{# UG Application Form - Nirmala College of Arts and Science #}
<html>
<head>
<style>
    body { font-family: 'Times New Roman', serif; color: black; font-size: 12px; margin: 0; padding: 0; }
    td { line-height: 18px; font-size: 12px; }
    table { border-collapse: collapse; }
    .section-header { text-align: center; font-weight: bold; padding: 6px 0; border: 1px solid black; }
    .field-row td { padding: 4px 10px; }
    .lbl { width: 38%; }
    .sep { width: 3%; }
    .val { width: 59%; }
</style>
</head>
<body class='page'>
<div class='sub-page'>

    <!-- College Header Banner -->
    <div style="text-align:center; margin-bottom: 0;">
        <img src="{{college.url}}/libcommon/images/college/{{college.collegeCode}}/banner.png" style="width:100%; display:block;" alt="College Banner"/>
    </div>

    <!-- Form Title -->
    <div style="text-align:center; padding: 4px 0 6px 0;">
        <strong style="font-size:14px;">{{form.name}}</strong>
    </div>

    <!-- Application No & Course Preferences -->
    <table width="100%" style="padding: 0; margin-bottom: 4px;">
        <tr>
            <td style="padding: 2px 10px;">
                <strong>Application No &nbsp;&nbsp;&nbsp;:</strong>&nbsp;&nbsp;<strong>{{student.applicationNo}}</strong>
            </td>
        </tr>
        <tr>
            <td style="padding: 2px 10px;">
                <strong>Course preferences :</strong>
                {% for pref in choices %}
                    <strong>{{ pref.patternCourseName|upper }}</strong>{% if not loop.last %}, {% endif %}
                {% endfor %}
            </td>
        </tr>
    </table>

    <!-- Personal Details + Photo -->
    <table width="100%" cellspacing="0" cellpadding="0">
        <tr>
            <td valign="top" style="padding: 5px;">
                <table width="100%">
                    <tr class="field-row">
                        <td class="lbl">Name of the Applicant</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.studentFirstName}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">CAP ID (if already obtained)</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.capIdIfAlreadyObtained}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Date of Birth</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.dateOfBirth|date("d/m/Y")}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Age</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.age}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Gender</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.gender|upper}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Religion</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.religion}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Student category</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.studentReservationId}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Nationality</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.commuCountry}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">State</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.commuState}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">District</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.commuDistrict}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Village</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.village}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Taluk</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.village1}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl" valign="top">Permanent Address</td>
                        <td class="sep" valign="top">:</td>
                        <td class="val">
                            {{student.commuAddressLine1}},<br/>
                            {{student.commuAddressLine2}}
                        </td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Pincode</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.pincode}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Mobile Number</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.studentMobile}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Email</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.studentEmail}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Aadhaar No</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.aadharNo}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Blood Group</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.bloodGroupId}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Annual Family Income</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.annualFamilyIncome}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Weightage Quotas</td>
                        <td class="sep">:</td>
                        <td class="val">
                            {% for data in student.dataGridWeightageQuota %}
                                {{ data.weightageQuota.weightageName }}{% if not loop.last %}, {% endif %}
                            {% endfor %}
                        </td>
                    </tr>
                </table>
            </td>
            <!-- Photo Box -->
            <td valign="top" style="width:105px; text-align:center; padding:5px;">
                <img src="{{student.studentPhoto}}" style="width:140px; height:160px; display:block; margin:0 auto;" alt="Photo"/>
            </td>
        </tr>
    </table>

    <!-- Parents Details -->
    <table width="100%" cellspacing="0" cellpadding="0" style="margin-top:6px;">
        <tr>
            <td class="section-header">Parents Details</td>
        </tr>
        <tr>
            <td style="padding: 5px;">
                <table width="100%">
                    <tr class="field-row">
                        <td class="lbl">Father's Name</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.fatherSalutation|upper}} {{student.fatherName}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Father's Occupation</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.fatherOccupation}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Father's Mobile No</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.fatherMobileNo}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Mother's Name</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.fatherSalutation1|upper}} {{student.motherName}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Mother's Occupation</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.motherOccupation}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Mother's Mobile No</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.motherMobileNo}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Guardian Name</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.guardianName}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Relationship with Guardian</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.relationshipWithGuardian}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Guardian contact number</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.guardianMobileNo}}</td>
                    </tr>
                </table>
            </td>
        </tr>
    </table>

    <!-- Other Details -->
    <table width="100%" cellspacing="0" cellpadding="0" style="margin-top:6px;">
        <tr>
            <td class="section-header">Other Details</td>
        </tr>
        <tr>
            <td style="padding: 5px;">
                <table width="100%">
                    <tr class="field-row">
                        <td style="width:70%;">Are you physically handicapped?</td>
                        <td style="width:3%;">:</td>
                        <td style="width:27%;">{{student.areYouPhysicallyHandicapped}}</td>
                    </tr>
                    <tr class="field-row">
                        <td>Do you require hostel facility?</td>
                        <td>:</td>
                        <td>{{student.hostel}}</td>
                    </tr>
                    <tr class="field-row">
                        <td>Do you need college bus facility?</td>
                        <td>:</td>
                        <td>{{student.collegeBus}}</td>
                    </tr>
                    <tr class="field-row">
                        <td>Are any of your relatives a current/previous student/staff at Nirmala Institutions?</td>
                        <td>:</td>
                        <td>{{student.relativesACurrentPreviousStudentstaffAtNirmalaInstitutions}}</td>
                    </tr>
                </table>
            </td>
        </tr>
    </table>
    <br><br><br><br><br><br><br><br><br>
    <!-- 10th Details -->
    <table width="100%" cellspacing="0" cellpadding="0" style="margin-top:6px;">
        <tr>
            <td class="section-header">10th Details</td>
        </tr>
        <tr>
            <td style="padding: 5px;">
                <table width="100%">
                    <tr class="field-row">
                        <td class="lbl">10<sup>th</sup> Board</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.tenthBoardStream}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">10<sup>th</sup> Percentage</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.tenthPercentage}}</td>
                    </tr>
                </table>
            </td>
        </tr>
    </table>

    <!-- Plus Two Details -->
    <table width="100%" cellspacing="0" cellpadding="0" style="margin-top:6px;">
        <tr>
            <td class="section-header">Plus Two Details</td>
        </tr>
        <tr>
            <td style="padding: 5px;">
                <table width="100%">
                    <tr class="field-row">
                        <td class="lbl">Plus Two Board</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.twelfthBoardStream}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Plus Two Year of Passing</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.xIIYearOfPassing}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Plus Two Percentage</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.hssPercentage}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Plus Two School Name and Place</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.plusTwoSchoolNameAndPlace}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">Stream of Study</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.twelfthStream}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">TC Number</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.tcNumberAndDate}}</td>
                    </tr>
                    <tr class="field-row">
                        <td class="lbl">TC Date</td>
                        <td class="sep">:</td>
                        <td class="val">{{student.tcDate}}</td>
                    </tr>
                </table>
            </td>
        </tr>
    </table>

    <!-- Payment Details -->
    <table width="100%" cellspacing="0" cellpadding="0" style="margin-top:6px;">
        <tr>
            <td>
                <!-- Header Table -->
                <table width="100%" cellspacing="0" cellpadding="0">
                    <tr>
                        <td class="section-header">Payment Details</td>
                    </tr>
                </table>

                <!-- Data Table -->
                <table width="100%" style="border: 1px solid black; border-collapse: collapse;">
                    <tr style="background-color:#f0f0f0;">
                        <th style="padding:6px; text-align:center; width:25%; border: 1px solid black;">Payment Receipt No.</th>
                        <th style="padding:6px; text-align:center; width:25%; border: 1px solid black;">Application No.</th>
                        <th style="padding:6px; text-align:center; width:25%; border: 1px solid black;">Application Fee Paid</th>
                         <th style="padding:6px; text-align:center; width:25%; border: 1px solid black;">Transaction ID </th>
                          <th style="padding:6px; text-align:center; width:25%; border: 1px solid black;">Transaction Date</th>
                        <th style="padding:6px; text-align:center; width:25%; border: 1px solid black;">Status</th>
                    </tr>
                    <tr>
                        <td style="padding:6px; text-align:center; border: 1px solid black;">{{student.applicationFeeReceiptNo}}</td>
                        <td style="padding:6px; text-align:center; border: 1px solid black;">{{student.applicationNo}}</td>
                        <td style="padding:6px; text-align:center; border: 1px solid black;">{{student.applicationFeeAmount}}</td>
                        <td style="padding:6px; text-align:center; border: 1px solid black;">{% if student.payment_method == 'CHEQUE' %}{{student.checkNo}}
                                    {% elseif student.payment_method == 'NEFT' %}{{student.offlineReceiptNo}}
                                    {% elseif student.payment_method == 'DD' %}{{student.ddNumber}}
                                    {% elseif student.payment_method == 'ONLINE' %}{{student.clnt_txn_ref}}
                                    {% elseif student.payment_method == 'CASH' %}{{student.offlinePaymentRemarks}}
                                    {% endif %}</td>
                        <td style="padding:6px; text-align:center; border: 1px solid black;">{{student.verifiedTime}}</td>
                        <td style="padding:6px; text-align:center; border: 1px solid black;">{{student.payment_status}}</td>
                    </tr>
                </table>
            </td>
        </tr>
    </table>
    <br><br><br><br><br><br>
    <table>
        <tr class="field-row">
            <td class=""><b>Applied Date</b></td>
            <td class=""><b>:</b></td>
            <td class=""><b>{{student.verifiedTime}}</b></td>
        </tr>
    </table>
</div>
</body>
</html>
