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Insurance.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Document</title>
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Baloo+2:wght@500&family=Baloo+Bhai+2:wght@500&display=swap"
rel="stylesheet">
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link
href="https://fonts.googleapis.com/css2?family=Baloo+2:wght@500&family=Baloo+Bhai+2:wght@500&family=Montserrat:wght@500&display=swap"
rel="stylesheet">
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<style>
* {
padding: 0;
margin: 0;
text-decoration: none;
list-style: none;
}
nav {
background-color: rgba(37, 38, 65, 1);
height: 80px;
/*60 */
width: 100%;
}
.logo {
color: white;
font-size: 35px;
list-style: 8px;
padding: 0 100px;
display: inline-block;
margin-left: -75px;
margin-top: -45px;
}
.logo img {
height: 190px;
width: 190px;
margin-top: -10px;
}
nav ul {
float: right;
margin-right: 20px;
}
nav ul li {
display: inline-block;
line-height: 100px;
margin: 0 5px;
transform: translateY(-8px);
}
nav ul li a {
border-radius: 3px;
color: white;
padding: 15px;
position: relative;
font-size: 24px;
}
.Donate {
background-color: #4CAF50;
/* background-color: #F48C06; */
color: #fff;
border: none;
padding: 10px 38px;
border-radius: 25px;
font-size: 20px;
font-weight: bold;
cursor: pointer;
transition: background-color 0.3s ease;
transform: translateY(-8px);
}
.Donate:hover {
background-color: #3e8e41;
}
nav ul li a::before {
content: "";
position: absolute;
left: 0;
top: 40px;
bottom: -2px;
width: 100%;
height: 1px;
background-color: white;
transform: scaleX(0);
transform-origin: left center;
transition: transform 0.3s cubic-bezier(0.5, 0, 0.1, 1.2);
}
nav ul li a:hover::before {
transform: scaleX(1);
}
.Donate a {
color: #fff;
}
.main {
border: 2x solid red;
}
.bg {
background-image: url("Insurance.png");
background-size: cover;
background-repeat: no-repeat;
height: 250px;
width: 100%;
}
span {
font-size: 60px;
text-align: left;
/* margin-top: 120px; */
position: relative;
top: 110px;
left: 40px;
font-family: 'Baloo 2', cursive;
font-family: 'Baloo Bhai 2', cursive;
/* color: #fff; */
text-shadow: 2px 2px 4px rgba(0, 0, 0, 0.5);
color: rgb(46, 44, 44);
}
.overlay {
position: absolute;
/* Set the position of the overlay to absolute */
top: 30;
left: 0;
width: 100%;
height: 50%;
background-color: rgba(255, 255, 255, 0.5);
/* Set the background color to white with 50% opacity */
}
.helpmain {
/* border: 2px solid red; */
position: relative;
margin-top: 20px;
}
.helpimg {
margin-top: 50px;
margin-left: 80px;
display: inline;
}
.helptext {
/* border: 2px solid blue; */
display: inline;
float: right;
font-size: 16px;
padding-left: 20px;
margin-top: 36px;
margin-right: 200px;
font-family: 'Montserrat', sans-serif;
}
.helptext a {
font-size: 16px;
background-color: #000000B3;
color: #fff;
padding: 16px 28px;
border-radius: 4px;
font-weight: 800;
font-family: Verdana, Geneva, Tahoma, sans-serif;
}
.helptext a:hover {
background-color: #424040b3;
color: #000000B3;
}
.box {
width: 300px;
background-color: #EEEEEE;
border: 1px solid #ccc;
border-radius: 5px;
box-shadow: 0 0 5px rgba(0, 0, 0, 0.1);
padding: 20px;
text-align: center;
display: inline;
float: left;
margin-left: 40px;
margin-top: 20px;
}
.box h2 {
margin-top: 0;
font-size: 20px;
font-weight: bold;
}
.box p {
margin-bottom: 0;
font-size: 22px;
line-height: 1.5;
}
.box a {
color: #007bff;
text-decoration: none;
}
.box a:hover {
text-decoration: underline;
}
.box1 {
width: 300px;
background-color: #EEEEEE;
border: 1px solid #ccc;
border-radius: 5px;
box-shadow: 0 0 5px rgba(0, 0, 0, 0.1);
padding: 20px;
text-align: center;
display: inline;
float: left;
margin-left: 30px;
margin-top: 20px;
}
.box1 h2 {
margin-top: 0;
font-size: 20px;
font-weight: bold;
}
.box1 p {
margin-bottom: 0;
font-size: 22px;
line-height: 1.5;
}
.box1 a {
color: #007bff;
text-decoration: none;
}
.box1 a:hover {
text-decoration: underline;
}
.box2 {
width: 300px;
background-color: #EEEEEE;
border: 1px solid #ccc;
border-radius: 5px;
box-shadow: 0 0 5px rgba(0, 0, 0, 0.1);
padding: 20px;
text-align: center;
display: inline;
float: left;
margin-left: 30px;
margin-top: 20px;
}
.box2 h2 {
margin-top: 0;
font-size: 20px;
font-weight: bold;
}
.box2 p {
margin-bottom: 0;
font-size: 22px;
line-height: 1.5;
}
.box2 a {
color: #007bff;
text-decoration: none;
}
.box2 a:hover {
text-decoration: underline;
}
.Helplinenum {
border: 1px dotted gray;
margin-top: 320px;
margin-left: 30px;
font-size: 19px;
padding-left: 15px;
background-color: #EEEEEE;
padding-top: 10px;
}
footer {
height: 200px;
margin-top: 90px;
background-color: rgba(37, 38, 65, 1);
font-family: 'Montserrat', sans-serif;
padding-bottom: 10px;
}
.logo1 {
color: white;
font-size: 35px;
list-style: 8px;
padding: 0 100px;
display: inline-block;
margin-left: 440px;
margin-top: -27px;
}
.logo1 img {
height: 190px;
width: 190px;
margin-top: -10px;
}
.section {
margin-left: 460px;
margin-top: -50px;
padding-bottom: 10px;
}
.form{
border: 2px solid #000000B3;
margin: 70px;
/* background-color: #ECEDF3; */
}
#helptext:hover {
background-color: #424040b3;
color: #000000B3;
}
</style>
</head>
<body>
<nav>
<div class="logo">
<img src="Defender_logo.png">
</div>
<ul>
<li><a href="index.html">Home</a></li>
<li><a href="wheather.html">Weather</a></li>
<li><a href="News_gallery.html">News Gallery</a></li>
<li><a href="support_center.html">Support Center</a></li>
<button class="Donate"><a href="Donation.html" target="_blank">Donate</a></button>
</ul>
</nav>
<div class="bg">
<!-- <div class="overlay"></div> -->
<!-- <span class="sp">Support Center</span> -->
</div>
<div class="form" >
<h1 style="margin-left: 50px;color: #000000B3; margin-top: 10px;">Insurance Details </h1>
<br>
<br>
<form action="flood_insurance.php" method="post">
<div class="form-group">
<label for="name" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Name:</label> <br>
<input type="text" id="name" name="name" required style="width: 900px; margin-left: 50px; height: 30px;"> <br> <br>
</div>
<div class="form-group">
<label for="email" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Email:</label> <br>
<input type="email" id="email" name="email" required style="width: 900px; margin-left: 50px; height: 30px;"> <br>
<br>
</div>
<div class="form-group">
<label for="phone" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Phone:</label> <br>
<input type="tel" id="phone" name="phone" required style="width: 900px; margin-left: 50px; height: 30px;"> <br>
<br>
</div>
<div class="form-group">
<label for="dob" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Date of Birth:</label> <br>
<input type="date" id="dob" name="dob" required style="width: 900px; margin-left: 50px; height: 30px;"> <br> <br>
</div>
<div class="form-group">
<label for="gender" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Gender:</label> <br>
<select id="gender" name="gender" required style="width: 900px; margin-left: 50px; height: 30px;"> <br>
<option value="">--Please select--</option>
<option value="male">Male</option>
<option value="female">Female</option>
<option value="other">Other</option>
</select>
<br>
<br>
</div>
<div class="form-group">
<label for="coverage" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Amount of Coverage:</label> <br>
<select id="coverage" name="coverage" required style="width: 900px; margin-left: 50px; height: 30px;"> <br>
<option value="">--Please select--</option>
<option value="50k">$50,000</option>
<option value="100k">$100,000</option>
<option value="250k">$250,000</option>
<option value="500k">$500,000</option>
<option value="1m">$1,000,000</option>
<option value="other">Other</option>
</select>
<br> <br>
</div>
<div class="form-group">
<label for="term" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Term Length:</label> <br>
<select id="term" name="term" required style="width: 900px; margin-left: 50px; height: 30px;"> <br>
<option value="">--Please select--</option>
<option value="10y">10 years</option>
<option value="20y">20 years</option>
<option value="30y">30 years</option>
<option value="other">Other</option>
</select>
<br>
<br>
</div>
<div class="form-group">
<label for="smoker" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Do you smoke?</label>
<div class="radio-group" style="width: 900px; margin-left: 50px; height: 30px; margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">
<input type="radio" id="yes" name="smoker" value="yes" required >
<label for="yes" >Yes</label>
<input type="radio" id="no" name="smoker" value="no" required >
<label for="no" >No</label>
</div>
<br>
</div>
<div class="form-group" >
<label for="conditions" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Have you been diagnosed with any medical conditions in the past 5 years?</label> <br> <br>
<div class="radio-group" style="width: 900px; margin-left: 50px; height: 30px; ;">
<input type="radio" id="yes-conditions" name="conditions" value="yes" required >
<label for="yes-conditions" style="font-weight:bold ; font-size: 22px;margin-top: 20px;" >Yes</label>
<input type="radio" id="no-conditions" name="conditions" value="no" required >
<label for="no-conditions" style="font-weight:bold ; font-size: 22px;margin-top: 20px;">No</label>
</div>
</div>
<br>
<div class="form-group">
<label for="condition-description" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">If yes, please describe:</label> <br>
<textarea name="condition_description" rows="4" cols="50"style="width: 900px; margin-left: 50px; height: 30px;"></textarea>
</div>
<br>
<label for="adhar_card" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Upload your Aadhar Card</label> <br>
<input type="file" style="font-weight:700px ; font-size: 22px;margin-top: 20px; margin-left: 50px;">
<br>
<label for="pan_card" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px;">Upload your Pan Card</label> <br>
<input type="file" style="font-weight:700px ; font-size: 22px;margin-top: 20px; margin-left: 50px;">
<br>
<input type="submit" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px; color: #fff; background-color: #000000B3; border-radius: 5px; padding: 10px; margin-bottom: 40px; cursor: pointer;">
<!-- <input type="submit" onclick="href=""" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px; color: #fff; background-color: #000000B3; border-radius: 5px; padding: 10px; margin-bottom: 40px; cursor: pointer;"> -->
<a href="showdata.php" style="margin-left: 50px;font-weight:bold ; font-size: 22px;margin-top: 20px; color: #fff; background-color: #000000B3; border-radius: 5px; padding: 10px; margin-bottom: 40px; cursor: pointer; " id="helptext"> Enrolled People</a>
</div>
<footer>
<div class="logo1">
<img style="align-items: center;" src="Defender_logo.png">
</div>
<div class="section">
<a href="About_us.html" style="color: #9CA3AF; font-weight: bold; font-family: 30px;">About Us |</a>
<a href="connect_with_us.html"
style="color: #9CA3AF; font-weight: bold; font-family: 30px;">Helpdesk |</a>
<a href="#" style="color: #9CA3AF; font-weight: bold; font-family: 30px;">Terms & Conditions</a>
</div>
<small style="color: #9CA3AF;margin-left:520px ; padding-top: 50px;"> ©2023 Defender. All rights
reserved</small>
<p
style="color:white ; font-size: 18px ;word-spacing: 2px; margin-left: 455px;margin-top: 20px;margin-bottom: 15px;">
Website developed by Nirbhay & Kartik</p>
</footer>
</body>
</html>