<div class="row">
  <div class="col-lg-12 mt-4">
    <div class="card">
      <div class="card-header form-card-header">
        <h4 class="m-b-0 text-light">ADD GOVERNMENT NOMINEE</h4>
      </div>
      <div class="card-body">
        <form id="add_nominee" class="form-material">
          <div class="form-body">
            <div class="row">
              <div class="col-md-12">
                <div class="form-group">
                  <label class="control-label"><strong>NAME <span>*</span></strong></label>
                  <input type="text" id="name" name="name" class="form-control"  autocomplete="off" maxlength="255" required="">
                  <label for="name" class="error"></label> 
                </div>
              </div>

              <div class="col-md-12">
                <div class="form-group">
                  <label class="control-label"><strong>DESIGNATION <span>*</span></strong></label>
                  <input type="text" id="designation" name="designation" class="form-control"  autocomplete="off" maxlength="100" required="">
                  <label for="designation" class="error"></label> 
                </div>
              </div>

              <div class="col-md-12">
                <div class="form-group">
                  <label class="control-label"><strong>ORGANISATION <span>*</span></strong></label>
                  <input type="text" id="organisation" name="organisation" class="form-control"  autocomplete="off" maxlength="100" required="">
                  <label for="organisation" class="error"></label> 
                </div>
              </div>

              <div class="col-md-12">
                <div class="form-group">
                  <label class="control-label"><strong>ADDRESS <span>*</span></strong></label>
                  <textarea id="address" name="address" class="form-control"  autocomplete="off" maxlength="500" rows="3" required=""></textarea>
                  <label for="address" class="error"></label> 
                </div>
              </div>

             <div class="col-md-6">
                <div class="form-group">
                  <label class="control-label"><strong>EMAIL <span>*</span></strong></label>
                  <input type="email" id="email_1" name="email_1" class="form-control"  autocomplete="off" maxlength="255" required="">
                  <label for="email_1" class="error"></label> 
                </div>
              </div>
              
              <div class="col-md-6">
                <div class="form-group">
                  <label class="control-label"><strong>OFFICE NO <span>*</span></strong></label>
                  <input type="text" id="office_number" name="office_number" class="form-control"  autocomplete="off" maxlength="100"  required="">
                  <label for="office_number" class="error"></label> 
                </div>
              </div>
              
              <div class="col-md-6">
                <div class="form-group">
                  <label class="control-label"><strong>FAX NO. </strong></label>
                  <input type="text" id="fax" name="fax" class="form-control"  autocomplete="off" maxlength="100">
                  <label for="fax" class="error"></label> 
                </div>
              </div>
              
               <div class="col-md-6">
                <div class="form-group">
                  <label class="control-label"><strong>MOBILE NO. </strong></label>
                  <input type="number" id="mobile" name="mobile" class="form-control"  autocomplete="off" maxlength="100">
                  <label for="mobile" class="error"></label> 
                </div>
              </div>

              <div class="col-md-12">
                <div class="form-group">
                  <label class="control-label"><strong>UPLOAD IMAGE</strong></label>
                  <input type="file" name="image" id="image" class="form-control"  autocomplete="off" maxlength="100"/>
                  <label> Note : image size ( 250 x 250 pixels )</label>
                  <label for="image" class="error"></label> 
                </div>
              </div>
            </div>
          </div>

          <div class="form-actions">
            <button type="submit" class="btn btn-rounded btn-outline-success col-md-3">SAVE</button>  
            <button type="button" class="btn btn-rounded btn-outline-danger col-md-3" onclick="window.location.href='<?php echo base_url(); ?>nominees/list'">CANCEL</button>  
          </div>
        </form>
      </div>
    </div>
  </div>
</div>