<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>ADD VILLAGE BASIC INFO</legend> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="selectbasic">VILLAGE NAME</label> <div class="col-md-4"> <select id="selectbasic" name="selectbasic" class="form-control"> <option value="1">ELURU</option> <option value="2">VATLURU</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="VCODE">VILLAGE CODE</label> <div class="col-md-4"> <select id="VCODE" name="VCODE" class="form-control"> <option value="1">1001</option> <option value="2">1002</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="TOTH">TOTAL HABITATIONS</label> <div class="col-md-4"> <select id="TOTH" name="TOTH" class="form-control"> <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> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="VILLP">VILLAGE PRESIDENT</label> <div class="col-md-4"> <input id="VILLP" name="VILLP" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="SECRETARYN">SECRETARY NAME</label> <div class="col-md-4"> <input id="SECRETARYN" name="SECRETARYN" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="TOTP">TOTAL POPULATION</label> <div class="col-md-4"> <input id="TOTP" name="TOTP" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="HELPLINE">HELPLINE NO</label> <div class="col-md-4"> <input id="HELPLINE" name="HELPLINE" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="sdds">total unemployed persons</label> <div class="col-md-4"> <input id="sdds" name="sdds" type="text" placeholder="" class="form-control input-md" required=""> <span class="help-block">only graduate's</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="gncvn">total employed persons</label> <div class="col-md-4"> <input id="gncvn" name="gncvn" type="text" placeholder="" class="form-control input-md" required=""> <span class="help-block">only graduate's</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="fsv">Government Pension holders</label> <div class="col-md-4"> <input id="fsv" name="fsv" type="text" placeholder="" class="form-control input-md" required=""> <span class="help-block">include widows,old-aged,disability,weavers</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="sdc">Total Pucca houses</label> <div class="col-md-4"> <input id="sdc" name="sdc" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="bsjs">Total kaccha houses</label> <div class="col-md-4"> <input id="bsjs" name="bsjs" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Multiple Checkboxes (inline) --> <div class="form-group"> <label class="col-md-4 control-label" for="czsc">Type of transport available to reach the nearest town from GP</label> <div class="col-md-4"> <label class="checkbox-inline" for="czsc-0"> <input type="checkbox" name="czsc" id="czsc-0" value="1"> RTC Bus Service </label> <label class="checkbox-inline" for="czsc-1"> <input type="checkbox" name="czsc" id="czsc-1" value="2"> Private Bus Service </label> <label class="checkbox-inline" for="czsc-2"> <input type="checkbox" name="czsc" id="czsc-2" value="3"> 7-Seater auto </label> <label class="checkbox-inline" for="czsc-3"> <input type="checkbox" name="czsc" id="czsc-3" value="4"> 3-seater auto </label> <label class="checkbox-inline" for="czsc-4"> <input type="checkbox" name="czsc" id="czsc-4" value="5"> Train service </label> <label class="checkbox-inline" for="czsc-5"> <input type="checkbox" name="czsc" id="czsc-5" value="6"> Boat service </label> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="DDD">Type of approach road the GP has</label> <div class="col-md-4"> <select id="DDD" name="DDD" class="form-control"> <option value="1">EARTH ROAD</option> <option value="2">GRAVEL ROAD</option> <option value="3">WATER BOUND ROAD</option> <option value="4">BITUMINOUS ROAD</option> <option value="5">CEMENT CONCRETE ROAD</option> </select> </div> </div> <!-- Multiple Radios --> <div class="form-group"> <label class="col-md-4 control-label" for="RAD1">Whether the GP having dumping yard facility?</label> <div class="col-md-4"> <div class="radio"> <label for="RAD1-0"> <input type="radio" name="RAD1" id="RAD1-0" value="1" checked="checked"> YES </label> </div> <div class="radio"> <label for="RAD1-1"> <input type="radio" name="RAD1" id="RAD1-1" value="2"> NO </label> </div> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="ILLIT">ILLITERATES</label> <div class="col-md-4"> <input id="ILLIT" name="ILLIT" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="ST POP">ST POPULATION</label> <div class="col-md-4"> <input id="ST POP" name="ST POP" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="LIT">LITERATES</label> <div class="col-md-4"> <input id="LIT" name="LIT" type="text" placeholder="" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="CHILDPOP">CHILD POPULATION</label> <div class="col-md-4"> <input id="CHILDPOP" name="CHILDPOP" type="text" placeholder="" class="form-control input-md"> <span class="help-block">[0-6 years]</span> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="scpop">SC POPULATION</label> <div class="col-md-4"> <input id="scpop" name="scpop" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Button (Double) --> <div class="form-group"> <label class="col-md-4 control-label" for="button1id1"></label> <div class="col-md-8"> <button id="button1id1" name="button1id1" class="btn btn-success">SUBMIT</button> <button id="button2id" name="button2id" class="btn btn-danger">CANCEL</button> </div> </div> </fieldset> </form>