<script type="text/javascript" src="<?php echo base_url();?>assets/js/ubayam.js"></script>
<aside class="right-side">
    <section class="content-header">
        <div class="title_bar">
            <h1 class="major_txt_color">Ubayam Add</h1>
            <div class="breadcrumb_container"><?php echo breadcrumb_links();?></div>
        </div>
    </section>
    <section class="content">
        <div class="row" id="main-content">
            <div class="col-xs-12">
                <form action="<?php echo $form_action;?>" method="post" name="ubayam_form" enctype="multipart/form-data" method="post">    
                    <input type="hidden" name="hidden_id" value="" />    
                    <div class="box box-danger">
                        <div class="box-body">
                            <ul class="error_container"></ul>
                            <div class="col-xs-12">
                                <div class="col-md-6">
                                    <div class="form-group float-clear">
                                        <label>Ubayakarar's Name<span class="required">*</span></label>
                                        <input type="text" class="form-control" name="name" placeholder="Ubayakarar's Name" autofocus />
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>Sanctum Name<span class="required">*</span></label>
                                        <input type="text" class="form-control" name="sanctum_name" placeholder="Sanctum Name" />
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>Ubayam Name<span class="required">*</span></label>
                                        <input type="text" class="form-control" name="ubayam_name" placeholder="Ubayam Name" />
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>No of Years<span class="required">*</span></label>
                                        <input type="text" class="form-control" name="no_of_yrs" placeholder="No of Years" />
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>Class</label>
                                        <select name="class" class="form-control select2 class">
                                            <option value="">Select Class</option>
                                            <option value="Morning">Morning</option>
                                            <option value="Evening">Evening</option>
                                        </select>
                                    </div>
                                    
                                    <div class="form-group float-clear">
                                        <label>Ubayam Amount<span class="required">*</span></label>
                                        <div class="input-group">
                                            <div class="input-group-addon">$</div>
                                            <input type="text" class="form-control float_value" name="ubayam_amount" placeholder="Ubayam Amount" />
                                        </div>
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>Email</label>
                                        <input type="text" class="form-control" name="email" placeholder="Email" />
                                    </div>
                                </div>
                                
                                <div class="col-md-6">
                                     <div class="form-group float-clear">
                                        <label>Ubayakarar's Name (T)</label>
                                        <div class="input-group">
                                            <input type="text" class="form-control tamil-name input-tamil" name="ubayakarar_tamil_name" placeholder="jkpH;bgah;" onclick="set_tamil_keypad(this);" />
                                            <div class="input-group-addon"><i class="fa fa-keyboard-o"></i></div>
                                        </div>
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>Sanctum Name (T)</label>
                                        <div class="input-group">
                                            <input type="text" class="form-control tamil-name input-tamil" name="sanctum_tamil_name" placeholder="jkpH;bgah;" onclick="set_tamil_keypad(this);" />
                                            <div class="input-group-addon"><i class="fa fa-keyboard-o"></i></div>
                                        </div>
                                    </div>
                                    <div class="form-group float-clear">
                                        <label>Ubayam Name (T)</label>
                                        <div class="input-group">
                                            <input type="text" class="form-control tamil-name input-tamil" name="ubayam_tamil_name" placeholder="jkpH;bgah;" onclick="set_tamil_keypad(this);" />
                                            <div class="input-group-addon"><i class="fa fa-keyboard-o"></i></div>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group float-clear">
                                        <label>Contact No<span class="required">*</span></label>
                                        <input type="text" class="form-control" name="phone_no" placeholder="Contact No" />
                                    </div>
                                    
                                    <div class="form-group float-clear">
                                        <label>Address</label>
                                        <textarea type="text" class="form-control" name="address"></textarea>
                                    </div>
                                    
                                    <!--<div class="form-group float-clear">
                                        <label>BLK</label>
                                        <input type="text" class="form-control" name="blk" placeholder="BLK" />
                                    </div>
                                    
                                    <div class="form-group float-clear">
                                        <label>Unit No</label>
                                        <input type="text" class="form-control" name="unit_no" placeholder="Unit No" />
                                    </div>-->
                                    
                                    <div class="form-group">
                                        <label class="leftcol">Status</label>
                                        <div>
                                            <label for="status" style="width: 32%;"><input type="radio" name="status" value="1" checked/> &nbsp;&nbsp;Active</label> 
                                            <label for="status" style="width: 32%;"><input type="radio" name="status" value="0" /> &nbsp;&nbsp;Inactive</label> 
                                        </div>
                                    </div>
                                    
                                   
                                </div>
                            </div>
                        </div>
                        
                        <div class="box-footer form-actions float-clear">
                            <input class="btn reset" type="reset" value="Reset" />
                            <input type="submit" name="submit" value="Save" class="btn btn-success btn-primary" />
                        </div>
                    </div><!-- /.box -->
                </form>
            </div><!-- /.col-xs-12 -->
        </div><!-- /.row -->
    </section><!-- /.content -->
</aside>