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Server : Apache/2.2.2 (Fedora) System : Linux App1.pathumtani.go.th 2.6.20-1.2320.fc5smp #1 SMP Tue Jun 12 19:40:16 EDT 2007 i686 User : apache ( 48) PHP Version : 5.2.9 Disable Function : NONE Directory : /var/www/html/pathumthani_eoffice/application/CA/ |
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<?
@session_start() ;
require_once "config/config.ini.php";
require_once "common/database.class.php";
?>
<html>
<head>
<title></title>
<META http-equiv=Content-Type content="text/html; charset=windows-874">
<style>
.preload{
border: 1px solid #999;
margin: 0px;
position:relative;
color: #000;
background-color: #EFECFF;
padding-right: 5px;
padding-left: 5px;
padding-top: 2px;
padding-bottom: 2px;
}
.input{
bo
border-bottom-width: 1px;
border-top-style: none;
border-right-style: none;
border-bottom-style: none;
border-left-style: none;
border-bottom-color: #000;
font-weight: normal;
font-family: Verdana, Geneva, sans-serif;
float: left;
height: 12px;
background-image: url(../../images_sys/dot1.jpg);
background-repeat: repeat-x;
border-top-color: #000;
border-right-color: #000;
border-left-color: #000;
background-position: 0px 19px;
}
</style>
<?
//$db = new database();
//$x=$db->connect();
?>
<style type="text/css">
<!--
body {
margin-left: 0px;
margin-top: 0px;
margin-right: 0px;
margin-bottom: 0px;
}
.comment{
color:#F00;
}
INPUT{
FONT-SIZE: 12px; FONT-FAMILY: Tahoma, "Microsoft Sans ";
}
-->
</style>
<link href="css/style.css" rel="stylesheet" type="text/css">
<style type="text/css">
<!--
body,td,th {
font-size: 11px;
}
-->
</style>
</head>
<script>
var PrintCommandObject = null;
function printPage(){
if(PrintCommandObject)
{
try{
PrintCommandObject.ExecWB(7, 2);
PrintCommandObject.outerHTML = "";
}
catch(e){
window.print();
}
}
else{
window.print();
}
}
window.onload = function(){
if (navigator.appName == "Microsoft Internet Explorer"){
// attach and initialize print command ActiveX object
try{
var PrintCommand = '<object id="PrintCommandObject" classid="CLSID:8856F961-340A-11D0-A96B-00C04FD705A2" width="0" height="0"></object>';
document.body.insertAdjacentHTML('beforeEnd', PrintCommand);
}
catch(e){}
}
setTimeout(printPage, 1);
};
</script>
<body>
<table width="700" border="0" align="center" cellpadding="10" cellspacing="0">
<tr>
<td align="center">
<?php
$CA_SN=base64_decode($xrnd);
/*if($xfromaction=="new"){
$strSQL="SELECT * FROM member where serial_number='$CA_SN'";
$result=mysql_query($strSQL);
$rowx=mysql_fetch_assoc($result);
$xmember_id=$rowx[member_id];
$xprename=$rowx[prename];
$xfname=$rowx[fname];
$xlname=$rowx[sname];
$xemail=$rowx[email];
//echo "$xlname";
}elseif($xfromaction=="edit"){
$strSQL="SELECT * from `ca_member` WHERE id ='$mid' limit 1";
$result=mysql_query($strSQL);
$row=mysql_fetch_assoc($result);
}elseif($xfromaction=="renew"){
$strSQL="SELECT * from `ca_member` WHERE serial_number ='$CA_SN' order by date_req desc limit 1";
$result=mysql_query($strSQL);
$row=mysql_fetch_assoc($result);
}*/
//echo "<pre>"; print_r($row); echo "</pre>";
?>
<form action="" method="post" name="frm1" onSubmit= "return ValidateDoc()">
<table width="100%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td colspan="4"><div class="mainlevel"><strong>คำขอใช้บริการใบรับรองอิเล็กทรอนิกส์ / แบบฟอร์มการสมัคร</strong> </div></td>
</tr>
<tr>
<td colspan="4" align="right">
<nobr>
<input name="sign_type" id="new_member_type" type="checkbox" value="1" >
สมัครใหม่
<input name="sign_type" id="continue_member_type" type="checkbox" value="2" >
ต่ออายุ </td>
</tr>
<tr id="serail_number_tbl" >
<td colspan="4" align="right">SERAIL NUMBER....<?=$CA_SN?>................ </td>
</tr>
<tr>
<td colspan="4" align="left" bgcolor="#CCCCCC" height="15px"><strong>ข้อมูลองค์กร</strong></td>
</tr>
<tr>
<td width="30" height="25" align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>ชื่อส่วนราชการ</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>กระทรวง</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>กรม</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>โทรศัพท์</strong><div class="input"></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>โทรศัพท์มือถือ</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>โทรสาร</strong></td>
</tr>
<tr>
<td colspan="4" align="left"></td>
</tr>
<tr>
<td colspan="4" align="left" bgcolor="#CCCCCC"><strong>ผู้ขอใช้บริการใบรับรองอิเล็กทรอนิกส์ </strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>คำนำหน้าชื่อ</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>ชื่อ</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>นามสกุล</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>PRENAME</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>NAME</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>SURNAME</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>อีเมล์</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>วันเดือนปีเกิด </strong></td>
<?
/* if($row[ps_birth_date]){
$d=explode("-",$row[ps_birth_date]);
$birth_date=$d[2]."/".$d[1]."/".($d[0]+543);
}*/
?>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>เชื้อชาติ</strong><div class="input"></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>สัญชาติ</strong></td>
</tr>
<tr >
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top"><strong>
<input name="new_member_type" id="new_member_type2" type="checkbox" value="1" >
</strong>บัตรประจำตัวประชาชน<strong>
<input name="new_member_type2" id="new_member_type3" type="checkbox" value="1" >
</strong>บัตรข้าราชการ</td>
</tr>
<tr id="PIN_card_tbl" >
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>เลขบัตร</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>โทรศัพท์</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>โทรศัพท์มือถือ</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>โทรสาร</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>ที่อยู่</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>ซอย</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>ถนน</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>หมู่บ้าน</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>ตำบล</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>อำเภอ</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>จังหวัด</strong></td>
</tr>
<tr>
<td align="left" valign="top"></td>
<td colspan="3" align="left" valign="top" class="input"><strong>รหัสไปรณีย์</strong></td>
</tr>
<tr>
<td colspan="4" align="left" bgcolor="#999999"><strong>สำหรับแจ้งผลการอนุมัติใบรับรองอิเล็กทรอนิกส์ </strong></td>
</tr>
<tr>
<td colspan="4" align="left" valign="top">
<input name="req_email" type="checkbox" id="req_email"
<?=$row[req_email]?"checked": "" ?> value="1" >
<strong>แจ้งผลการอนุมัติทางอีเมล์............................................................................................................................</strong></td>
</tr>
<tr>
<td colspan="4" align="left">
<input name="req_phone" type="checkbox" id="req_phone" <?=$row[req_phone]?"checked": "" ?> >
<strong>แจ้งผลการอนุมัติทางโทรศัพท์......................................................................................................................</strong></td>
</tr>
<tr>
<td colspan="4" align="left">
<input name="req_fax" type="checkbox" id="req_fax" value="1" <?=$row[req_fax]?"checked": "" ?> >
<strong>แจ้งผลการอนุมัติทางโทรสา์ร.......................................................................................................................</strong></td>
</tr>
<tr>
<td colspan="4" align="left">
<input name="req_add" type="checkbox" id="req_add" value="1" <?=$row[req_add]?"checked": "" ?> >
<strong>แจ้งผลการอนุมัติทางที่อยู่...........................................................................................................................</strong></td>
</tr>
<tr>
<td colspan="4" align="right"><em style="font-size:14px">*สำหรับการแจ้งผลการอนุมัติใบรับรองอิเล็กทรอนิกส์ ถ้าไม่ระบุข้อความจะใช้ข้อมูลผู้ขอใช้บริการใบรับรองอิเล็กทรอนิกส์ข้างบน</em><strong> </strong></td>
</tr>
<tr>
<td align="right"></td>
<td width="513" align="right"></td>
<td width="254" colspan="2">
</td>
</tr>
<tr>
<td colspan="4" align="center"></td>
</tr>
</table>
</form>
</td>
</tr>
</table>
</body>
</html>