<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>Customer Reg-2 bn</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="name_bn">যাত্রীর নাম</label> <div class="col-md-8"> <input id="name_bn" name="name_bn" type="text" placeholder="বাংলায়" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="name_en">Passenger Name</label> <div class="col-md-8"> <input id="name_en" name="name_en" type="text" placeholder="English In Capital" class="form-control input-md" required=""> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="sex_bn">লিঙ্গ</label> <div class="col-md-4"> <select id="sex_bn" name="sex_bn" class="form-control"> <option value="1">পুরুষ</option> <option value="2">মহিলা</option> </select> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="marital_rel">বৈবাহিক সম্পর্ক</label> <div class="col-md-4"> <select id="marital_rel" name="marital_rel" class="form-control"> <option value="1">বিবাহিত</option> <option value="2">অবিবাহিত</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="care_of">পিতা /স্বামীর নাম</label> <div class="col-md-8"> <input id="care_of" name="care_of" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="mother_bn">মাতার নাম</label> <div class="col-md-8"> <input id="mother_bn" name="mother_bn" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="passport_no">পাসপোর্ট নাম্বার</label> <div class="col-md-8"> <input id="passport_no" name="passport_no" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="expire_date">মেয়াদ উত্তীর্ণের তারিখ</label> <div class="col-md-4"> <input id="expire_date" name="expire_date" type="text" placeholder="Calendar Option" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="birth_date_bn">জন্ম তারিখ</label> <div class="col-md-4"> <input id="birth_date_bn" name="birth_date_bn" type="text" placeholder="Calendar Option" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="age_bn">বয়স</label> <div class="col-md-4"> <input id="age_bn" name="age_bn" type="text" placeholder="age auto calculate" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="study_bn">শিক্ষাগত যোগ্যতা</label> <div class="col-md-5"> <input id="study_bn" name="study_bn" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="profession ">পেশা</label> <div class="col-md-5"> <input id="profession " name="profession " type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="address_bn">ঠিকানা</label> <div class="col-md-4"> <textarea class="form-control" id="address_bn" name="address_bn"></textarea> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="mobile_bn">মোবাইল নং</label> <div class="col-md-5"> <input id="mobile_bn" name="mobile_bn" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="wife_hus_bn">বিবাহিত মহিলাদের ক্ষেত্রে স্বামী একই সাথে হজ্বে যাবে কি-না?</label> <div class="col-md-4"> <select id="wife_hus_bn" name="wife_hus_bn" class="form-control"> <option value="1">Yes</option> <option value="2">No</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="wife_hus_bn_no">স্বামী একই সাথে হজ্বে না গেলে শরীয়ত সম্মত মাহ্রাম এর নাম</label> <div class="col-md-8"> <input id="wife_hus_bn_no" name="wife_hus_bn_no" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="address_moh">মাহরাম এর ঠিকানা </label> <div class="col-md-4"> <textarea class="form-control" id="address_moh" name="address_moh"></textarea> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="mobile_moh">মোবাইল নং</label> <div class="col-md-5"> <input id="mobile_moh" name="mobile_moh" type="text" placeholder="" class="form-control input-md"> </div> </div> <!-- Select Basic --> <div class="form-group"> <label class="col-md-4 control-label" for="package_bn">প্যাকেজ</label> <div class="col-md-4"> <select id="package_bn" name="package_bn" class="form-control"> <option value="1">package-1</option> <option value="2">package-2</option> <option value="3">package-3</option> <option value="4">etc</option> </select> </div> </div> <!-- File Button --> <div class="form-group"> <label class="col-md-4 control-label" for="photo_bn">পাসপোর্ট সাইজ এর ছবি</label> <div class="col-md-4"> <input id="photo_bn" name="photo_bn" class="input-file" type="file"> </div> </div> </fieldset> </form>