blob: d6ba46b11f28082c77a2eb7e00859d5803f38ed5 (
plain)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
|
<div class="form-group">
{formlabel label="NI Number" for="nino"}
{forminput}
<input size="10" type="text" name="nino" id="nino" value="{$gContent->mInfo.nino|escape}" />
{/forminput}
</div>
<div class="form-group">
{formlabel label="Date of Birth" for="dob"}
{forminput}
<input size="10" type="text" name="dob" id="dob" value="{$gContent->mInfo.dob|escape}" />
{/forminput}
</div>
<div class="form-group">
{formlabel label="Date of eighteen" for="eighteenth"}
{forminput}
<input size="10" type="text" name="eighteenth" id="eighteenth" value="{$gContent->mInfo.eighteenth|escape}" />
{/forminput}
</div>
<div class="form-group">
{formlabel label="Date of Death" for="dod"}
{forminput}
<input size="10" type="text" name="dod" id="dod" value="{$gContent->mInfo.dod|escape}" />
{/forminput}
</div>
|