rsudalimanshur.e-blud.co.id Open in urlscan Pro
103.84.194.154  Public Scan

Form analysis
1 forms found in the DOM

Name: loginform — POST https://rsudalimanshur.e-blud.co.id\/auth/authenticate

<form action="https://rsudalimanshur.e-blud.co.id\/auth/authenticate" class="form-horizontal" method="post" id="loginform" name="loginform">
  <div class="row">
    <input type="text" name="username" id="username" class="form__input" placeholder="Username">
    <input type="password" name="password" id="password" class="form__input" placeholder="Password">
    <div class="wrap-input100 validate-input" data-validate="Valid email is required: ex@abc.xyz">
      <div class="col-sm-12">
        <div class="input-group">
          <span class="focus-input100"></span>
          <span class="symbol-input100"><i class="fa fa-th-list"></i></span>
          <select name="loginperiode" id="password" class="input100">
            <option value="2021">2021</option>
            <option value="2022">2022</option>
            <option value="2023">2023</option>
            <option value="2024" selected="">2024</option>
            <!--<option value="9999">Pelatihan</option>-->
          </select>
        </div>
      </div>
    </div>
  </div>
  <div class="row">
    <h5 style="color: black" for="remember_me">
      <input type="checkbox" name="remember_me" id="remember_me" class="row"> Remember Me!
    </h5>
  </div>
  <div class="row">
    <input type="submit" value="Submit" class="btn">
  </div>
</form>

Text Content

2021 2022 2023 2024

REMEMBER ME!


SIPD e-BLUD | 2021