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77 lines (57 loc) · 1.89 KB
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Document</title>
<style>
#disp {
display: none;
}
</style>
</head>
<body>
<form action="#" onsubmit="handlSubmit()">
<input type="text" name="name" id="name" placeholder="Enrter Name">
<br><br>
<input type="number" name="b_date" id="b_date" placeholder="Enter Birthdate">
<br><br>
<input type="number" name="number" id="m_no" placeholder="Enter Mobile No">
<br><br>
<input type="radio" name="Salaried" id="Salaried">Salaried
<br>
<input type="radio" name="Self-Employee" id="Self-Employee">Self-Employee
<br><br>
<select name="anual-income" id="anual-income" onclick="handlClick()">
<option value="0">--Anual Income--</option>
<option value="0-3">0-3 Lakh</option>
<option value="3-5">3 to 5 Lakh</option>
<option value="5-10">5 to 10 Lakh</option>
<option value="up10">Above 10 Lakh</option>
</select>
<br><br>
<input type="radio" name="smoke" id="smoke">Yes
<br>
<input type="radio" name="smoke_n" id="smoke_n">No
<br><br>
<input type="submit" value="submit">
<table border="2">
<th>Name</th>
<th>Age</th>
<th>Mobile No</th>
<th>Insurance Amount</th>
<th>Primium</th>
<tr>
<th id="name"></th>
<th id="age"></th>
<th id="mobile_no"></th>
<th id="insurance amount"></th>
<th id="primium"></th>
</tr>
</table>
<div id="disp">
</div>
</form>
<script src="js/test2.js"></script>
</body>
</html>