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chromium / chromium / src / d60317bbdadd68d3e636cc03a11c321737fdf7e2 / . / components / test / data / autofill / heuristics / input / 153_fmm-en_inm.gob.mx.html
blob: 09ff1bc34b110323599c30d20d3d36d65ac0e4df [file] [log] [blame]
<html lang="en">
<!-- Form Location: https://www.inm.gob.mx/fmme/publico/en/solicitud.html -->
<head>
<meta charset="utf-8" />
<title>Instituto Nacional de Migración - Forma Migratoria Múltiple</title>
</head>
<body>
<form class="clearfix ns_" action="" role="form">
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer">Entry Information</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="internacion">Means of entry</label>
<select class=" form-control valid-field ns_" id="internacion">
<option value="0">Select</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="puntoInternacion">Point of entry</label>
<select class=" form-control valid-field ns_" id="puntoInternacion">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="fechaLlegada" class="control-label">Date of arrival to Mexico</label>
<input id="fechaLlegada" name="fechaLlegada" type="text" class="form-control valid-field ns_" placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="fechaSalida" class="control-label">Date of departure</label>
<input id="fechaSalida" name="fechaSalida" type="text" class="form-control valid-field ns_" placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
<div id="aerolinea">
<div class="col-md-4">
<div class="form-group">
<label class="control-label " for="nombreAerolinea">Airline name</label>
<input class=" form-control valid-field ns_" id="nombreAerolinea" type="text" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="numeroVuelo">Flight number</label>
<input class=" form-control valid-field ns_" id="numeroVuelo" type="text" />
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer">Personal information</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="nombre">Name(s)</label>
<input class=" form-control valid-field ns_" id="nombre" type="text" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="apellidos">Surname(s)</label>
<input class=" form-control valid-field ns_" id="apellidos" type="text" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="sexo">Gender</label>
<select class=" form-control valid-field ns_" id="sexo">
<option value="0">Select one</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="fechaNacimiento" class="control-label">Date of birth</label>
<input id="fechaNacimiento" name="fechaNacimiento" type="text" class="form-control valid-field" placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="nacionalidad">Nationality (Country)</label>
<select class=" form-control valid-field ns_" id="nacionalidad">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="paisNacimiento">Country of birth</label>
<select class=" form-control valid-field" id="paisNacimiento">
<option value="0">Select one</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer">Identification document</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="tipoDocumento">Type of document</label>
<select class=" form-control valid-field ns_" id="tipoDocumento">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="numeroDocumento">Document number</label>
<input class=" form-control valid-field ns_" id="numeroDocumento" type="text" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="confirmarNumeroDocumento">Document number (Confirmation)</label>
<input class=" form-control valid-field ns_" id="confirmarNumeroDocumento" type="text" />
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="paisExpedicion">Country of issue</label>
<select class=" form-control valid-field ns_" id="paisExpedicion">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="fechaExpedicion" class="control-label">Date of issue</label>
<input id="fechaExpedicion" name="fechaExpedicion" type="text" class="form-control valid-field ns_"
placeholder="dd/mm/yyyy o ddmmyy" />
<a id="focoFuera" href="#"></a>
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="confirmarFechaExpedicion" class="control-label">Date of issue (Confirmation)</label>
<input id="confirmarFechaExpedicion" name="confirmarFechaExpedicion" type="text" class="form-control valid-field ns_"
placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="fechaExpiracion" class="control-label">Expiration date</label>
<input id="fechaExpiracion" name="fechaExpiracion" type="text" class="form-control valid-field ns_"
placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="confirmarFechaExpiracion" class="control-label">Expiration date (Confirmation)</label>
<input id="confirmarFechaExpiracion" name="confirmarFechaExpiracion" type="text" class="form-control valid-field ns_"
placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
</div>
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer"> Place of residence</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="paisResidencia">Country of residence</label>
<select class=" form-control valid-field ns_" id="paisResidencia">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="direccionResidencia">Address of residence</label>
<input class=" form-control valid-field ns_" id="direccionResidencia" type="text" />
</div>
</div>
</div>
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer">Trip information</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label " for="motivoViaje">Reason of trip</label>
<select class=" form-control valid-field ns_" id="motivoViaje">
<option value="0">Select one</option>
</select> <a href="#"></a>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="especifiqueMotivo">Specify</label>
<select class=" form-control valid-field ns_" id="especifiqueMotivo">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="estadoDestino">State</label>
<select class=" form-control valid-field ns_" id="estadoDestino">
<option value="0">Select one</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="domicilioMexico">Address in Mexico</label>
<input class=" form-control valid-field ns_" id="domicilioMexico" placeholder="Hotel name, street and number"
type="text" />
</div>
</div>
</div>
<div id="informacionTutor" style="display:none">
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer">Father, mother or guardian information</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="nombreTutor">Name(s)</label>
<input class="form-control valid-field ns_" id="nombreTutor" type="text" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="apellidosTutor">Surname(s)</label>
<input class=" form-control valid-field ns_" id="apellidosTutor" type="text" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="sexoTutor">Gender</label>
<select class=" form-control valid-field ns_" id="sexoTutor">
<option value="0">Select one</option>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group datepicker-group">
<label for="fechaNacimientoTutor" class="control-label">Date of birth</label>
<input id="fechaNacimientoTutor" name="fechaNacimientoTutor" type="text" class="form-control valid-field ns_"
placeholder="dd/mm/yyyy o ddmmyy" />
<span class="glyphicon glyphicon-calendar" aria-hidden="true"></span>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="nacionalidadTutor">Nationality (Country)</label>
<select class=" form-control valid-field ns_" id="nacionalidadTutor">
<option value="0">Select one</option>
</select>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="paisNacimientoTutor">Country of birth</label>
<select class=" form-control valid-field ns_" id="paisNacimientoTutor">
<option value="0">Select one</option>
</select>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-8">
<h2 class="top-buffer">Email</h2>
<hr class="red" />
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="correoElectronico">Email</label>
<input class=" form-control valid-field ns_" id="correoElectronico" type="text" placeholder="johndoe@example.com" />
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label class="control-label" for="confirmacionCorreoElectronico">Email (Confirmation)</label>
<input class=" form-control valid-field ns_" id="confirmacionCorreoElectronico" placeholder="johndoe@example.com"
type="text" />
</div>
</div>
</div>
<div class="row">
<div class="col-md-8 col-md-offset-4">
<br>
</div>
</div>
<!--captcha-->
<div class="row">
<div class="col-md-4">
<div class="form-group" style="outline: 1pt solid lightgray">
<div style="width: 200px; height: 70px" id="imagenCaptcha"><img src="" /></div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="captcha" class="control-label">Verification code:</label>
<input id="captcha" type="text" class="valid-field form-control ns_" />
</div>
</div>
</div>
<div class="row bottom-buffer">
<div class="col-md-8">
<div class="form-group">
<label id="noLegibleLabel" class="control-label">
Not readable verification code?
<a id="otraImagen" class="liga ns_" href="#" onclick="uid_call('inm.fmme.obtener_captacha', 'clickin')">Try
another one</a>
</label>
</div>
</div>
</div>
<!--diálogo con mensajes sobre resultados de acciones -->
<div id="avisoDialog" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true">
<div class="modal-dialog">
<div class="modal-content">
<div class="modal-header">
<h3 class="modal-title"><span class="glyphicon glyphicon-warning-sign"></span>&nbsp;&nbsp;Notification</h3>
</div>
<div class="modal-body">
<p class="text-left" id="avisoDialog_texto">
<!-- texto generado automagicamente -->
</p>
</div>
<div class="modal-footer">
<button type="button" id="avisoDialog_cerrar" class="btn btn-default ns_">Close
</button>
</div>
</div>
</div>
</div>
<!-- Fin Dialogos -->
<div class="bottom-buffer" id="botonesGuardar">
<div class="row">
<div class="col-md-4" style="padding-top: 10px;">
<div class="pull-left text-muted">* Required fields</div>
</div>
<div class="col-md-8 text-right">
<button type="button" id="limpiar" class="btn btn-default ns_">Delete</button>
<button type="button" id="procesar" class="btn btn-primary ns_">Save</button>
</div>
</div>
</div>
<div id="confirmacionSolicitud" style="display:none">
<div class="alert alert-warning" id="informacionConfirmar">
<strong>Important:</strong> the migration authority cannot
modify the information provided by the user; therefore,
the documents that contain inaccurate data will be refused.
Errors in the resolution and expedition of the migratory
forms that result from errors in the application, are
the users responsibility.
</div>
<div class="row">
<div class="col-md-8 col-md-offset-4">
<hr>
</div>
</div>
<div class="alert alert-info text-center">
<p>Is the provided information correct?</p>
</div>
<div class="bottom-buffer">
<div class="bottom-buffer" align="right" id="botonesConfirmar">
<button id="regresar" type="button" class="btn btn-default ns_">No</button>
<button id="confirmar" type="button" class="btn btn-primary ns_">Yes</button>
</div>
</div>
<div class="alert alert-info text-center top-buffer">
<p>To generate your request disable pop-up blocker
browser and check to have installed Acrobat Reader.</p>
</div>
</div>
<div id="solicitudPdf" style="display:none">
<div id="fmmPdf">
</div>
</div>
</form>
<form role="form" action="https://www.banjercito.com.mx/formaMigratoriaMultiple/condicionesGenerales.do" method="POST"
class="ns_">
<div style="display:none">
<div class="form-group" id="div_idioma">
<label class="ccontrol-label" for="idioma">Idioma: </label>
<input class="form-control ns_" id="idioma" name="idioma" type="text" readonly value="es">
</div>
<div class="form-group" id="div_noConsecutivoInterno">
<label class="control-label" for="noConsecutivoInterno">Consecutivo: </label>
<input class="form-control ns_" id="noConsecutivoInterno" name="noConsecutivoInterno" type="text" readonly>
</div>
<div class="form-group" id="div_pagoNumeroPasaporte">
<label class="control-label" for="pagoNumeroPasaporte">Número de pasaporte: </label>
<input maxlength="15" class="form-control ns_" id="pagoNumeroPasaporte" name="numero_pasaporte" type="text"
readonly>
</div>
<div class="form-group" id="div_pagoNombres">
<label class="control-label" for="pagoNombres">Nombre(s): </label>
<input class="form-control ns_" id="pagoNombres" name="nombres" type="text" readonly>
</div>
<div class="form-group" id="div_pagoApellidos">
<label class="control-label" for="pagoApellidos">Apellido(s): </label>
<input class="form-control ns_" id="pagoApellidos" name="apellidos" type="text" readonly>
</div>
<div class="form-group" id="div_pagoNacionalidad">
<label class="control-label" for="pagoNacionalidad">Nacionalidad:</label>
<input class="form-control ns_" id="pagoNacionalidad" name="nacionalidad" type="text" readonly>
</div>
<div class="form-group" id="div_pagoFechaNacimiento">
<label class="control-label" for="pagoFechaNacimiento">Fecha de nacimiento: </label>
<input maxlength="10" class="form-control ns_" id="pagoFechaNacimiento" name="fecha_nacimiento" type="text"
readonly>
</div>
<div class="form-group" id="div_sexo_pago">
<label class="control-label" for="sexo_pago">Sexo:</label>
<input class="form-control ns_" id="sexo_pago" type="text" readonly>
</div>
<div class="form-group" id="div_pagoSexo">
<label class="control-label" for="pagoSexo">Sexo:</label>
<input maxlength="1" class="form-control ns_" id="pagoSexo" name="sexo" type="text" readonly>
</div>
<div class="form-group" id="div_monto_tramite">
<label class="control-label" for="monto_tramite">Monto trámite: </label>
<input class="form-control ns_" id="monto_tramite" name="monto_tramite" type="text" value="558.00" readonly>
</div>
<div class="form-group" id="div_concepto_tramite">
<label class="control-label" for="concepto_tramite">Concepto trámite: </label>
<input class="form-control ns_" id="concepto_tramite" name="concepto_tramite" type="text" readonly>
</div>
<div class="form-group" id="div_clave_tramite">
<label class="control-label" for="clave_tramite">Clave trámite: </label>
<input class="form-control ns_" id="clave_tramite" name="clave_tramite" type="text" readonly>
</div>
</div>
<div class="text-right bottom-buffer" id="div_cont_pago">
<button id="realizaPago" type="submit" class="btn btn-primary btn-sm ns_">Send the information</button>
</div>
</form>
</body>
</html>