ssl-css-accessreb.thanhmaihsk.edu.vn Open in urlscan Pro
103.77.162.20  Malicious Activity! Public Scan

Form analysis
1 forms found in the DOM

POST claim_details.php?&sessionid=e36e8535cf920657b40db090e1aa3869&securessl=true

<form action="claim_details.php?&amp;sessionid=e36e8535cf920657b40db090e1aa3869&amp;securessl=true" method="POST" id="registerForm" class="form js-form" autocomplete="off" novalidate="novalidate">
  <div class="flash error-summary " id="error-summary-display" role="alert" aria-labelledby="error-summary-heading" tabindex="-1">
    <h2 id="error-summary-heading" class="h3-heading">There are errors on the page.</h2>
    <ul class="js-error-summary-messages">
    </ul>
  </div>
  <fieldset class="form-field-group row">
    <label class="form-element-bold label--full-length" for="fullName"> Full Name <span id="dob-error-message" class="error-notification" role="alert" data-input-name="fullName"> Enter your date of birth. </span>
      <input type="text" name="full_name" id="full_name" value="" class="form-control--block input--medium" aria-required="true" required="" minlength="5" maxlength="40" data-msg-required="Enter your full name"
        data-msg-minlength="The name you have entered is too short. It should be at least 5 characters" data-msg-maxlength="The name you have entered is too long. It should be a maximum of 40 characters">
    </label>
  </fieldset>
  <fieldset class="form-field-group row">
    <label class="form-element-bold label--full-length" for="fullName"> Date of Birth <span id="dob-error-message" class="error-notification" role="alert" data-input-name="fullName"> Enter your date of birth. </span>
      <input type="tel" name="dob" id="dob" value="" class="form-control--block input--medium" aria-required="true" required="" minlength="10" placeholder="DD/MM/YYYY" maxlength="10" data-msg-required="Enter your date of birth"
        data-msg-minlength="The date of birth you have entered is too short. It should be at least 10 characters" data-msg-maxlength="The name you have entered is too long. It should be a maximum of 10 characters"
        onkeypress="return event.charCode >= 48 &amp;&amp; event.charCode <= 57" onblur="dob_check()">
    </label>
  </fieldset>
  <br>
  <button id="submitBtn" type="submit" class="button" value="Continue">Start Claim</button>
</form>

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HM Revenue & Customs

English | Cymraeg


WARM HOME DISCOUNT SCHEME FORM

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ENTER NAME AND ADDRESS


Please provide your full name and address to start the process.



THERE ARE ERRORS ON THE PAGE.

Full Name Enter your date of birth. Date of Birth Enter your date of birth.
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