 Korban Ansuran Bahagian Lembu (RM133.33) 0123 3 0.00 Korban Bahagian Lembu - Pakej Ihsan (RM400) BELUM MULA Korban Bahagian Lembu - Pakej Rahmah (RM450) BELUM MULA Korban Bahagian Lembu - Pakej Kasih (RM500) BELUM MULA Pakej Sedekah Daging Lembu (RM50) 0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416417418419420421422423424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468469470471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500501502503504505506 506 0.00 Akikah Kambing - Pakej Platinum (RM1175) 012345 5 0.00 Taja Pendidikan (RM30) BELUM MULA Taja Pendidikan (RM50) BELUM MULA Taja Pendidikan (RM100) BELUM MULA Bantuan Umum Operasi BELUM MULA JUMLAH 0 0.00 JUMLAH KESELURUHAN (RM) 0.00 Caj Perkhidmatan Peniaga (RM) 1.50 BUTIRAN PELANGGAN Nama Emel Nombor HP Pilih kod dail negara untuk nombor telefon bimbit anda... 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PerlisKedahPulau PinangPerakKelantanTerengganuPahangSelangorNegeri SembilanMelakaJohorSabahSarawakWP Kuala LumpurWP PutrajayaWP Labuan BUTIRAN PEMBAYARAN Kaedah Pembayaran Perbankan Dalam Talian (Billplz) Caj perkhidmatan peniaga akan dikenakan sebanyak RM 1.50 untuk setiap transaksi yang berjaya Perbankan Dalam Talian (ToyyibPay) Caj perkhidmatan peniaga akan dikenakan sebanyak RM 1.00 untuk setiap transaksi yang berjaya Mesin Deposit Tunai Sila lakukan bayaran berjumlah RM 0.00 ke akaun bank pilihan anda di bawah. * Anda mesti memasukkan emel admin@cintasyriamalaysia.com di ruangan emel semasa melakukan transaksi menerusi Perbankan Internet. * Anda mesti mengambil dan memuat naik gambar bukti pembayaran jika anda melakukan transaksi menerusi Mesin Deposit Tunai. PenamaCINTA SYRIA MALAYSIA 05 No. Akaun550511620815 Buka Maybank2u -------------------------------------------------------------------------------- Pilih Akaun Bank PenamaCINTA SYRIA MALAYSIA 05 No. Akaun550511620815 Bayar Menerusi Perbankan Internet Mesin Deposit Tunai Masa Bayaran Tarikh Bayaran Nota Bayaran Bukti Bayaran Pilih FailTukar Fail × Tekan butang di atas untuk pilih fail. Pilih fail berformat JPG, PNG, GIF, PDF atau DOC sahaja. Pastikan saiz fail tidak melebihi 20000 KB. -------------------------------------------------------------------------------- Bank Pilih bank... Alliance Bank Affin Bank AmBank CIMB Clicks Bank Islam Bank Rakyat Bank Muamalat BSN Hong Leong Bank HSBC Bank Kuwait Finance House Maybank2u OCBC Bank Public Bank RHB Now Standard Chartered Teruskan ke Pembayaran