{"id":7314,"date":"2025-11-21T15:40:57","date_gmt":"2025-11-21T07:40:57","guid":{"rendered":"https:\/\/louisthai.com\/?page_id=7314"},"modified":"2026-01-15T09:42:50","modified_gmt":"2026-01-15T01:42:50","slug":"client-registration-application","status":"publish","type":"page","link":"https:\/\/louisthai.com\/hk\/client-registration-application\/","title":{"rendered":"Client Registration Application"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"7314\" class=\"elementor elementor-7314\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-34cf33a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"34cf33a\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d39f45e\" data-id=\"d39f45e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-49120d8 elementor-widget elementor-widget-shortcode\" data-id=\"49120d8\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style>\n    #lt-register-wrapper-id {\n        --lt-ink: #111827;\n        --lt-sub: #6b7280;\n        --lt-line: #e5e7eb;\n        --lt-bg: #f3f4f6;\n        --lt-card: #ffffff;\n        --lt-accent: #111827;\n        --lt-accent-soft: #e5e7ff;\n    }\n\n    #lt-register-wrapper-id {\n        box-sizing: border-box;\n        font: 16px\/1.5 -apple-system, BlinkMacSystemFont, \"Segoe UI\", Roboto, Helvetica, Arial, sans-serif !important;\n        background: var(--lt-bg) !important;\n        color: var(--lt-ink) !important;\n        width: 100% !important;\n        max-width: 100% !important;\n        line-height: 1.5 !important;\n    }\n\n    #lt-register-wrapper-id * {\n        box-sizing: border-box;\n    }\n\n    #lt-register-wrapper-id header {\n        position: sticky;\n        top: 0;\n        z-index: 20;\n        backdrop-filter: blur(16px);\n        background: rgba(243, 244, 246, .92) !important;\n        border-bottom: 1px solid var(--lt-line) !important;\n        margin: 0 !important;\n    }\n\n    #lt-register-wrapper-id header .bar {\n        max-width: 1040px;\n        margin: 0 auto;\n        padding: 10px 16px;\n        display: flex;\n        align-items: center;\n        justify-content: space-between;\n        gap: 12px;\n        flex-wrap: wrap;\n    }\n\n    #lt-register-wrapper-id header h1 {\n        margin: 0 !important;\n        font-size: 18px !important;\n        font-weight: 600 !important;\n        color: var(--lt-ink) !important;\n        line-height: 1.2 !important;\n    }\n\n    #lt-register-wrapper-id header .pill {\n        font-size: 12px !important;\n        padding: 4px 10px !important;\n        border-radius: 999px !important;\n        border: 1px solid var(--lt-line) !important;\n        color: var(--lt-sub) !important;\n        background: #fff !important;\n        white-space: nowrap;\n        display: inline-block;\n    }\n\n    #lt-register-wrapper-id main {\n        max-width: 1040px;\n        margin: 18px auto 90px !important;\n        padding: 0 16px 24px !important;\n    }\n\n    #lt-register-wrapper-id .card {\n        background: var(--lt-card) !important;\n        border-radius: 20px !important;\n        border: 1px solid var(--lt-line) !important;\n        padding: 18px 18px 20px !important;\n        margin-bottom: 16px !important;\n        box-shadow: 0 12px 30px rgba(15, 23, 42, .04) !important;\n    }\n\n    #lt-register-wrapper-id .card h2 {\n        margin: 0 0 10px !important;\n        font-size: 15px !important;\n        text-transform: none !important;\n        letter-spacing: .02em !important;\n        color: var(--lt-ink) !important;\n        line-height: 1.4 !important;\n    }\n\n    #lt-register-wrapper-id .muted {\n        color: var(--lt-sub) !important;\n        font-size: 12px !important;\n    }\n\n    #lt-register-wrapper-id label {\n        font-size: 13px !important;\n        display: block !important;\n        color: var(--lt-ink) !important;\n        margin-bottom: 4px !important;\n        font-weight: normal !important;\n    }\n\n    #lt-register-wrapper-id input:not([type=\"checkbox\"]):not([type=\"radio\"]),\n    #lt-register-wrapper-id select,\n    #lt-register-wrapper-id textarea {\n        width: 100% !important;\n        padding: 10px 11px !important;\n        border-radius: 12px !important;\n        border: 1px solid var(--lt-line) !important;\n        font-size: 14px !important;\n        font-family: inherit !important;\n        background: #fff !important;\n        color: var(--lt-ink) !important;\n        margin: 0 !important;\n        box-shadow: none !important;\n        height: auto !important;\n        min-height: 42px;\n    }\n\n    #lt-register-wrapper-id input:focus,\n    #lt-register-wrapper-id select:focus,\n    #lt-register-wrapper-id textarea:focus {\n        outline: 2px solid #111827 !important;\n        outline-offset: 1px !important;\n        border-color: #111827 !important;\n    }\n\n    #lt-register-wrapper-id input[type=\"checkbox\"],\n    #lt-register-wrapper-id input[type=\"radio\"] {\n        width: auto !important;\n        height: auto !important;\n        padding: 0 !important;\n        margin-right: 6px !important;\n        border-radius: 4px !important;\n        accent-color: var(--lt-accent) !important;\n        outline: none !important;\n        display: inline-block !important;\n        vertical-align: middle !important;\n        appearance: auto !important;\n        \/* Ensure native look is preserved but colored *\/\n    }\n\n    #lt-register-wrapper-id textarea {\n        resize: vertical;\n        min-height: 80px !important;\n    }\n\n    #lt-register-wrapper-id .row {\n        display: grid;\n        grid-template-columns: 1fr;\n        gap: 10px;\n        margin-top: 8px;\n    }\n\n    #lt-register-wrapper-id .row.two {\n        grid-template-columns: repeat(2, minmax(0, 1fr));\n    }\n\n    #lt-register-wrapper-id .row.three {\n        grid-template-columns: repeat(3, minmax(0, 1fr));\n    }\n\n    #lt-register-wrapper-id .inline {\n        display: flex;\n        align-items: center;\n        gap: 8px;\n        flex-wrap: wrap;\n    }\n\n    #lt-register-wrapper-id .inline label {\n        display: inline-flex;\n        align-items: center;\n        gap: 6px;\n        font-size: 13px !important;\n        margin-bottom: 0 !important;\n    }\n\n    #lt-register-wrapper-id .section-label {\n        font-size: 12px !important;\n        font-weight: 500 !important;\n        text-transform: uppercase !important;\n        letter-spacing: .12em !important;\n        color: var(--lt-sub) !important;\n        margin-bottom: 4px !important;\n    }\n\n    #lt-register-wrapper-id .check-grid {\n        display: grid;\n        grid-template-columns: repeat(3, minmax(0, 1fr));\n        gap: 6px 16px;\n        margin: 8px 0 6px;\n    }\n\n    #lt-register-wrapper-id .check-grid label {\n        display: inline-flex;\n        align-items: center;\n        gap: 4px;\n        font-size: 13px !important;\n        white-space: nowrap;\n        margin-bottom: 0 !important;\n    }\n\n    #lt-register-wrapper-id .issues-table {\n        width: 100%;\n        border-collapse: collapse;\n        margin-top: 8px;\n        font-size: 13px !important;\n    }\n\n    #lt-register-wrapper-id .issues-table th,\n    #lt-register-wrapper-id .issues-table td {\n        border: 1px solid var(--lt-line) !important;\n        padding: 6px 8px !important;\n        color: var(--lt-ink) !important;\n    }\n\n    #lt-register-wrapper-id .issues-table th {\n        background: #f9fafb !important;\n        font-weight: 600 !important;\n        text-align: left;\n    }\n\n    #lt-register-wrapper-id .issues-table th.small,\n    #lt-register-wrapper-id .issues-table td.small {\n        text-align: center;\n        width: 70px;\n    }\n\n    #lt-register-wrapper-id #gridWrap h2 {\n        margin-bottom: 4px !important;\n    }\n\n    #lt-register-wrapper-id .grid-note {\n        font-size: 12px !important;\n        color: var(--lt-sub) !important;\n        margin-bottom: 8px !important;\n    }\n\n    #lt-register-wrapper-id .grid-controls {\n        display: flex;\n        align-items: center;\n        justify-content: space-between;\n        gap: 8px;\n        flex-wrap: wrap;\n        margin-bottom: 8px;\n    }\n\n    #lt-register-wrapper-id .grid-controls select {\n        max-width: 180px;\n    }\n\n    #lt-register-wrapper-id .lt-grid {\n        width: 100%;\n        border-collapse: separate;\n        border-spacing: 8px;\n        table-layout: fixed;\n        margin: 0;\n    }\n\n    #lt-register-wrapper-id .lt-grid td {\n        padding: 0 !important;\n        border: none !important;\n    }\n\n    #lt-register-wrapper-id .cell {\n        position: relative;\n        width: 100%;\n        aspect-ratio: 1\/1;\n        border-radius: 12px !important;\n        border: 1px solid var(--lt-line) !important;\n        background: #f9fafb !important;\n        overflow: hidden;\n        display: block;\n    }\n\n    #lt-register-wrapper-id .cell input {\n        position: absolute;\n        inset: 0;\n        width: 100% !important;\n        height: 100% !important;\n        border: 0 !important;\n        background: transparent !important;\n        text-align: center !important;\n        font-size: 18px !important;\n        font-weight: 500 !important;\n        padding: 0 !important;\n        margin: 0 !important;\n        min-height: 0 !important;\n    }\n\n    #lt-register-wrapper-id .sum-row .cell {\n        background: #eef2ff !important;\n        border-color: #c7d2fe !important;\n        font-weight: 600 !important;\n    }\n\n    #lt-register-wrapper-id .seed-cell {\n        background: #e5f3ff !important;\n        border-color: #bfdbfe !important;\n    }\n\n    #lt-register-wrapper-id .table-d {\n        width: 100%;\n        border-collapse: collapse;\n        font-size: 13px !important;\n        margin-top: 8px;\n    }\n\n    #lt-register-wrapper-id .table-d th,\n    #lt-register-wrapper-id .table-d td {\n        border: 1px solid var(--lt-line) !important;\n        padding: 6px 8px !important;\n        vertical-align: top;\n        color: var(--lt-ink) !important;\n    }\n\n    #lt-register-wrapper-id .table-d th {\n        background: #f9fafb !important;\n        font-weight: 600 !important;\n        text-align: center;\n    }\n\n    #lt-register-wrapper-id .sig-grid {\n        display: grid;\n        grid-template-columns: 1fr;\n        gap: 16px;\n    }\n\n    @media (min-width:768px) {\n        #lt-register-wrapper-id .sig-grid {\n            grid-template-columns: repeat(2, minmax(0, 1fr));\n        }\n    }\n\n    #lt-register-wrapper-id .sig-box {\n        border: 1px solid var(--lt-line) !important;\n        border-radius: 16px !important;\n        padding: 10px 10px 12px !important;\n        background: #f9fafb !important;\n    }\n\n    #lt-register-wrapper-id .sig-box-title {\n        font-size: 13px !important;\n        font-weight: 600 !important;\n        margin-bottom: 6px !important;\n    }\n\n    #lt-register-wrapper-id canvas.sig-pad {\n        width: 100% !important;\n        height: 180px !important;\n        border-radius: 12px !important;\n        border: 1px solid var(--lt-line) !important;\n        background: #fff !important;\n        touch-action: none;\n        display: block;\n    }\n\n    #lt-register-wrapper-id .actions {\n        position: fixed;\n        bottom: 0;\n        left: 0;\n        right: 0;\n        background: rgba(243, 244, 246, .96) !important;\n        border-top: 1px solid var(--lt-line) !important;\n        padding: 10px 16px !important;\n        z-index: 30;\n    }\n\n    #lt-register-wrapper-id .actions .wrap {\n        max-width: 1040px;\n        margin: 0 auto;\n        display: flex;\n        gap: 8px;\n        justify-content: flex-end;\n        flex-wrap: wrap;\n    }\n\n    #lt-register-wrapper-id button {\n        appearance: none !important;\n        border-radius: 999px !important;\n        border: 1px solid var(--lt-line) !important;\n        background: var(--lt-accent) !important;\n        color: #fff !important;\n        font-size: 13px !important;\n        font-weight: 600 !important;\n        padding: 9px 14px !important;\n        cursor: pointer !important;\n        line-height: 1.5 !important;\n        text-decoration: none !important;\n        transition: opacity 0.2s;\n    }\n\n    #lt-register-wrapper-id button:hover {\n        opacity: 0.9;\n    }\n\n    #lt-register-wrapper-id button.secondary {\n        background: #fff !important;\n        color: var(--lt-ink) !important;\n    }\n\n    @media print {\n        #lt-register-wrapper-id .no-print {\n            display: none !important;\n        }\n\n        #lt-register-wrapper-id {\n            background: white !important;\n        }\n\n        #lt-register-wrapper-id .card {\n            box-shadow: none !important;\n            border: none !important;\n        }\n    }\n\n    #lt-register-wrapper-id .consult-inline {\n        display: flex;\n        gap: 8px;\n        align-items: center;\n    }\n\n    #lt-register-wrapper-id .consult-inline input[type=\"date\"],\n    #lt-register-wrapper-id .consult-inline input[type=\"time\"] {\n        flex: 1 1 0;\n        width: auto !important;\n        max-width: 100% !important;\n    }\n\n    #lt-register-wrapper-id .card-header-row {\n        display: flex;\n        justify-content: space-between;\n        align-items: flex-start;\n        flex-wrap: wrap;\n        gap: 16px;\n    }\n\n    #lt-register-wrapper-id .consult-box {\n        text-align: right;\n    }\n\n    #lt-register-wrapper-id .consult-box-title {\n        font-size: 12px !important;\n        font-weight: 500 !important;\n        color: var(--lt-sub) !important;\n        margin-bottom: 4px !important;\n        text-transform: uppercase !important;\n        letter-spacing: 0.05em !important;\n    }\n<\/style>\n\n<div id=\"lt-register-wrapper-id\" class=\"lt-register-wrapper\">\n    <div class=\"lt-registration-form-container\">\n        <header>\n            <div class=\"bar\">\n                <h1>E-Registration & Open Application Form<\/h1>\n                <span class=\"pill\">Auto-save \u00b7 Doc_No.A57 \u00b7 PDF export enabled<\/span>\n            <\/div>\n        <\/header>\n        <main id=\"capture\">\n            <!-- SECTION A: CLIENT INFO -->\n            <section class=\"card\" id=\"section-a\">\n                <div class=\"card-header-row\">\n                    <div>\n                        <div class=\"section-label\">SECTION A<\/div>\n                        <h2>Client Information<\/h2>\n                    <\/div>\n                    <div class=\"consult-box\">\n                        <div class=\"consult-box-title\">Consult Enquire<\/div>\n                        <div class=\"consult-inline\">\n                            <input type=\"date\" name=\"consult_enq_date\" \/>\n                            <input type=\"time\" name=\"consult_enq_time\" \/>\n                        <\/div>\n                    <\/div>\n                <\/div>\n\n                <p class=\"muted\">\n                    This document is valid for Malaysia local and International use. You hereby noticed and fully\n                    understanding of\n                    Unauthorized copying, downloading,\n                    modifying, reverse-engineering, distributing, or misusing any Company Assets is\n                    a serious violation of Malaysian law. Offenders may be liable under the Copyright\n                    Act 1987 and the Computer Crimes Act 1997, which impose substantial fines ranging\n                    from RM 10,000.00 to RM 200,000.00 per infringement, civil damages payable to the\n                    Company, and criminal penalties for unauthorized access, tampering, or data\n                    manipulation. Depending on the severity of the breach, individuals may face\n                    imprisonment of up to 10 years, and in cases involving digital circumvention,\n                    illegal access devices, or deliberate software manipulation, penalties may\n                    escalate to imprisonment of up to 20 years. The Company reserves full legal\n                    rights to investigate and pursue civil or criminal action without prior notice.\n                    This facility is a part of Property of LOUIS THAI INTERNATIONAL GROUP SDN BHD\n                    which is protecting and confidential legal document. &amp; Internal use only.\n                    @ All Right Reserve 2026 and beyond LOUIS THAI Group and its subsidaries.\n                <\/p>\n                <div class=\"row two\" style=\"margin-top:12px\">\n                    <div>\n                        <label>Gender<\/label>\n                        <div class=\"inline\">\n                            <label><input name=\"gender\" type=\"radio\" value=\"Male\" \/>Male<\/label>\n                            <label><input name=\"gender\" type=\"radio\" value=\"Female\" \/>Female<\/label>\n                            <label><input name=\"gender\" type=\"radio\" value=\"Unknowns\" \/>Unknowns<\/label>\n                        <\/div>\n                    <\/div>\n                    <div><\/div>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Date Of Birth (Birth Local Date)\n                        <input name=\"dob\" type=\"date\" \/>\n                    <\/label>\n                    <label>Time Of Birth (Birth Local Time)\n                        <input name=\"tob\" type=\"time\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Client Name (Nick Name + Full Name)\n                        <input name=\"client_name\" placeholder=\"Full name\" \/>\n                    <\/label>\n                    <label>Title\n                        <input name=\"title\" placeholder=\"Mr \/ Ms \/ Dr \u2026\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Region \/ Area\n                        <input name=\"region\" placeholder=\"e.g. Selangor \/ Sabah\" \/>\n                    <\/label>\n                    <label>Current Staying City\n                        <input name=\"current_city\" placeholder=\"e.g. Subang Jaya\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Contact Number <span class=\"muted\">(Update phone numbers)<\/span>\n                        <input inputmode=\"tel\" name=\"phone\" placeholder=\"+60 \u2026\" \/>\n                    <\/label>\n                    <label>Age\n                        <input inputmode=\"numeric\" name=\"age\" type=\"number\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Email Address\n                        <input name=\"email\" type=\"email\" placeholder=\"e.g. name@example.com\" \/>\n                    <\/label>\n                    <label>Religion\n                        <input name=\"religion\" type=\"text\" placeholder=\"e.g. Buddhist \/ Christian \/ None\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Type of Job &amp; Position\n                        <input name=\"job\" placeholder=\"e.g. CEO \/ Designer\" \/>\n                    <\/label>\n                    <label>Co. Name\n                        <input name=\"company\" placeholder=\"Company Name\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Nationality\n                        <input name=\"nationality\" value=\"MALAYSIAN\" \/>\n                    <\/label>\n                    <label>If out of Malaysia region please state\n                        <input name=\"nationality_note\" placeholder=\"Region \/ Country\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Birth Country\n                        <input name=\"birth_country\" placeholder=\"Malaysia\" \/>\n                    <\/label>\n                    <label>Birth City\n                        <input name=\"birth_city\" placeholder=\"Kuala Lumpur\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row\">\n                    <label>Birth Place \/ Address (optional)\n                        <input name=\"birth_addr\" placeholder=\"Street, district, etc.\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row\">\n                    <label>Current Staying Address\n                        <input name=\"current_address\" placeholder=\"Unit \/ Street \/ Building \/ Postcode\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Nation Identification Card No.\n                        <input name=\"id_card\" placeholder=\"e.g. 960408-12-XXXX\" \/>\n                    <\/label>\n                    <label>Race\n                        <input name=\"race\" placeholder=\"e.g. Chinese \/ Malay \/ Indian \/ Others\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Marital Status\n                        <input name=\"marital_status\" placeholder=\"Single \/ Married \/ Divorced \/ Widowed\" \/>\n                    <\/label>\n                    <label>Sexsualities\n                        <input name=\"sexualities\" placeholder=\"Heterosexual \/ Gay \/ Lesbian \/ Bi \/ Others\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Latitude\n                        <input id=\"lat\" name=\"lat\" readonly \/>\n                    <\/label>\n                    <label>Longitude\n                        <input id=\"lng\" name=\"lng\" readonly \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row\">\n                    <button class=\"secondary\" id=\"btnGeo\" type=\"button\">Lookup Longitude \/ Latitude\n                        (OpenStreetMap)<\/button>\n                <\/div>\n\n                <div class=\"section-label\" style=\"margin-top:18px;\">Educational Background<\/div>\n                <div class=\"row two\">\n                    <label>Primary School Name\n                        <input name=\"edu_primary_school\" type=\"text\" \/>\n                    <\/label>\n                    <label>From Year - End Year\n                        <input name=\"edu_primary_years\" type=\"text\" placeholder=\"e.g. 1999 - 2005\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Secondary School Name\n                        <input name=\"edu_secondary_school\" type=\"text\" \/>\n                    <\/label>\n                    <label>From Year - End Year\n                        <input name=\"edu_secondary_years\" type=\"text\" placeholder=\"e.g. 2006 - 2011\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row three\">\n                    <label>Higher Education College Name\n                        <input name=\"edu_college_name\" type=\"text\" \/>\n                    <\/label>\n                    <label>From Year - End Year\n                        <input name=\"edu_college_years\" type=\"text\" placeholder=\"e.g. 2012 - 2014\" \/>\n                    <\/label>\n                    <label>Major\n                        <input name=\"edu_college_major\" type=\"text\" placeholder=\"e.g. Design \/ Business\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row three\">\n                    <label>Higher Education University Name\n                        <input name=\"edu_uni_fd_name\" type=\"text\" \/>\n                    <\/label>\n                    <label>From Year - End Year\n                        <input name=\"edu_uni_fd_years\" type=\"text\" placeholder=\"e.g. 2014 - 2016\" \/>\n                    <\/label>\n                    <label>Major\n                        <input name=\"edu_uni_fd_major\" type=\"text\" placeholder=\"e.g. Foundation in Arts\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row three\">\n                    <label>Higher Education University Name\n                        <input name=\"edu_uni_bm_name\" type=\"text\" \/>\n                    <\/label>\n                    <label>From Year - End Year\n                        <input name=\"edu_uni_bm_years\" type=\"text\" placeholder=\"e.g. 2016 - 2019\" \/>\n                    <\/label>\n                    <label>Major\n                        <input name=\"edu_uni_bm_major\" type=\"text\" placeholder=\"e.g. BSc in Marketing\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row three\">\n                    <label>Higher Education University Name\n                        <input name=\"edu_uni_mp_name\" type=\"text\" \/>\n                    <\/label>\n                    <label>From Year - End Year\n                        <input name=\"edu_uni_mp_years\" type=\"text\" placeholder=\"e.g. 2020 - 2024\" \/>\n                    <\/label>\n                    <label>Major\n                        <input name=\"edu_uni_mp_major\" type=\"text\" placeholder=\"e.g. PhD in Psychology\" \/>\n                    <\/label>\n                <\/div>\n\n                <div class=\"section-label\" style=\"margin-top:18px;\">Personal Fin Information<\/div>\n                <div class=\"row two\">\n                    <label>IRB Income Tax No.\n                        <input name=\"irb_tax_no\" type=\"text\" \/>\n                    <\/label>\n                    <label>Country of Tax Residence\n                        <input name=\"tax_residence_country\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>TIN No.\n                        <input name=\"tin_no\" type=\"text\" \/>\n                    <\/label>\n                    <label>Other Country Income Tax Payable No.\n                        <input name=\"other_tax_no\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Monthly Income Average Range (MYR)\n                        <input name=\"monthly_income_range\" type=\"text\" placeholder=\"e.g. 3,000\u20135,000\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Bank Name (Only provide your own Banking Account Details)\n                        <input name=\"bank_name_1\" type=\"text\" \/>\n                    <\/label>\n                    <label>Bank Account Number (refund \/ e-Credit purposes)\n                        <input name=\"bank_acc_1\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Bank Name (Alternative Banking Choice)\n                        <input name=\"bank_name_2\" type=\"text\" \/>\n                    <\/label>\n                    <label>Bank Account Number 2\n                        <input name=\"bank_acc_2\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n\n                <div class=\"section-label\" style=\"margin-top:18px;\">Property Declaration Information<\/div>\n                <div class=\"row two\">\n                    <label>Number of Vehicle\n                        <input name=\"num_vehicle\" type=\"text\" placeholder=\"e.g. 0 \/ 1 \/ 2 ...\" \/>\n                    <\/label>\n                    <label>Number of Property Units\n                        <input name=\"num_property_units\" type=\"text\" placeholder=\"e.g. 1 \/ 2 \/ 3 \/ 4 \/ 5\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>1st Vehicle Plate Number &amp; Color\n                        <input name=\"veh1_plate_color\" type=\"text\" \/>\n                    <\/label>\n                    <label>2nd Vehicle Plate Number &amp; Color\n                        <input name=\"veh2_plate_color\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>3rd Vehicle Plate Number &amp; Color\n                        <input name=\"veh3_plate_color\" type=\"text\" \/>\n                    <\/label>\n                    <label>4th Vehicle Plate Number &amp; Color\n                        <input name=\"veh4_plate_color\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>5th Vehicle Plate Number &amp; Color\n                        <input name=\"veh5_plate_color\" type=\"text\" \/>\n                    <\/label>\n                    <label>6th Vehicle Plate Number &amp; Color\n                        <input name=\"veh6_plate_color\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row\">\n                    <label>Stated Each Unit Location and its cost (MYR)\n                        <textarea name=\"property_unit_locations\" rows=\"3\" placeholder=\"Unit 1 \u2013 Location &amp; costUnit 2 \u2013 Location &amp; cost...\"><\/textarea>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Acre of Land\n                        <input name=\"acre_of_land\" type=\"text\" placeholder=\"e.g. 1.5\" \/>\n                    <\/label>\n                    <label>Stated Land Location\n                        <input name=\"land_location\" type=\"text\" placeholder=\"e.g. Kedah, Malaysia\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row\">\n                    <label>Other Property Boat \/ Plane \/ Train \/ Rocket\n                        <input name=\"other_property\" type=\"text\" placeholder=\"Describe other major property\" \/>\n                    <\/label>\n                <\/div>\n\n                <div class=\"section-label\" style=\"margin-top:18px;\">Life Status Declaration<\/div>\n                <div class=\"row two\">\n                    <label>Current Life Status\n                        <div class=\"inline\">\n                            <label><input type=\"radio\" name=\"life_status\" value=\"unborn\" \/>Unborn<\/label>\n                            <label><input type=\"radio\" name=\"life_status\" value=\"alive\" \/>Still Alive<\/label>\n                            <label><input type=\"radio\" name=\"life_status\" value=\"deceased\" \/>Deceased<\/label>\n                        <\/div>\n                    <\/label>\n                    <div><\/div>\n                <\/div>\n\n                <div class=\"card-subsection\" id=\"deathDetails\" style=\"margin-top:10px;display:none;\">\n                    <p class=\"muted\">If client is deceased, please \u2713 tick all applicable causes of death and fill in\n                        date &amp;\n                        time.<\/p>\n                    <div class=\"row\">\n                        <div class=\"check-grid\"><\/div>\n                    <\/div>\n                    <div class=\"row two\">\n                        <label>Date of Death\n                            <input type=\"date\" name=\"death_date\" \/>\n                        <\/label>\n                        <label>Time of Death\n                            <input type=\"time\" name=\"death_time\" \/>\n                        <\/label>\n                    <\/div>\n                <\/div>\n\n                <div class=\"section-label\" style=\"margin-top:18px;\">Healthy Declaration Section<\/div>\n                <div class=\"row two\">\n                    <label>Healthy Issue Current\n                        <input name=\"health_current\" type=\"text\" placeholder=\"Describe current issue\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"health_current_year\" type=\"text\" placeholder=\"e.g. 2025\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Healthy Issue Past 1\n                        <input name=\"health_past1\" type=\"text\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"health_past1_year\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Healthy Issue Past 2\n                        <input name=\"health_past2\" type=\"text\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"health_past2_year\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Healthy Issue Past 3\n                        <input name=\"health_past3\" type=\"text\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"health_past3_year\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Healthy Issue Past 4\n                        <input name=\"health_past4\" type=\"text\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"health_past4_year\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n\n                <div class=\"section-label\" style=\"margin-top:18px;\">Legal Declaration Section<\/div>\n                <div class=\"row two\">\n                    <label>Court Case 1\n                        <input name=\"court_case1\" type=\"text\" placeholder=\"Short description\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"court_case1_year\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row two\">\n                    <label>Court Case 2\n                        <input name=\"court_case2\" type=\"text\" placeholder=\"Short description\" \/>\n                    <\/label>\n                    <label>Year\n                        <input name=\"court_case2_year\" type=\"text\" \/>\n                    <\/label>\n                <\/div>\n            <\/section>\n\n            <!-- Integrated Communication -->\n            <section class=\"card\">\n                <div class=\"section-label\">COMMUNICATION<\/div>\n                <h2>Integrated Communication<\/h2>\n                <p class=\"muted\">Tick all channels involved for this client contact or referral.<\/p>\n                <div class=\"check-grid\">\n                    <label><input name=\"ic_rc\" type=\"checkbox\" \/>RC<\/label>\n                    <label><input name=\"ic_rv\" type=\"checkbox\" \/>RV<\/label>\n                    <label><input name=\"ic_fif\" type=\"checkbox\" \/>FIF<\/label>\n                    <label><input name=\"ic_fbads\" type=\"checkbox\" \/>FB ADS<\/label>\n                    <label><input name=\"ic_igads\" type=\"checkbox\" \/>IG ADS<\/label>\n                    <label><input name=\"ic_fbf\" type=\"checkbox\" \/>FB F<\/label>\n                    <label><input name=\"ic_igf\" type=\"checkbox\" \/>IG F<\/label>\n                    <label><input name=\"ic_f\" type=\"checkbox\" \/>F<\/label>\n                    <label><input name=\"ic_seo\" type=\"checkbox\" \/>SEO<\/label>\n                    <label><input name=\"ic_others\" type=\"checkbox\" \/>OTHERS<\/label>\n                <\/div>\n                <div class=\"row\">\n                    <label>Ref by\n                        <input name=\"ic_refby\" \/>\n                    <\/label>\n                <\/div>\n                <div class=\"row\">\n                    <label>Relation of\n                        <input name=\"ic_relationof\" \/>\n                    <\/label>\n                <\/div>\n            <\/section>\n\n            <!-- SECTION B: 7x9 GRID -->\n            <section class=\"card\" id=\"gridWrap\">\n                <div class=\"section-label\">SECTION B<\/div>\n                <h2>Do not fill-up by non autorities<\/h2>\n                <p class=\"grid-note\">\n                    For internal use section<br \/>\n                    Permission for use this section is required. <b>time<\/b> Policy 2025\n                <\/p>\n                <div class=\"grid-controls\">\n                    <div>\n                        <label class=\"muted\">Select your language<\/label>\n                        <select id=\"numLang\">\n                            <option value=\"arabic\">Standard<\/option>\n                            <option value=\"thai\">\u0e44\u0e17\u0e22<\/option>\n                        <\/select>\n                    <\/div>\n                    <button class=\"secondary\" id=\"resetGrid\" type=\"button\">Reset Grid<\/button>\n                <\/div>\n                <table class=\"lt-grid\" id=\"grid7x9\">\n                    <tbody><\/tbody>\n                <\/table>\n                <p class=\"muted\" style=\"margin-top:8px\">\n                    Psychic Perception Index (PPI)\n                <\/p>\n            <\/section>\n\n            <!-- SECTION C: Descriptions & Declarations -->\n            <section class=\"card\" id=\"section-c\">\n                <div class=\"section-label\">SECTION C<\/div>\n                <h2>Descriptions &amp; Declarations<\/h2>\n                <p class=\"muted\">\n                    Client declare vs. consultant findings \u2014 tick on the left (client) and right (consultant). Multiple\n                    issues\n                    can be selected.\n                <\/p>\n                <table class=\"issues-table\">\n                    <thead>\n                        <tr>\n                            <th>Issue<\/th>\n                            <th class=\"small\">Client<\/th>\n                            <th class=\"small\">Consultant<\/th>\n                        <\/tr>\n                    <\/thead>\n                    <tbody>\n                        <tr>\n                            <td>Wealthy Issue \u8d22\u5bcc\u4e4b\u5fe7<\/td>\n                            <td class=\"small\"><input name=\"c_w_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_w_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Loan Issue \u8d37\u6b3e\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_loan_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_loan_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Finance Issue \u7ecf\u6d4e\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_fin_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_fin_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Property Trading \u623f\u4ea7\u4e70\u5356\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_prop_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_prop_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Car Issue \u8f66\u8f86 \/ \u8f66\u8d37\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_car_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_car_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Investment \u6295\u8d44\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_inv_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_inv_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Insurance \u4fdd\u9669\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_ins_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_ins_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Fraud Issue \u8bc8\u9a97\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_fraud_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_fraud_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Debt Issue \u503a\u52a1\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_debt_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_debt_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Healthy Check \u4f53\u68c0 \/ \u5065\u5eb7\u68c0\u6d4b<\/td>\n                            <td class=\"small\"><input name=\"c_healthcheck_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_healthcheck_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Cancer \u764c\u75c7<\/td>\n                            <td class=\"small\"><input name=\"c_cancer_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_cancer_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Bond Issue \u503a\u5238 \/ \u6295\u8d44\u7968\u636e<\/td>\n                            <td class=\"small\"><input name=\"c_bond_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_bond_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Unclear Disease \u4e0d\u660e\u75c7\u72b6 \/ \u75be\u75c5<\/td>\n                            <td class=\"small\"><input name=\"c_unclear_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_unclear_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Impairment \u6b8b\u75be \/ \u673a\u80fd\u53d7\u635f<\/td>\n                            <td class=\"small\"><input name=\"c_impair_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_impair_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Broke-up \/ Divorce \u5206\u624b \/ \u79bb\u5a5a<\/td>\n                            <td class=\"small\"><input name=\"c_divorce_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_divorce_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Love Broken \u611f\u60c5\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_lovebroken_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_lovebroken_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Single Love \u5355\u604b \/ \u5355\u65b9\u9762\u611f\u60c5<\/td>\n                            <td class=\"small\"><input name=\"c_singlelove_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_singlelove_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Third Party Involved \u7275\u6d89\u7b2c\u4e09\u8005<\/td>\n                            <td class=\"small\"><input name=\"c_third_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_third_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Family Problem \u5bb6\u5ead\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_family_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_family_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Career Hunter \u5347\u804c \/ \u6c42\u804c<\/td>\n                            <td class=\"small\"><input name=\"c_careerhunt_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_careerhunt_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Future Career Suggestion \u672a\u6765\u4e8b\u4e1a\u5efa\u8bae<\/td>\n                            <td class=\"small\"><input name=\"c_careersugg_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_careersugg_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Business Recession \u751f\u610f\u4e0b\u6ed1<\/td>\n                            <td class=\"small\"><input name=\"c_business_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_business_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Education Oversea \u6d77\u5916\u6559\u80b2<\/td>\n                            <td class=\"small\"><input name=\"c_overseaedu_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_overseaedu_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Involved Necromancy \u68a6\u7075 \/ \u964d\u5934\u76f8\u5173<\/td>\n                            <td class=\"small\"><input name=\"c_necro_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_necro_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Amulet Inquire \u5723\u7269 \/ \u62a4\u8eab\u7b26\u54a8\u8be2<\/td>\n                            <td class=\"small\"><input name=\"c_amulet_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_amulet_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Spirit Issue \u7075\u4f53 \/ \u7075\u5f02\u95ee\u9898<\/td>\n                            <td class=\"small\"><input name=\"c_spirit_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_spirit_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Statues Inquire \u4f5b\u50cf \/ \u795e\u50cf\u54a8\u8be2<\/td>\n                            <td class=\"small\"><input name=\"c_statues_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_statues_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Feng Shui Inquire \u98ce\u6c34\u54a8\u8be2<\/td>\n                            <td class=\"small\"><input name=\"c_fs_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_fs_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Past Life \u524d\u4e16<\/td>\n                            <td class=\"small\"><input name=\"c_pastlife_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_pastlife_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Next Life \u6765\u4e16<\/td>\n                            <td class=\"small\"><input name=\"c_nextlife_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_nextlife_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Cause of Dead \u6b7b\u56e0<\/td>\n                            <td class=\"small\"><input name=\"c_cod_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_cod_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Miscarriage \u6d41\u4ea7 \/ \u5815\u80ce \/ \u80ce\u6b7b\u8179\u4e2d<\/td>\n                            <td class=\"small\"><input name=\"c_mis_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_mis_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Baby Born \u65b0\u751f\u513f \/ \u5b9d\u5b9d\u51fa\u751f<\/td>\n                            <td class=\"small\"><input name=\"c_baby_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_baby_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Psychology \u7cbe\u795e \/ \u5fc3\u7406\u5065\u5eb7<\/td>\n                            <td class=\"small\"><input name=\"c_psy_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_psy_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Personality \u4e2a\u6027 \/ \u6027\u683c<\/td>\n                            <td class=\"small\"><input name=\"c_personality_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_personality_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Normal Screening Check \u5e38\u89c4\u68c0\u67e5<\/td>\n                            <td class=\"small\"><input name=\"c_normalcheck_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_normalcheck_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Vehicle Luck \u8f66\u8f86\u8fd0\u52bf<\/td>\n                            <td class=\"small\"><input name=\"c_vehicleluck_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_vehicleluck_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Housing Luck \u5bb6\u5b85\u8fd0\u52bf<\/td>\n                            <td class=\"small\"><input name=\"c_houseluck_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_houseluck_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Other Issue \u5176\u4ed6\u4e8b\u9879<\/td>\n                            <td class=\"small\"><input name=\"c_other_client\" type=\"checkbox\" \/><\/td>\n                            <td class=\"small\"><input name=\"c_other_consult\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                    <\/tbody>\n                <\/table>\n                <div class=\"row\" style=\"margin-top:12px\">\n                    <label>Client\u2019s own description, story and declarations about the selected issues. Additional notes\n                        \/\n                        spiritual declarations.\n                        <textarea name=\"c_description\" rows=\"6\"><\/textarea>\n                    <\/label>\n                <\/div>\n            <\/section>\n\n            <!-- SECTION D: Actions & Solutions -->\n            <section class=\"card\" id=\"section-d\">\n                <div class=\"section-label\">SECTION D<\/div>\n                <h2><strong>Actions &amp; Solutions of Suggestions<\/strong><\/h2>\n                <table class=\"table-d\">\n                    <thead>\n                        <tr>\n                            <th style=\"width:32%\">Consideration<\/th>\n                            <th style=\"width:7%\">Yes<\/th>\n                            <th style=\"width:7%\">No<\/th>\n                            <th>Reasons \/ Details<\/th>\n                        <\/tr>\n                    <\/thead>\n                    <tbody>\n                        <tr>\n                            <td>Necessary implement ritual product in this case?<br \/>\n                                <small class=\"muted\">Remark<\/small><br \/>\n                                <input name=\"d_need_remark\" \/>\n                            <\/td>\n                            <td style=\"text-align:center\"><input name=\"d_need_yes\" type=\"checkbox\" \/><\/td>\n                            <td style=\"text-align:center\"><input name=\"d_need_no\" type=\"checkbox\" \/><\/td>\n                            <td rowspan=\"2\">\n                                <div class=\"muted\" style=\"margin-bottom:4px\">Which ritual product should implement?\n                                <\/div>\n                                <div style=\"margin-bottom:4px\">\n                                    <label><input name=\"d_w9c\" type=\"checkbox\" \/>W9C<\/label>\n                                    <label style=\"margin-left:10px\"><input name=\"d_w9h\" type=\"checkbox\" \/>W9H<\/label>\n                                    <label style=\"margin-left:10px\"><input name=\"d_w1c\" type=\"checkbox\" \/>W1C<\/label>\n                                    <label style=\"margin-left:10px\"><input name=\"d_wkc\" type=\"checkbox\" \/>WKC<\/label>\n                                    <label style=\"margin-left:10px\"><input name=\"d_w9py\" type=\"checkbox\" \/>W9PY<\/label>\n                                <\/div>\n                                <div style=\"margin-bottom:4px\">\n                                    <label><input name=\"d_t01\" type=\"checkbox\" \/>T01<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t02\" type=\"checkbox\" \/>T02<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t03\" type=\"checkbox\" \/>T03<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t04\" type=\"checkbox\" \/>T04<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t05\" type=\"checkbox\" \/>T05<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t06\" type=\"checkbox\" \/>T06<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t07\" type=\"checkbox\" \/>T07<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t08\" type=\"checkbox\" \/>T08<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t09\" type=\"checkbox\" \/>T09<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t10\" type=\"checkbox\" \/>T10<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t11\" type=\"checkbox\" \/>T11<\/label>\n                                    <label style=\"margin-left:6px\"><input name=\"d_t12\" type=\"checkbox\" \/>T12<\/label>\n                                <\/div>\n                                <div style=\"margin-top:4px\">\n                                    <label>Others:\n                                        <input name=\"d_others\" style=\"margin-top:4px\" \/>\n                                    <\/label>\n                                <\/div>\n                            <\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Confident after applying ritual product in this case?<br \/>\n                                <small class=\"muted\">Remark<\/small><br \/>\n                                <input name=\"d_confident_remark\" \/>\n                            <\/td>\n                            <td style=\"text-align:center\"><input name=\"d_confident_yes\" type=\"checkbox\" \/><\/td>\n                            <td style=\"text-align:center\"><input name=\"d_confident_no\" type=\"checkbox\" \/><\/td>\n                        <\/tr>\n                        <tr>\n                            <td>Percentage estimate of success after implement ritual product in this case<\/td>\n                            <td colspan=\"2\">\n                                <label><input name=\"d_percent\" type=\"radio\" value=\"lt50\" \/> &lt; 50%<\/label><br \/>\n                                <label><input name=\"d_percent\" type=\"radio\" value=\"gt50\" \/> &gt; 50%<\/label><br \/>\n                                <span class=\"muted\">moderate 50\u201350<\/span>\n                            <\/td>\n                            <td>\n                                <label>Comments\n                                    <textarea name=\"d_comments\" rows=\"4\"><\/textarea>\n                                <\/label>\n                            <\/td>\n                        <\/tr>\n                    <\/tbody>\n                <\/table>\n                <div class=\"row\" style=\"margin-top:10px\">\n                    <label class=\"inline\" style=\"gap:6px\">\n                        <input name=\"faag_accept\" type=\"checkbox\" \/>\n                        <span><strong>FAAG Agreement (Failure to Assimilate Advised Guidance Agreement)<\/strong> The\n                            Client\n                            hereby acknowledges and agrees that, in circumstances where the projected success\n                            probability of any\n                            consultation, ritual product, prediction, advisory service, or spiritual guidance provided\n                            by LOUIS\n                            THAI International Group Sdn. Bhd. (\u201cthe Company\u201d) is assessed to be below fifty percent\n                            (50%), and\n                            the Client nevertheless elects to proceed with the Service, all resulting outcomes\n                            classified as\n                            \u201cFailure to Assimilate Advised Guidance (FAAG)\u201d shall remain solely and entirely the\n                            Client\u2019s\n                            responsibility. FAAG refers to the Client\u2019s refusal, omission, inability, or failure\u2014whether\n                            deliberate or unintended\u2014to understand, adopt, comply with, or follow the guidance,\n                            instructions,\n                            remedial actions, timelines, behavioural adjustments, or preventive steps advised by the\n                            Company.\n                            Once the Client ticks, signs, agrees, or otherwise indicates acceptance of the FAAG\n                            Agreement\n                            (whether digitally or physically), no refund, reimbursement, damages, compensation, or\n                            remedy of any\n                            kind shall apply, notwithstanding any provision under the general Refund Policy of the\n                            Company.<\/span>\n                    <\/label>\n                <\/div>\n            <\/section>\n\n            <!-- SIGNATURES -->\n            <section class=\"card\" id=\"section-sign\">\n                <div class=\"section-label\">SIGNATURES<\/div>\n                <h2>Client &amp; Consultant Signatures<\/h2>\n                <div class=\"sig-grid\">\n                    <div class=\"sig-box\">\n                        <div class=\"sig-box-title\">Client Signature<\/div>\n                        <canvas class=\"sig-pad\" id=\"sigClient\"><\/canvas>\n                        <div class=\"row two\" style=\"margin-top:8px\">\n                            <button class=\"secondary\" data-clear=\"sigClient\" type=\"button\">Clear<\/button>\n                            <button class=\"secondary\" data-save=\"sigClient\" type=\"button\">Save Signature<\/button>\n                        <\/div>\n                        <div class=\"row two\" style=\"margin-top:6px\">\n                            <label>Signed Date\n                                <input name=\"sig_client_date\" type=\"date\" \/>\n                            <\/label>\n                            <label>Signed Place\n                                <input name=\"sig_client_place\" placeholder=\"City \/ Country\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/div>\n                    <div class=\"sig-box\">\n                        <div class=\"sig-box-title\">Consultant Signature<\/div>\n                        <canvas class=\"sig-pad\" id=\"sigConsult\"><\/canvas>\n                        <div class=\"row two\" style=\"margin-top:8px\">\n                            <button class=\"secondary\" data-clear=\"sigConsult\" type=\"button\">Clear<\/button>\n                            <button class=\"secondary\" data-save=\"sigConsult\" type=\"button\">Save Signature<\/button>\n                        <\/div>\n                        <div class=\"row two\" style=\"margin-top:6px\">\n                            <label>Signed Date\n                                <input name=\"sig_consult_date\" type=\"date\" \/>\n                            <\/label>\n                            <label>Signed Place\n                                <input name=\"sig_consult_place\" placeholder=\"City \/ Country\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/section>\n        <\/main>\n\n        <div class=\"actions button-bar no-print\">\n            <div class=\"wrap\">\n                <button class=\"secondary\" id=\"clearForm\" type=\"button\">Reset Form<\/button>\n                <button class=\"secondary\" id=\"saveDraft\" type=\"button\">Save Draft<\/button>\n                <button id=\"exportPdf\" type=\"button\">Export PDF<\/button>\n                <button type=\"button\" id=\"printBtn\">Print<\/button>\n            <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n<script>\n    \/* JS will be injected here *\/\n    const lt_ajax_obj = {\n        ajax_url: \"https:\/\/louisthai.com\/wp-admin\/admin-ajax.php\",\n        nonce: \"1a65b68f67\"\n    };\n\n    (function ($) {\n        'use strict';\n\n        const STORAGE_KEY = 'lt_client_form_v4';\n        const formFields = () =>\n            Array.from(document.querySelectorAll('.lt-registration-form-container input, .lt-registration-form-container textarea, .lt-registration-form-container select'))\n                .filter(el => el.type !== 'button' && !el.matches('.sig-pad'));\n\n        function readState() {\n            try { return JSON.parse(localStorage.getItem(STORAGE_KEY) || '{}') } catch (e) { return {} }\n        }\n        function writeState(s) {\n            localStorage.setItem(STORAGE_KEY, JSON.stringify(s));\n        }\n\n        (function restore() {\n            const s = readState();\n            formFields().forEach(el => {\n                const n = el.name || el.id;\n                if (!n) return;\n                if (s[n] !== undefined) {\n                    if (el.type === 'checkbox' || el.type === 'radio') {\n                        el.checked = !!s[n];\n                    } else {\n                        el.value = s[n];\n                    }\n                }\n                el.addEventListener('input', () => {\n                    const st = readState();\n                    st[n] = (el.type === 'checkbox' || el.type === 'radio') ? el.checked : el.value;\n                    writeState(st);\n                });\n                if (el.type === 'radio') {\n                    el.addEventListener('change', () => {\n                        const st = readState();\n                        st[n] = el.checked;\n                        writeState(st);\n                    });\n                }\n            });\n        })();\n\n        async function geocodeBirthPlace() {\n            const country = document.querySelector('[name=\"birth_country\"]').value.trim();\n            const city = document.querySelector('[name=\"birth_city\"]').value.trim();\n            const addr = document.querySelector('[name=\"birth_addr\"]').value.trim();\n            const q = [addr, city, country].filter(Boolean).join(', ');\n            if (!q) { alert('\u8bf7\u5148\u586b\u5199\u56fd\u5bb6\/\u57ce\u5e02\/\u5730\u5740\u4e2d\u7684\u81f3\u5c11\u4e00\u9879'); return; }\n            try {\n                const url = 'https:\/\/nominatim.openstreetmap.org\/search?format=jsonv2&limit=1&addressdetails=1&q=' + encodeURIComponent(q);\n                const res = await fetch(url, { headers: { 'Accept': 'application\/json' } });\n                if (!res.ok) throw new Error('HTTP ' + res.status);\n                const arr = await res.json();\n                if (!arr || !arr.length) { alert('\u672a\u627e\u5230\u5750\u6807\uff0c\u8bf7\u5c1d\u8bd5\u66f4\u7cbe\u786e\u7684\u5730\u5740'); return; }\n                const it = arr[0];\n                document.getElementById('lat').value = it.lat || '';\n                document.getElementById('lng').value = it.lon || '';\n            } catch (e) {\n                console.error(e);\n                alert('\u67e5\u8be2\u5931\u8d25\uff0c\u8bf7\u7a0d\u540e\u518d\u8bd5');\n            }\n        }\n        const btnGeo = document.getElementById('btnGeo');\n        if (btnGeo) btnGeo.addEventListener('click', geocodeBirthPlace);\n\n        \/\/ --- GRID LOGIC (AJAX) ---\n        (function () {\n            const COLS = 7, ROWS = 9;\n            const numMapThai = ['\u0e50', '\u0e51', '\u0e52', '\u0e53', '\u0e54', '\u0e55', '\u0e56', '\u0e57', '\u0e58', '\u0e59'];\n            let lang = 'arabic';\n\n            function build() {\n                const tb = document.querySelector('#grid7x9 tbody');\n                if (!tb) {\n                    console.warn('LT Plugin: Grid tbody not found');\n                    return;\n                }\n                tb.innerHTML = '';\n                for (let r = 0; r < ROWS; r++) {\n                    const tr = document.createElement('tr');\n                    if (r === 3) tr.classList.add('sum-row'); \/\/ Row 3 is sum row\n                    for (let c = 0; c < COLS; c++) {\n                        const td = document.createElement('td');\n                        const div = document.createElement('div');\n                        div.className = 'cell';\n                        if (r < 3 && c === 0) div.classList.add('seed-cell');\n                        const input = document.createElement('input');\n                        input.dataset.r = r;\n                        input.dataset.c = c;\n                        input.name = `g_${r}_${c}`;\n                        \/\/ Only first col of first 3 rows is editable\n                        if (!(r < 3 && c === 0)) input.readOnly = true;\n                        div.appendChild(input);\n                        td.appendChild(div);\n                        tr.appendChild(td);\n                    }\n                    tb.appendChild(tr);\n                }\n                attachSeedListeners();\n            }\n\n            const q = (r, c) => document.querySelector(`#grid7x9 input[data-r=\"${r}\"][data-c=\"${c}\"]`);\n            const setVal = (r, c, v) => {\n                const el = q(r, c);\n                if (!el) return;\n                el.value = v ? formatNum(v) : '';\n            };\n\n            function formatNum(n) {\n                if (!n && n !== 0) return '';\n                if (lang === 'thai') {\n                    return String(n).split('').map(ch => {\n                        const idx = parseInt(ch, 10);\n                        return Number.isFinite(idx) ? numMapThai[idx] : ch;\n                    }).join('');\n                }\n                return String(n);\n            }\n\n            function parseNum(str) {\n                if (!str) return 0;\n                const normalized = str.split('').map(ch => {\n                    const idx = numMapThai.indexOf(ch);\n                    return idx >= 0 ? String(idx) : ch;\n                }).join('');\n                const n = Number(normalized);\n                return Number.isFinite(n) ? n : 0;\n            }\n\n            function attachSeedListeners() {\n                document.querySelectorAll('#grid7x9 input').forEach(inp => {\n                    const r = Number(inp.dataset.r), c = Number(inp.dataset.c);\n                    if (!(r < 3 && c === 0)) return;\n\n                    inp.addEventListener('input', e => {\n                        triggerCalculation();\n                    });\n                });\n            }\n\n            function triggerCalculation() {\n                \/\/ Gather seeds\n                const seeds = {};\n                for (let r = 0; r < 3; r++) {\n                    const val = parseNum(q(r, 0).value);\n                    seeds[r] = val;\n                }\n\n                $.ajax({\n                    url: lt_ajax_obj.ajax_url,\n                    type: 'POST',\n                    data: {\n                        action: 'lt_calculate_grid',\n                        nonce: lt_ajax_obj.nonce,\n                        seeds: seeds\n                    },\n                    success: function (res) {\n                        if (res.success) {\n                            updateGrid(res.data);\n                        }\n                    }\n                });\n            }\n\n            function updateGrid(gridData) {\n                for (let r = 0; r < ROWS; r++) {\n                    for (let c = 0; c < COLS; c++) {\n                        const val = gridData[r][c];\n                        const el = q(r, c);\n                        if (el === document.activeElement) continue;\n                        setVal(r, c, val);\n                    }\n                }\n            }\n\n            const resetGridBtn = document.getElementById('resetGrid');\n            if (resetGridBtn) {\n                resetGridBtn.addEventListener('click', () => {\n                    document.querySelectorAll('#grid7x9 input').forEach(i => i.value = '');\n                });\n            }\n\n            const numLang = document.getElementById('numLang');\n            if (numLang) {\n                numLang.addEventListener('change', e => {\n                    lang = e.target.value;\n                    triggerCalculation();\n                });\n            }\n\n            if (document.readyState === 'loading') {\n                document.addEventListener('DOMContentLoaded', build);\n            } else {\n                build();\n            }\n        })();\n\n        \/\/ --- SIGNATURE PAD ---\n        function initSignaturePad(canvasId, storageField) {\n            const canvas = document.getElementById(canvasId);\n            if (!canvas) return;\n            const ctx = canvas.getContext('2d');\n            let drawing = false, last = null;\n\n            function resize() {\n                const rect = canvas.getBoundingClientRect();\n                const ratio = window.devicePixelRatio || 1;\n                const data = canvas.toDataURL();\n                canvas.width = rect.width * ratio;\n                canvas.height = rect.height * ratio;\n                ctx.setTransform(ratio, 0, 0, ratio, 0, 0);\n                ctx.lineWidth = 2;\n                ctx.lineCap = 'round';\n                ctx.strokeStyle = '#111827';\n                if (data && data !== 'data:,') { \/\/ Check if empty\n                    const img = new Image();\n                    img.onload = () => ctx.drawImage(img, 0, 0, rect.width, rect.height);\n                    img.src = data;\n                }\n            }\n            window.addEventListener('resize', resize);\n            setTimeout(resize, 50);\n\n            function pos(e) {\n                const rect = canvas.getBoundingClientRect();\n                const t = e.touches ? e.touches[0] : e;\n                return { x: t.clientX - rect.left, y: t.clientY - rect.top };\n            }\n            function draw(p) {\n                if (!last) last = p;\n                ctx.beginPath();\n                ctx.moveTo(last.x, last.y);\n                ctx.lineTo(p.x, p.y);\n                ctx.stroke();\n                last = p;\n            }\n            canvas.addEventListener('pointerdown', e => {\n                drawing = true;\n                last = pos(e);\n                canvas.setPointerCapture(e.pointerId);\n            });\n            canvas.addEventListener('pointermove', e => {\n                if (!drawing) return;\n                draw(pos(e));\n            });\n            canvas.addEventListener('pointerup', () => {\n                drawing = false; last = null;\n                save();\n            });\n            canvas.addEventListener('pointerleave', () => {\n                drawing = false; last = null;\n            });\n\n            function save() {\n                const s = readState();\n                s[storageField] = canvas.toDataURL('image\/png');\n                writeState(s);\n            }\n            function clear() {\n                ctx.clearRect(0, 0, canvas.width, canvas.height);\n                const s = readState();\n                s[storageField] = null;\n                writeState(s);\n            }\n\n            document.querySelectorAll(`[data-clear=\"${canvasId}\"]`).forEach(btn => {\n                btn.addEventListener('click', clear);\n            });\n            document.querySelectorAll(`[data-save=\"${canvasId}\"]`).forEach(btn => {\n                btn.addEventListener('click', save);\n            });\n\n            const saved = readState()[storageField];\n            if (saved) {\n                const img = new Image();\n                img.onload = () => {\n                    const rect = canvas.getBoundingClientRect();\n                    ctx.drawImage(img, 0, 0, rect.width, rect.height);\n                };\n                img.src = saved;\n            }\n        }\n\n        initSignaturePad('sigClient', 'sig_client_image');\n        initSignaturePad('sigConsult', 'sig_consult_image');\n\n        const saveDraftBtn = document.getElementById('saveDraft');\n        if (saveDraftBtn) {\n            saveDraftBtn.addEventListener('click', () => {\n                const s = {};\n                formFields().forEach(el => {\n                    const n = el.name || el.id;\n                    if (!n) return;\n                    s[n] = (el.type === 'checkbox' || el.type === 'radio') ? el.checked : el.value;\n                });\n                const sigState = readState();\n                if (sigState.sig_client_image) s.sig_client_image = sigState.sig_client_image;\n                if (sigState.sig_consult_image) s.sig_consult_image = sigState.sig_consult_image;\n                writeState(s);\n                toast('Draft saved locally');\n            });\n        }\n\n        const clearFormBtn = document.getElementById('clearForm');\n        if (clearFormBtn) {\n            clearFormBtn.addEventListener('click', () => {\n                if (!confirm('Clear all fields and local draft?')) return;\n                localStorage.removeItem(STORAGE_KEY);\n                formFields().forEach(el => {\n                    if (el.type === 'checkbox' || el.type === 'radio') { el.checked = false; }\n                    else { el.value = ''; }\n                });\n                toast('Form cleared \u2014 please reload the page for blank signatures.');\n            });\n        }\n\n        const exportPdfBtn = document.getElementById('exportPdf');\n        if (exportPdfBtn) {\n            exportPdfBtn.addEventListener('click', () => {\n                const element = document.getElementById('capture');\n                const nameInput = document.querySelector('[name=\"client_name\"]');\n                const filename = (nameInput ? nameInput.value : 'client') + '_form.pdf';\n\n                \/\/ Save current scroll position\n                const scrollPos = window.pageYOffset || document.documentElement.scrollTop;\n                \/\/ Scroll to top to ensure html2canvas starts from the beginning\n                window.scrollTo(0, 0);\n\n                const opt = {\n                    margin: 0.5,\n                    filename,\n                    image: { type: 'jpeg', quality: 0.98 },\n                    html2canvas: {\n                        scale: 2,\n                        useCORS: true,\n                        scrollY: 0,\n                        scrollX: 0\n                    },\n                    jsPDF: { unit: 'in', format: 'a4', orientation: 'portrait' }\n                };\n\n                if (window.html2pdf) {\n                    html2pdf().set(opt).from(element).save().then(() => {\n                        \/\/ Restore scroll position\n                        window.scrollTo(0, scrollPos);\n                    }).catch(err => {\n                        console.error('PDF export error:', err);\n                        window.scrollTo(0, scrollPos);\n                    });\n                } else {\n                    alert('PDF library not loaded');\n                    window.scrollTo(0, scrollPos);\n                }\n            });\n        }\n\n        function toast(msg) {\n            const el = document.createElement('div');\n            el.textContent = msg;\n            el.style.cssText = 'position:fixed;left:50%;bottom:80px;transform:translateX(-50%);background:#111827;color:#fff;padding:8px 12px;border-radius:999px;font-size:12px;z-index:9999;';\n            document.body.appendChild(el);\n            setTimeout(() => el.remove(), 1600);\n        }\n\n        \/\/ Print functionality - bypass copy protection by opening new window\n        const printBtn = document.getElementById('printBtn');\n        if (printBtn) {\n            printBtn.addEventListener('click', function () {\n                \/\/ Get the content to print\n                const content = document.getElementById('lt-register-wrapper-id');\n                if (!content) {\n                    alert('Could not find content to print');\n                    return;\n                }\n\n                \/\/ Get all style tags from the page that contain our plugin styles\n                let allStyles = '';\n                document.querySelectorAll('style').forEach(function (styleEl) {\n                    \/\/ Include styles that reference our wrapper ID or are general styles\n                    if (styleEl.textContent.includes('lt-register') ||\n                        styleEl.textContent.includes('#lt-register-wrapper-id')) {\n                        allStyles += styleEl.outerHTML + '\\n';\n                    }\n                });\n\n                \/\/ Clone the content and remove no-print elements\n                const contentClone = content.cloneNode(true);\n                contentClone.querySelectorAll('.no-print').forEach(el => el.remove());\n\n                \/\/ Copy all input values from original to clone\n                const originalInputs = content.querySelectorAll('input, textarea, select');\n                const clonedInputs = contentClone.querySelectorAll('input, textarea, select');\n\n                originalInputs.forEach(function (origInput, index) {\n                    const clonedInput = clonedInputs[index];\n                    if (!clonedInput) return;\n\n                    if (origInput.type === 'checkbox' || origInput.type === 'radio') {\n                        \/\/ For checkboxes and radios, set the checked attribute\n                        if (origInput.checked) {\n                            clonedInput.setAttribute('checked', 'checked');\n                        } else {\n                            clonedInput.removeAttribute('checked');\n                        }\n                    } else if (origInput.tagName === 'SELECT') {\n                        \/\/ For selects, set the selected option\n                        clonedInput.value = origInput.value;\n                        const options = clonedInput.querySelectorAll('option');\n                        options.forEach(function (opt) {\n                            if (opt.value === origInput.value) {\n                                opt.setAttribute('selected', 'selected');\n                            } else {\n                                opt.removeAttribute('selected');\n                            }\n                        });\n                    } else if (origInput.tagName === 'TEXTAREA') {\n                        \/\/ For textareas, set the inner text\n                        clonedInput.textContent = origInput.value;\n                        clonedInput.setAttribute('value', origInput.value);\n                    } else {\n                        \/\/ For regular inputs, set the value attribute\n                        clonedInput.setAttribute('value', origInput.value);\n                    }\n                });\n\n                \/\/ Copy canvas signatures as images\n                const originalCanvases = content.querySelectorAll('canvas');\n                const clonedCanvases = contentClone.querySelectorAll('canvas');\n                originalCanvases.forEach(function (origCanvas, index) {\n                    const clonedCanvas = clonedCanvases[index];\n                    if (!clonedCanvas) return;\n\n                    \/\/ Replace canvas with an image\n                    try {\n                        const dataUrl = origCanvas.toDataURL('image\/png');\n                        const img = document.createElement('img');\n                        img.src = dataUrl;\n                        img.style.cssText = 'width:100%;height:180px;border-radius:12px;border:1px solid #e5e7eb;background:#fff;display:block;';\n                        clonedCanvas.parentNode.replaceChild(img, clonedCanvas);\n                    } catch (e) {\n                        console.warn('Could not copy canvas:', e);\n                    }\n                });\n\n                \/\/ Open a new window\n                const printWindow = window.open('', '_blank', 'width=900,height=700');\n                if (!printWindow) {\n                    alert('Please allow popups for this site to print');\n                    return;\n                }\n\n                \/\/ Write the content to the new window\n                printWindow.document.write('<!DOCTYPE html><html><head>');\n                printWindow.document.write('<title>Print - E-Registration Form<\/title>');\n                printWindow.document.write('<meta charset=\"UTF-8\">');\n                printWindow.document.write(allStyles);\n                printWindow.document.write('<style>');\n                printWindow.document.write('body { margin: 0; padding: 20px; background: white !important; }');\n                printWindow.document.write('#lt-register-wrapper-id { background: white !important; }');\n                printWindow.document.write('.card { box-shadow: none !important; }');\n                printWindow.document.write('@media print { body { margin: 0; padding: 0; } .card { page-break-inside: avoid; } }');\n                printWindow.document.write('<\/style>');\n                printWindow.document.write('<\/head><body>');\n                printWindow.document.write(contentClone.outerHTML);\n                printWindow.document.write('<\/body><\/html>');\n                printWindow.document.close();\n\n                \/\/ Wait for content to load then print\n                printWindow.onload = function () {\n                    setTimeout(function () {\n                        printWindow.print();\n                    }, 300);\n                };\n            });\n        }\n\n        \/\/ Death details visibility\n        (function () {\n            const deathDetails = document.getElementById('deathDetails');\n            if (!deathDetails) return;\n            const causeGrid = deathDetails.querySelector('.check-grid');\n\n            const causes = [\n                '\u81ea\u7136\u8001\u5316 \/ Natural old age',\n                '\u5fc3\u810f\u75c5\u53d1\u4f5c \/ Heart attack',\n                '\u5fc3\u529b\u8870\u7aed \/ Heart failure',\n                '\u4e2d\u98ce \/ Stroke',\n                '\u8111\u51fa\u8840 \/ Brain hemorrhage',\n                '\u8111\u6897\u585e \/ Cerebral infarction',\n                '\u80ba\u708e \/ Pneumonia',\n                '\u6162\u6027\u963b\u585e\u6027\u80ba\u75c5 \/ Chronic obstructive pulmonary disease',\n                '\u54ee\u5598\u6025\u6027\u53d1\u4f5c \/ Acute asthma attack',\n                '\u80be\u529f\u80fd\u8870\u7aed \/ Kidney failure',\n                '\u809d\u529f\u80fd\u8870\u7aed \/ Liver failure',\n                '\u7cd6\u5c3f\u75c5\u5e76\u53d1\u75c7 \/ Diabetes complications',\n                '\u9ad8\u8840\u538b\u5e76\u53d1\u75c7 \/ Hypertension complications',\n                '\u8d25\u8840\u75c7 \/ Sepsis',\n                '\u4e25\u91cd\u611f\u67d3 \/ Severe infection',\n                '\u764c\u75c7\u672b\u671f \/ Terminal cancer',\n                '\u80ba\u764c \/ Lung cancer',\n                '\u809d\u764c \/ Liver cancer',\n                '\u80c3\u764c \/ Stomach cancer',\n                '\u5927\u80a0\u764c \/ Colon cancer',\n                '\u4e73\u817a\u764c \/ Breast cancer',\n                '\u524d\u5217\u817a\u764c \/ Prostate cancer',\n                '\u80f0\u817a\u764c \/ Pancreatic cancer',\n                '\u6dcb\u5df4\u7624 \/ Lymphoma',\n                '\u767d\u8840\u75c5 \/ Leukemia',\n                '\u8f66\u7978 \/ Traffic accident',\n                '\u6469\u6258\u8f66\u610f\u5916 \/ Motorcycle accident',\n                '\u98de\u673a\u5931\u4e8b \/ Airplane crash',\n                '\u8239\u53ea\u4e8b\u6545 \/ Ship accident',\n                '\u9ad8\u5904\u5760\u843d \/ Fall from height',\n                '\u6eba\u6c34 \/ Drowning',\n                '\u706b\u707e\u610f\u5916 \/ Fire accident',\n                '\u70e7\u4f24\u5e76\u53d1\u75c7 \/ Severe burn complications',\n                '\u89e6\u7535 \/ Electrocution',\n                '\u5de5\u4f5c\u573a\u6240\u610f\u5916 \/ Workplace accident',\n                '\u5316\u5b66\u54c1\u4e2d\u6bd2 \/ Chemical poisoning',\n                '\u4e00\u6c27\u5316\u78b3\u4e2d\u6bd2 \/ Carbon monoxide poisoning',\n                '\u98df\u7269\u4e2d\u6bd2 \/ Food poisoning',\n                '\u836f\u7269\u8fc7\u654f\u53cd\u5e94 \/ Severe allergic drug reaction',\n                '\u4e25\u91cd\u8fc7\u654f\u6027\u4f11\u514b \/ Anaphylactic shock',\n                '\u4ea7\u540e\u5e76\u53d1\u75c7 \/ Postpartum complications',\n                '\u5206\u5a29\u5e76\u53d1\u75c7 \/ Childbirth complications',\n                '\u65b0\u751f\u513f\u5e76\u53d1\u75c7 \/ Neonatal complications',\n                '\u9057\u4f20\u6027\u75be\u75c5 \/ Hereditary disease',\n                '\u81ea\u8eab\u514d\u75ab\u75be\u75c5\u5e76\u53d1\u75c7 \/ Autoimmune disease complications',\n                '\u963f\u5c14\u8328\u6d77\u9ed8\u75c7\u5e76\u53d1\u75c7 \/ Alzheimer\u2019s complications',\n                '\u5e15\u91d1\u68ee\u75c7\u5e76\u53d1\u75c7 \/ Parkinson\u2019s complications',\n                '\u957f\u671f\u5367\u5e8a\u5e76\u53d1\u75c7 \/ Long-term bedridden complications',\n                '\u4e25\u91cd\u8425\u517b\u4e0d\u826f \/ Severe malnutrition',\n                '\u6781\u5ea6\u8131\u6c34 \/ Severe dehydration',\n                '\u70ed\u8870\u7aed \/ Heatstroke',\n                '\u4f4e\u6e29\u5931\u6e29 \/ Hypothermia',\n                '\u52a8\u7269\u54ac\u4f24 \/ Animal attack',\n                '\u86c7\u54ac\u4f24 \/ Snake bite',\n                '\u6606\u866b\u53ee\u54ac\u8fc7\u654f \/ Insect bite allergy',\n                '\u624b\u672f\u5931\u8d25 \/ Surgical complications',\n                '\u9ebb\u9189\u610f\u5916 \/ Anesthesia accident',\n                '\u5668\u5b98\u79fb\u690d\u5931\u8d25 \/ Organ transplant failure',\n                '\u514d\u75ab\u6291\u5236\u5e76\u53d1\u75c7 \/ Immunosuppression complications',\n                '\u4f20\u67d3\u75c5\u6d41\u884c \/ Epidemic infectious disease',\n                '\u65b0\u51a0\u80ba\u708e\u5e76\u53d1\u75c7 \/ COVID-19 complications',\n                '\u767b\u9769\u70ed\u5e76\u53d1\u75c7 \/ Dengue complications',\n                '\u6d41\u611f\u5e76\u53d1\u75c7 \/ Influenza complications',\n                '\u7ed3\u6838\u75c5\u5e76\u53d1\u75c7 \/ Tuberculosis complications',\n                '\u827e\u6ecb\u75c5\u5e76\u53d1\u75c7 \/ HIV\/AIDS-related illness',\n                '\u80a0\u80c3\u51fa\u8840 \/ Gastrointestinal bleeding',\n                '\u6d88\u5316\u9053\u7a7f\u5b54 \/ Digestive tract perforation',\n                '\u6025\u6027\u80f0\u817a\u708e \/ Acute pancreatitis',\n                '\u80c6\u56ca\u708e\u5e76\u53d1\u75c7 \/ Cholecystitis complications',\n                '\u5fc3\u5f8b\u4e0d\u6574\u731d\u6b7b \/ Sudden cardiac arrhythmia death',\n                '\u731d\u6b7b\u4e0d\u660e\u539f\u56e0 \/ Sudden unexplained death',\n                '\u624b\u672f\u540e\u5e76\u53d1\u8840\u6813 \/ Postoperative thrombosis',\n                '\u80ba\u6813\u585e \/ Pulmonary embolism',\n                '\u6df1\u9759\u8109\u8840\u6813 \/ Deep vein thrombosis',\n                '\u957f\u671f\u5367\u5e8a\u8840\u6813 \/ Bedridden thrombosis',\n                '\u957f\u671f\u9152\u7cbe\u4e2d\u6bd2 \/ Chronic alcohol intoxication',\n                '\u957f\u671f\u836f\u7269\u635f\u5bb3\u5668\u5b98 \/ Long-term medication organ damage',\n                '\u804c\u4e1a\u75c5\u5e76\u53d1\u75c7 \/ Occupational disease complications',\n                '\u77ff\u533a\u5de5\u4f5c\u5e76\u53d1\u75c7 \/ Mining-related illness',\n                '\u8f90\u5c04\u76f8\u5173\u75be\u75c5 \/ Radiation-related illness',\n                '\u73af\u5883\u6c61\u67d3\u76f8\u5173\u75be\u75c5 \/ Pollution-related illness',\n                '\u957f\u671f\u538b\u529b\u76f8\u5173\u5fc3\u8840\u7ba1\u75be\u75c5 \/ Stress-related cardiovascular disease',\n                '\u6781\u7aef\u60c5\u7eea\u5f15\u53d1\u5fc3\u810f\u6027\u731d\u6b7b \/ Emotion-triggered cardiac death',\n                '\u65c5\u884c\u671f\u95f4\u610f\u5916\u75be\u75c5 \/ Travel-related sudden illness',\n                '\u5b97\u6559\u4eea\u5f0f\u610f\u5916 \/ Ritual-related accident',\n                '\u81ea\u7136\u707e\u5bb3\u6b7b\u4ea1 \/ Natural disaster',\n                '\u5730\u9707 \/ Earthquake',\n                '\u6d2a\u6c34 \/ Flood',\n                '\u5c71\u5d29 \/ Landslide',\n                '\u53f0\u98ce \/ Typhoon \/ Hurricane',\n                '\u9f99\u5377\u98ce \/ Tornado',\n                '\u706b\u5c71\u7206\u53d1 \/ Volcanic eruption',\n                '\u6218\u4e89\u76f8\u5173\u6b7b\u4ea1 \/ War-related death',\n                '\u6050\u6016\u88ad\u51fb \/ Terrorist attack',\n                '\u7ed1\u67b6\u6740\u5bb3 \/ Kidnapping and murder',\n                '\u62a2\u52ab\u6740\u5bb3 \/ Robbery-related killing',\n                '\u5bb6\u66b4\u81f4\u6b7b \/ Domestic violence death',\n                '\u793e\u533a\u66b4\u529b\u4e8b\u4ef6 \/ Community violence',\n                '\u8b66\u65b9\u8ffd\u6355\u76f8\u5173\u6b7b\u4ea1 \/ Law-enforcement-related death',\n                '\u76d1\u72f1\u4e2d\u81ea\u7136\u6b7b\u4ea1 \/ Natural death in custody',\n                '\u76d1\u72f1\u4e2d\u75be\u75c5\u6076\u5316 \/ Worsened illness in custody',\n                '\u672a\u77e5\u539f\u56e0 \/ Unknown cause',\n                '\u5176\u4ed6\u7279\u6b8a\u539f\u56e0\uff08\u5907\u6ce8\uff09 \/ Other specific cause (remark)'\n            ];\n\n            if (causeGrid && causeGrid.children.length === 0) {\n                causes.forEach((label, idx) => {\n                    const wrap = document.createElement('label');\n                    wrap.className = 'group';\n                    const input = document.createElement('input');\n                    input.type = 'checkbox';\n                    input.name = 'death_cause_' + (idx + 1);\n                    wrap.appendChild(input);\n                    wrap.append(document.createTextNode(' ' + label));\n                    causeGrid.appendChild(wrap);\n                });\n            }\n\n            function updateDeathVisibility() {\n                const checked = document.querySelector('input[name=\"life_status\"]:checked');\n                const val = checked ? checked.value : '';\n                deathDetails.style.display = (val === 'deceased') ? '' : 'none';\n            }\n            document.querySelectorAll('input[name=\"life_status\"]').forEach(r => {\n                r.addEventListener('change', updateDeathVisibility);\n            });\n            updateDeathVisibility();\n        })();\n\n    })(jQuery);\n<\/script><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-500a604 elementor-widget elementor-widget-html\" data-id=\"500a604\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style>\n    :root{\n      --ink:#111827;\n      --sub:#6b7280;\n      --line:#e5e7eb;\n      --bg:#f3f4f6;\n      --card:#ffffff;\n      --accent:#111827;\n      --accent-soft:#e5e7ff;\n    }\n    *{box-sizing:border-box}\n    html,body{\n      margin:0;\n      padding:0;\n      font:16px\/1.5 -apple-system,BlinkMacSystemFont,\"Segoe UI\",Roboto,Helvetica,Arial;\n      background:var(--bg);\n      color:var(--ink);\n    }\n    header{\n      position:sticky;\n      top:0;\n      z-index:20;\n      backdrop-filter:blur(16px);\n      background:rgba(243,244,246,.92);\n      border-bottom:1px solid var(--line);\n    }\n    header .bar{\n      max-width:1040px;\n      margin:0 auto;\n      padding:10px 16px;\n      display:flex;\n      align-items:center;\n      justify-content:space-between;\n      gap:12px;\n      flex-wrap:wrap;\n    }\n    header h1{\n      margin:0;\n      font-size:18px;\n      font-weight:600;\n    }\n    header .pill{\n      font-size:12px;\n      padding:4px 10px;\n      border-radius:999px;\n      border:1px solid var(--line);\n      color:var(--sub);\n      background:#fff;\n      white-space:nowrap;\n    }\n    main{\n      max-width:1040px;\n      margin:18px auto 90px;\n      padding:0 16px 24px;\n    }\n    .card{\n      background:var(--card);\n      border-radius:20px;\n      border:1px solid var(--line);\n      padding:18px 18px 20px;\n      margin-bottom:16px;\n      box-shadow:0 12px 30px rgba(15,23,42,.04);\n    }\n    .card h2{\n      margin:0 0 10px;\n      font-size:15px;\n      text-transform:none;\n      letter-spacing:.02em;\n    }\n    .muted{color:var(--sub);font-size:12px}\n    label{font-size:13px;display:block}\n    input,select,textarea{\n      width:100%;\n      padding:10px 11px;\n      border-radius:12px;\n      border:1px solid var(--line);\n      font-size:14px;\n      font-family:inherit;\n      background:#fff;\n    }\n    input:focus,select:focus,textarea:focus{\n      outline:2px solid #111827;\n      outline-offset:1px;\n    }\n    input[type=\"checkbox\"],input[type=\"radio\"]{\n      width:auto;\n      height:auto;\n      padding:0;\n      margin-right:6px;\n      border-radius:4px;\n      accent-color:var(--accent);\n      outline:none;\n    }\n    textarea{resize:vertical;min-height:80px}\n    .row{display:grid;grid-template-columns:1fr;gap:10px;margin-top:8px}\n    .row.two{grid-template-columns:repeat(2,minmax(0,1fr))}\n    .row.three{grid-template-columns:repeat(3,minmax(0,1fr))}\n    .inline{display:flex;align-items:center;gap:8px}\n    .inline label{display:inline-flex;align-items:center;gap:6px;font-size:13px}\n    .section-label{\n      font-size:12px;\n      font-weight:500;\n      text-transform:uppercase;\n      letter-spacing:.12em;\n      color:var(--sub);\n      margin-bottom:4px;\n    }\n\n    \/* Integrated Communication *\/\n    .check-grid{\n      display:grid;\n      grid-template-columns:repeat(3,minmax(0,1fr));\n      gap:6px 16px;\n      margin:8px 0 6px;\n    }\n    .check-grid label{\n      display:inline-flex;\n      align-items:center;\n      gap:4px;\n      font-size:13px;\n      white-space:nowrap;\n    }\n\n    \/* SECTION C issues table *\/\n    .issues-table{\n      width:100%;\n      border-collapse:collapse;\n      margin-top:8px;\n      font-size:13px;\n    }\n    .issues-table th,\n    .issues-table td{\n      border:1px solid var(--line);\n      padding:6px 8px;\n    }\n    .issues-table th{\n      background:#f9fafb;\n      font-weight:600;\n      text-align:left;\n    }\n    .issues-table th.small,\n    .issues-table td.small{text-align:center;width:70px}\n\n    \/* 7x9 GRID *\/\n    #gridWrap h2{margin-bottom:4px}\n    .grid-note{font-size:12px;color:var(--sub);margin-bottom:8px}\n    .grid-controls{\n      display:flex;\n      align-items:center;\n      justify-content:space-between;\n      gap:8px;\n      flex-wrap:wrap;\n      margin-bottom:8px;\n    }\n    .grid-controls select{\n      max-width:180px;\n    }\n    .lt-grid{\n      width:100%;\n      border-collapse:separate;\n      border-spacing:8px;\n      table-layout:fixed;\n    }\n    .lt-grid td{padding:0}\n    .cell{\n      position:relative;\n      width:100%;\n      aspect-ratio:1\/1;\n      border-radius:12px;\n      border:1px solid var(--line);\n      background:#f9fafb;\n      overflow:hidden;\n    }\n    .cell input{\n      position:absolute;\n      inset:0;\n      width:100%;\n      height:100%;\n      border:0;\n      background:transparent;\n      text-align:center;\n      font-size:18px;\n      font-weight:500;\n    }\n    .sum-row .cell{\n      background:#eef2ff;\n      border-color:#c7d2fe;\n      font-weight:600;\n    }\n    .seed-cell{\n      background:#e5f3ff;\n      border-color:#bfdbfe;\n    }\n\n    \/* Section D table *\/\n    .table-d{\n      width:100%;\n      border-collapse:collapse;\n      font-size:13px;\n      margin-top:8px;\n    }\n    .table-d th,\n    .table-d td{\n      border:1px solid var(--line);\n      padding:6px 8px;\n      vertical-align:top;\n    }\n    .table-d th{\n      background:#f9fafb;\n      font-weight:600;\n      text-align:center;\n    }\n\n    \/* Signature *\/\n    .sig-grid{\n      display:grid;\n      grid-template-columns:1fr;\n      gap:16px;\n    }\n    @media (min-width:768px){\n      .sig-grid{grid-template-columns:repeat(2,minmax(0,1fr))}\n    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