<?php

session_start();

//Date: 6.10.2025

?>

<style>

@import url('https://fonts.googleapis.com/css?family=Oswald');

.left {
    
background: #4B4B4B;
border-radius: 10px 0 0 10px;
margin-right: 5px;

}

.left hr {

border: 1px solid #666666;

}

.right {

background: #DEDEDE;
border-radius: 0 10px 10px 0;
margin-right: 5px;

}

.left h4 {

font-family: 'Oswald', sans-serif;
font-size: 22px;
color: #E1E1E1 !important;
padding: 5px;
margin: 0;
border: 0px solid red;

}

.left span {

font-family: 'Oswald', sans-serif;
font-size: 25px;
color: #E1E1E1 !important;
padding: 5px;
margin: 0;
border: 0px solid red;

}

.right span {

font-family: 'Oswald', sans-serif;
font-size: 25px;
color #717171 !important;
padding: 5px;
margin: 0;
border: 0px solid red;

}

.left p{

font-family: Arial, helvetica, sans-serif;
font-size: 18px;
color: #BBBBBB;
padding: 5px;
margin: 0;
border: 0px solid red;

}

.right p {

font-family: Arial, helvetica, sans-serif;
font-size: 18px;
color: #717171;
padding: 5px;
margin: 0;
border: 0px solid red;

}

.right label {

font-family: Arial, helvetica, sans-serif;
font-size: 20px;
color: #717171;
padding: 5px;
margin: 0;
border: 0px solid red;

}


img { border: 1px solid #888; }

</style>


<?php 

include(".scripts/cap/simple-php-captcha.php");


$_SESSION['captcha'] = simple_php_captcha( array(
	'min_length' => 5,
	'max_length' => 5,
	'characters' => 'ABCDEFGHJKLMNPRSTUVWXYZabcdefghjkmnprstuvwxyz23456789',
	'min_font_size' => 28,
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	'color' => '#575757',
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	'angle_max' => 10,
	'shadow' => false,
	'shadow_color' => '#fff',
	'shadow_offset_x' => -1,
	'shadow_offset_y' => 1
));

?>

<!DOCTYPE html>
<html>
<head>
<title>TM47 Forms | ThaiDocs.online</title>
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/css/bootstrap.min.css" integrity="sha384-Gn5384xqQ1aoWXA+058RXPxPg6fy4IWvTNh0E263XmFcJlSAwiGgFAW/dAiS6JXm" crossorigin="anonymous">
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0/js/bootstrap.min.js" integrity="sha384-JZR6Spejh4U02d8jOt6vLEHfe/JQGiRRSQQxSfFWpi1MquVdAyjUar5+76PVCmYl" crossorigin="anonymous"></script>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">

</head>
<body>
<br />
<div class="row justify-content-md-center">
    <div class="col-3 left">
        
<span>Guideline</span>

<p>Below are guidelines to help you better fill in all the details for your TM47 Application also known as 90 Day Report. </p>

<h4 class="grey">Written at</h4>
<p align="left">Where the application is written at, i.e: Elephant Resort</p>

<hr class="grey">

<h4 class="grey">First Name</h4>
<p align="left">The first name of the applicant</p>

<h4 class="grey">Middle Name</h4>
<p align="left">Leave blank if no middle name.</p>

<h4 class="grey">Family Name</h4>
<p align="left">Last name of the applicant</p>

<hr class="grey">

<h4 class="grey">Nationality</h4>
<p align="left">Enter your Nationality i.e Israel</p>

<hr class="grey">

<h4 class="grey">Passport No</h4>
<p align="left">Enter your passport number</p>
<h4 class="grey">Type of Visa</h4>
<p align="left">What kind of Visa, Tourist? or Non-Immigrant</p>

<hr class="grey">

<h4 class="grey">Arrived by</h4>
<p align="left">How did you arrive, boat, flight, car</p>
<h4 class="grey">Date of Arrival</h4>
<p align="left">According to your stamp what was the date, fill in the date field</p>
<h4 class="grey">Departure/Arrival Card Number</h4>
<p align="left">Your TM06 Card number</p>

<hr class="grey">

<h4 class="grey">Address No.</h4>
<p align="left">Address no, is something like 14/14</p>
<h4 class="grey">Road</h4>
<p align="left">Road is something like Sai Yuan Road or Wiset Road</p>
<h4 class="grey">Tambon</h4>
<p align="left">Tambon is Sub-district like Chalong, Rawai, Nai Harn</p>
<h4 class="grey">Amphoe</h4>
<p align="left">Amphoe is the district like Mueang Phuket</p>
<h4 class="grey">Changwat</h4>
<p align="left">Changwat is the province, Phuket, Chon Buri, Sakhon Nakhon</p>

    </div>
    <div class="col-4 right">
        
<span>TM.47</span>

<p>The form below is meant for Visa extension within the Kingdom of Thailand. </p>

<form id="tmforms" name="tmforms" method="post" action="./.scripts/tm47/output.php">

<div class="form-group">  
<label for="writtenat">Written at*:</label>
<input type="text" class="form-control" name="writtenat" placeholder="Elephant Resort" />
</div>

<div class="row">
<div class="col">
<label for="firstname">First Name*:</label>
<input type="text" class="form-control" name="firstname" placeholder="John" />
</div>
<div class="col">
<label for="middlename">Middle Name:</label>
<input type="text" class="form-control" name="middlename" placeholder="Jay"/>
</div>
<div class="col">
<label for="familyname">Family Name*:</label>
<input type="text" class="form-control" name="familyname" placeholder="Smith" />
</div>
</div>

<div class="form-group">  
<label for="nationality">Nationality*:</label>
<input type="text" class="form-control" name="nationality" placeholder="Icelandic" />
</div>

<hr class="grey">

<div class="form-group">  
<label for="pno">Passport No*:</label>
<input type="text" class="form-control" name="pno" placeholder="XXXXXXXX" />
</div>

<label for="typeofvisa">Type of Visa*:</label>
<br />
<div class="form-check form-check-inline">  
<input type="radio" class="form-check-input" name="pvisa" value="tourist">
  <label class="form-check-label" for="exampleRadios2">
    Tourist
  </label>
 </div>
 <div class="form-check form-check-inline">
<input type="radio" class="form-check-input" name="pvisa" value="nonimm">
  <label class="form-check-label" for="exampleRadios2">
    Non-Imm
  </label>
</div>


<hr class="grey">

<div class="form-group">  
<label for="arrivedby">Arrived by*:</label>
<input type="text" class="form-control" name="arrivedby" placeholder="Flight?, Boat?" />
</div>

<label for="dateofarrival">Date of Arrival*:</label>
<div class="form-inline">  
<select class="form-control" name="doadd">
<?php
for ($x = 1; $x <= 31; $x++) {
    echo '<option value="' .$x. '">' .$x. '</option>';
} 
?>
</select>

<select class="form-control" name="doamm">
  <option value="January">January</option>
  <option value="February">February</option>
  <option value="March">March</option>
  <option value="April">April</option>
  <option value="May">May</option>
  <option value="June">June</option>
  <option value="July">July</option>
  <option value="August">August</option>
  <option value="September">September</option>
  <option value="October">October</option>
  <option value="November">November</option>
  <option value="December">December</option>
</select>

<select class="form-control" name="doayyyy">
<?php
for ($x = date("Y")-10; $x <= date("Y"); $x++) {
    echo '<option value="' .$x. '">' .$x. '</option>';
} 
?>
</select>
</div>

<div class="form-group">  
<label for="departurecardno">Departure Card No*:</label>
<input type="text" class="form-control" name="departurecardno" placeholder="XXXXXXXXXX" />
</div>

<hr class="grey">

<div class="form-group">  
<label for="addressno">Address No*:</label>
<input type="text" class="form-control" name="addressno" placeholder="16/33" />
</div>
<div class="form-group">  
<label for="addressroad">Road*:</label>
<input type="text" class="form-control" name="addressroad" placeholder="Sai Yuan" />
</div>
<div class="form-group">  
<label for="tambon">Tambon(Sub-district)*:</label>
<input type="text" class="form-control" name="tambon" placeholder="Rawai" />
</div>
<div class="form-group">  
<label for="amphoe">Amphoe(District)*:</label>
<input type="text" class="form-control" name="amphoe" placeholder="Mueang Phuket" />
</div>
<div class="form-group">  
<label for="changwat">Changwat(Province)*:</label>
<input type="text" class="form-control" name="changwat" placeholder="Phuket" />
</div>

<hr class="grey">
<div class="form-group">  
<label for="phone">Phone Number*:</label>
<input type="text" class="form-control" name="phone" placeholder="+66XXXXXXXXX" />
</div>

<hr class="grey">

<img src="./.scripts/cap/simple-php-captcha.php?_CAPTCHA&amp;t=0.88478300+1523771086" class="push_right" />

<div class="form-group">  
<label for="captcha">Type the above characters in the field*:</label>
<input type="text" class="form-control" name="captcha" id="contactcaptcha" />
</div>

<input class="btn btn-success btn-lg" type="submit" value="Submit Forms">
<input class="btn btn-danger btn-lg" type="reset" value="Clear Forms">

</form>

</div>
</div>
</div>
<br />

<div class="row justify-content-md-center">

<a class="btn btn-dark btn-lg" href="#" onclick="window.history.go(-1)" role="button">Go Back to Main</a>

</div>
<br />
</body>
</html>