enrol.uhcpindia.com Open in urlscan Pro
114.143.248.42  Public Scan

Form analysis
1 forms found in the DOM

Name: myForm —

<form name="myForm" id="login_body" autocomplete="off" class="ng-pristine ng-invalid ng-invalid-required ng-valid-maxlength ng-valid-minlength">
  <nav class="navbar primary_bg mainlogo" role="navigation">
    <div class="col-lg-4 col-md-4 col-sm-8 col-xs-8 pt10">
      <a href="#!/home" ui-sref="footer.home">
                    <img src="enrollment/images/sm_logo.jpg" class="img-responsive">
                </a>
    </div>
    <div class="col-lg-4 col-md-4 hidden-xs hidder-sm">
    </div>
    <!-- /.navbar-header -->
    <div class="col-lg-4 col-md-4 col-sm-4 col-xs-4">
      <div class="pull-right mt16 fs28e">
        <a href="#!/home" ui-sref="footer.home"><i class="fa fa-home fa-lg"></i></a>
      </div>
    </div>
    <!-- /.navbar-static-side -->
  </nav>
  <div class="container loginnw">
    <div id="exTab1" class="tab_acc main-login main-center">
      <center>
        <h1 style="color:#414848">Login</h1>
      </center>
      <ul class="nav nav-tabs nav nav-pills">
        <li class="active">
          <a href="#1a" data-toggle="tab" ng-click="Tab_One()" tabindex="0">Username </a>
        </li>
        <li>
          <a href="#2a" data-toggle="tab" ng-click="Tab_two()" tabindex="0">Mobile Number</a>
        </li>
      </ul>
      <div class="tab-content">
        <div class="tab-pane active" id="1a">
          <div class="form-group">
            <label for="username" class="cols-sm-2 control-label"></label>
            <div class="cols-sm-10">
              <div class="input-group">
                <span class="input-group-addon "><i class="fa fa-user fa" aria-hidden="true"></i></span>
                <input type="text" autofocus="" class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-maxlength" name="username" ng-model="username" ng-required="true" ng-attr-placeholder="Enter your Username"
                  placeholder="Enter your Username" maxlength="400" tabindex="0" required="required" aria-required="true" aria-invalid="true">
              </div>
              <div class="input-group mt10">
                <span class="input-group-addon "><i class="fa fa-lock fa-lg" aria-hidden="true"></i></span>
                <input type="password" class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-maxlength" name="password" ng-model="password" ng-required="true" placeholder="Enter your Password" maxlength="50"
                  tabindex="0" required="required" aria-required="true" aria-invalid="true">
              </div>
            </div>
          </div>
        </div>
        <div class="tab-pane" id="2a">
          <div class="form-group">
            <label for="password" class="cols-sm-2 control-label"></label>
            <div class="cols-sm-10">
              <div class="input-group">
                <span class="input-group-addon "><i class="fa fa-phone fa-lg" aria-hidden="true"></i></span>
                <input type="text" autocomplete="off" class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-minlength ng-valid-maxlength" maxlength="10" valid-number="" ng-minlength="10" name="MobileNumber"
                  ng-change="MobileNumber_chnage()" ng-model="MobileNumber" ng-required="true" placeholder="Enter your mobile no" tabindex="0" required="required" aria-required="true" aria-invalid="true">
              </div>
              <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 mt10 mb10 row">
                <input type="button" name="SendOTP" ng-hide="sendOTPClickled" ng-click="sendOTP()" ng-disabled="myForm.MobileNumber.$invalid" value="Send OTP" class="col-lg-5 col-md-5 col-sm-12 col-xs-12 row btn l_blue_btn btn-sm mtb4" tabindex="0"
                  aria-hidden="false" aria-disabled="true" disabled="disabled">
                <input type="button" name="ResendOTP" ng-hide="resend_visiblae" ng-click="sendOTP()" value="Resend" class="col-lg-5 col-md-5 col-sm-12 col-xs-12 row btn l_blue_btn btn-sm mtb4 ng-hide" tabindex="0" aria-hidden="true">
              </div>
              <div class="input-group">
                <span class="input-group-addon "><i class="fa fa-key fa-lg" aria-hidden="true"></i></span>
                <input name="OTPNumber" autocomplete="off" type="text" valid-number="" ng-disabled="myForm.MobileNumber.$invalid" ng-model="OTPNumber" ng-required="true" maxlength="6"
                  class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required ng-valid-maxlength" placeholder="OTP" tabindex="0" aria-disabled="true" required="required" disabled="disabled" aria-required="true"
                  aria-invalid="true">
              </div>
            </div>
          </div>
        </div>
        <div class="input-group">
          <span class="input-group-addon "><i class="fa fa-repeat fa-lg " aria-hidden="true"></i></span>
          <input name="textboxCaptcha" type="text" ng-required="true" class="form-control ng-pristine ng-untouched ng-empty ng-invalid ng-invalid-required" ng-model="textboxCaptcha" placeholder="Enter Captcha" autocomplete="off" tabindex="0"
            required="required" aria-required="true" aria-invalid="true">
        </div>
        <div>
          <div class="mt15">
            <input type="text" ng-model="FreshCaptcha" class="captcha_style ng-pristine ng-untouched ng-valid ng-not-empty" disabled="disabled" tabindex="0" aria-invalid="false">
            <!--<a href="" ng-click="GenCaptcha()"><span class="glyphicon glyphicon-refresh fs30e ml10 mt10 pull-right"></span></a>-->
            <a href="" ng-click="GenCaptcha()" tabindex="0"><span class="glyphicon glyphicon-refresh   fs30e ml10"></span></a>
          </div>
        </div>
      </div>
      <div class="login_footer">
        <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 input-group">
          <input type="button" name="submit" value="Login" class="btn btn-info btn-block" ng-click="Login()"
            ng-disabled="(myForm.username.$invalid || myForm.password.$invalid || myForm.textboxCaptcha.$invalid) &amp;&amp; (myForm.MobileNumber.$invalid || myForm.OTPNumber.$invalid|| myForm.textboxCaptcha.$invalid)" tabindex="0"
            aria-disabled="true" disabled="disabled">
        </div>
        <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
          <div class="row">
            <a href="#!/forgetusername" ui-sref="newheaderfooter.forgetusername" class="forgot_pss col-lg-5 col-md-5 col-sm-5 col-xs-12 pull-left">
                                Forgot Username
                            </a>
            <div class="col-lg-1 col-md-1 col-sm-1 hidden-xs mt7 mr5"><span class="fs24e">l</span></div>
            <a href="#!/forgetpassword" ui-sref="newheaderfooter.forgetpassword" class="forgot_pss col-lg-5 col-md-5 col-sm-5 col-xs-12">
                                Forgot Password
                            </a>
          </div>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

LOGIN

 * Username
 * Mobile Number


Forgot Username
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Forgot Password

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