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POST handshake_submit-d.php

<form action="handshake_submit-d.php" method="post" enctype="multipart/form-data">
  <div class="content-wthree1">
    <div class="grid-agileits1">
      <div class="form-control">
        <label class="header">First Name<span style="font-size:14px; color:red;">*</span></label>
        <input type="text" onkeypress="return lettersValidate(event)" id="name" name="f_name" value="" placeholder="" title="Please enter your First Name" onkeyup="this.value = this.value.toUpperCase();" required="">
      </div>
      <div class="form-control">
        <label style="margin-top: 4px;" class="header">Middle Name </label>
        <input type="text" onkeypress="return lettersValidate(event)" id="name" name="m_name" value="" title="Please enter your middle name" onkeyup="this.value = this.value.toUpperCase();">
      </div>
      <div class="form-control">
        <label class="header">Last Name<span style="font-size:14px; color:red;">*</span></label>
        <input type="text" onkeypress="return lettersValidate(event)" id="name" name="l_name" value="" title="Please enter your Full Name" required="" onkeyup="this.value = this.value.toUpperCase();">
      </div>
      <div class="grid-w3layouts1">
        <div class="w3-agile1">
          <label class="rating">Choose gender<span style="font-size:14px; color:red;">*</span> </label>
          <ul>
            <li style="position: absolute; margin-left: 100px;">
              <input type="radio" id="a-option" name="gender" value="Female">
              <label for="a-option">Female </label>
              <div class="check"></div>
            </li>
            <li style="position: absolute;">
              <input type="radio" id="b-option" name="gender" value="Male">
              <label for="b-option">Male</label>
              <div class="check">
                <div class="inside"></div>
              </div>
            </li>
          </ul>
        </div>
      </div>
      <div class="form-control">
        <label style="margin-top: 15px;" class="header">Date of Birth<span style="font-size:14px; color:red;">*</span> (Format: MM/DD/YYYY)</label>
        <input id="datepicker1" class="date-slashes" type="text" name="dob" value="" required="">
      </div>
      <div class="form-control">
        <label class="header">Country of Birth<span style="font-size:14px; color:red;">*</span> </label>
        <select id="c_birth" name="c_birth" class="form-control" required="">
          <option value="">Select Country</option>
          <option value="India">India</option>
          <option value="Afghanistan">Afghanistan</option>
          <option value="Albania">Albania</option>
          <option value="Algeria">Algeria</option>
          <option value="American Samoa">American Samoa</option>
          <option value="Andorra">Andorra</option>
          <option value="Angola">Angola</option>
          <option value="Anguilla">Anguilla</option>
          <option value="Antarctica">Antarctica</option>
          <option value="Antigua and Barbuda">Antigua and Barbuda</option>
          <option value="Argentina">Argentina</option>
          <option value="Armenia">Armenia</option>
          <option value="Aruba">Aruba</option>
          <option value="Australia">Australia</option>
          <option value="Austria">Austria</option>
          <option value="Azerbaijan">Azerbaijan</option>
          <option value="Bahamas">Bahamas</option>
          <option value="Bahrain">Bahrain</option>
          <option value="Bangladesh">Bangladesh</option>
          <option value="Barbados">Barbados</option>
          <option value="Belarus">Belarus</option>
          <option value="Belgium">Belgium</option>
          <option value="Belize">Belize</option>
          <option value="Benin">Benin</option>
          <option value="Bermuda">Bermuda</option>
          <option value="Bhutan">Bhutan</option>
          <option value="Bolivia">Bolivia</option>
          <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
          <option value="Botswana">Botswana</option>
          <option value="Bouvet Island">Bouvet Island</option>
          <option value="Brazil">Brazil</option>
          <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
          <option value="Brunei Darussalam">Brunei Darussalam</option>
          <option value="Bulgaria">Bulgaria</option>
          <option value="Burkina Faso">Burkina Faso</option>
          <option value="Burundi">Burundi</option>
          <option value="Cambodia">Cambodia</option>
          <option value="Cameroon">Cameroon</option>
          <option value="Canada">Canada</option>
          <option value="Cape Verde">Cape Verde</option>
          <option value="Cayman Islands">Cayman Islands</option>
          <option value="Central African Republic">Central African Republic</option>
          <option value="Chad">Chad</option>
          <option value="Chile">Chile</option>
          <option value="China">China</option>
          <option value="Christmas Island">Christmas Island</option>
          <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
          <option value="Colombia">Colombia</option>
          <option value="Comoros">Comoros</option>
          <option value="Democratic Republic of the Congo">Democratic Republic of the Congo</option>
          <option value="Republic of Congo">Republic of Congo</option>
          <option value="Cook Islands">Cook Islands</option>
          <option value="Costa Rica">Costa Rica</option>
          <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>
          <option value="Cuba">Cuba</option>
          <option value="Cyprus">Cyprus</option>
          <option value="Czech Republic">Czech Republic</option>
          <option value="Denmark">Denmark</option>
          <option value="Djibouti">Djibouti</option>
          <option value="Dominica">Dominica</option>
          <option value="Dominican Republic">Dominican Republic</option>
          <option value="East Timor">East Timor</option>
          <option value="Ecuador">Ecuador</option>
          <option value="Egypt">Egypt</option>
          <option value="El Salvador">El Salvador</option>
          <option value="Equatorial Guinea">Equatorial Guinea</option>
          <option value="Eritrea">Eritrea</option>
          <option value="Estonia">Estonia</option>
          <option value="Ethiopia">Ethiopia</option>
          <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
          <option value="Faroe Islands">Faroe Islands</option>
          <option value="Fiji">Fiji</option>
          <option value="Finland">Finland</option>
          <option value="France">France</option>
          <option value="France, Metropolitan">France, Metropolitan</option>
          <option value="French Guiana">French Guiana</option>
          <option value="French Polynesia">French Polynesia</option>
          <option value="French Southern Territories">French Southern Territories</option>
          <option value="Gabon">Gabon</option>
          <option value="Gambia">Gambia</option>
          <option value="Georgia">Georgia</option>
          <option value="Germany">Germany</option>
          <option value="Ghana">Ghana</option>
          <option value="Gibraltar">Gibraltar</option>
          <option value="Guernsey">Guernsey</option>
          <option value="Greece">Greece</option>
          <option value="Greenland">Greenland</option>
          <option value="Grenada">Grenada</option>
          <option value="Guadeloupe">Guadeloupe</option>
          <option value="Guam">Guam</option>
          <option value="Guatemala">Guatemala</option>
          <option value="Guinea">Guinea</option>
          <option value="Guinea-Bissau">Guinea-Bissau</option>
          <option value="Guyana">Guyana</option>
          <option value="Haiti">Haiti</option>
          <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>
          <option value="Honduras">Honduras</option>
          <option value="Hong Kong">Hong Kong</option>
          <option value="Hungary">Hungary</option>
          <option value="Iceland">Iceland</option>
          <option value="India">India</option>
          <option value="Isle of Man">Isle of Man</option>
          <option value="Indonesia">Indonesia</option>
          <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>
          <option value="Iraq">Iraq</option>
          <option value="Ireland">Ireland</option>
          <option value="Israel">Israel</option>
          <option value="Italy">Italy</option>
          <option value="Ivory Coast">Ivory Coast</option>
          <option value="Jersey">Jersey</option>
          <option value="Jamaica">Jamaica</option>
          <option value="Japan">Japan</option>
          <option value="Jordan">Jordan</option>
          <option value="Kazakhstan">Kazakhstan</option>
          <option value="Kenya">Kenya</option>
          <option value="Kiribati">Kiribati</option>
          <option value="Korea, Democratic ">Korea, Democratic </option>
          <option value="Korea, Republic of">Korea, Republic of</option>
          <option value="Kosovo">Kosovo</option>
          <option value="Kuwait">Kuwait</option>
          <option value="Kyrgyzstan">Kyrgyzstan</option>
          <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
          <option value="Latvia">Latvia</option>
          <option value="Lebanon">Lebanon</option>
          <option value="Lesotho">Lesotho</option>
          <option value="Liberia">Liberia</option>
          <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
          <option value="Liechtenstein">Liechtenstein</option>
          <option value="Lithuania">Lithuania</option>
          <option value="Luxembourg">Luxembourg</option>
          <option value="Macau">Macau</option>
          <option value="North Macedonia">North Macedonia</option>
          <option value="Madagascar">Madagascar</option>
          <option value="Malawi">Malawi</option>
          <option value="Malaysia">Malaysia</option>
          <option value="Maldives">Maldives</option>
          <option value="Mali">Mali</option>
          <option value="Malta">Malta</option>
          <option value="Marshall Islands">Marshall Islands</option>
          <option value="Martinique">Martinique</option>
          <option value="Mauritania">Mauritania</option>
          <option value="Mauritius">Mauritius</option>
          <option value="Mayotte">Mayotte</option>
          <option value="Mexico">Mexico</option>
          <option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
          <option value="Moldova, Republic of">Moldova, Republic of</option>
          <option value="Monaco">Monaco</option>
          <option value="Mongolia">Mongolia</option>
          <option value="Montenegro">Montenegro</option>
          <option value="Montserrat">Montserrat</option>
          <option value="Morocco">Morocco</option>
          <option value="Mozambique">Mozambique</option>
          <option value="Myanmar">Myanmar</option>
          <option value="Namibia">Namibia</option>
          <option value="Nauru">Nauru</option>
          <option value="Nepal">Nepal</option>
          <option value="Netherlands">Netherlands</option>
          <option value="Netherlands Antilles">Netherlands Antilles</option>
          <option value="New Caledonia">New Caledonia</option>
          <option value="New Zealand">New Zealand</option>
          <option value="Nicaragua">Nicaragua</option>
          <option value="Niger">Niger</option>
          <option value="Nigeria">Nigeria</option>
          <option value="Niue">Niue</option>
          <option value="Norfolk Island">Norfolk Island</option>
          <option value="Northern Mariana Islands">Northern Mariana Islands</option>
          <option value="Norway">Norway</option>
          <option value="Oman">Oman</option>
          <option value="Pakistan">Pakistan</option>
          <option value="Palau">Palau</option>
          <option value="Palestine">Palestine</option>
          <option value="Panama">Panama</option>
          <option value="Papua New Guinea">Papua New Guinea</option>
          <option value="Paraguay">Paraguay</option>
          <option value="Peru">Peru</option>
          <option value="Philippines">Philippines</option>
          <option value="Pitcairn">Pitcairn</option>
          <option value="Poland">Poland</option>
          <option value="Portugal">Portugal</option>
          <option value="Puerto Rico">Puerto Rico</option>
          <option value="Qatar">Qatar</option>
          <option value="Reunion">Reunion</option>
          <option value="Romania">Romania</option>
          <option value="Russian Federation">Russian Federation</option>
          <option value="Rwanda">Rwanda</option>
          <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
          <option value="Saint Lucia">Saint Lucia</option>
          <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
          <option value="Samoa">Samoa</option>
          <option value="San Marino">San Marino</option>
          <option value="Sao Tome and Principe">Sao Tome and Principe</option>
          <option value="Saudi Arabia">Saudi Arabia</option>
          <option value="Senegal">Senegal</option>
          <option value="Serbia">Serbia</option>
          <option value="Seychelles">Seychelles</option>
          <option value="Sierra Leone">Sierra Leone</option>
          <option value="Singapore">Singapore</option>
          <option value="Slovakia">Slovakia</option>
          <option value="Slovenia">Slovenia</option>
          <option value="Solomon Islands">Solomon Islands</option>
          <option value="Somalia">Somalia</option>
          <option value="South Africa">South Africa</option>
          <option value="South Georgia ">South Georgia </option>
          <option value="South Sudan">South Sudan</option>
          <option value="Spain">Spain</option>
          <option value="Sri Lanka">Sri Lanka</option>
          <option value="St. Helena">St. Helena</option>
          <option value="St. Pierre and Miquelon">St. Pierre and Miquelon</option>
          <option value="Sudan">Sudan</option>
          <option value="Suriname">Suriname</option>
          <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>
          <option value="Swaziland">Swaziland</option>
          <option value="Sweden">Sweden</option>
          <option value="Switzerland">Switzerland</option>
          <option value="Syrian Arab Republic">Syrian Arab Republic</option>
          <option value="Taiwan">Taiwan</option>
          <option value="Tajikistan">Tajikistan</option>
          <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
          <option value="Thailand">Thailand</option>
          <option value="Togo">Togo</option>
          <option value="Tokelau">Tokelau</option>
          <option value="Tonga">Tonga</option>
          <option value="Trinidad and Tobago">Trinidad and Tobago</option>
          <option value="Tunisia">Tunisia</option>
          <option value="Turkey">Turkey</option>
          <option value="Turkmenistan">Turkmenistan</option>
          <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
          <option value="Tuvalu">Tuvalu</option>
          <option value="Uganda">Uganda</option>
          <option value="Ukraine">Ukraine</option>
          <option value="United Arab Emirates">United Arab Emirates</option>
          <option value="United Kingdom">United Kingdom</option>
          <option value="United States minor islands">United States minor islands</option>
          <option value="Uruguay">Uruguay</option>
          <option value="Uzbekistan">Uzbekistan</option>
          <option value="Vanuatu">Vanuatu</option>
          <option value="Vatican City State">Vatican City State</option>
          <option value="Venezuela">Venezuela</option>
          <option value="Vietnam">Vietnam</option>
          <option value="Virgin Islands (British)">Virgin Islands (British)</option>
          <option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
          <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>
          <option value="Western Sahara">Western Sahara</option>
          <option value="Yemen">Yemen</option>
          <option value="Zambia">Zambia</option>
          <option value="Zimbabwe">Zimbabwe</option>
        </select>
      </div>
      <div class="form-control">
        <label class="header">Country of Citizenship<span style="font-size:14px; color:red;">*</span> </label>
        <select id="c_ship" name="c_ship" class="form-control">
          <option value="">Select Country</option>
          <option value="India">India</option>
          <option value="Afghanistan">Afghanistan</option>
          <option value="Albania">Albania</option>
          <option value="Algeria">Algeria</option>
          <option value="American Samoa">American Samoa</option>
          <option value="Andorra">Andorra</option>
          <option value="Angola">Angola</option>
          <option value="Anguilla">Anguilla</option>
          <option value="Antarctica">Antarctica</option>
          <option value="Antigua and Barbuda">Antigua and Barbuda</option>
          <option value="Argentina">Argentina</option>
          <option value="Armenia">Armenia</option>
          <option value="Aruba">Aruba</option>
          <option value="Australia">Australia</option>
          <option value="Austria">Austria</option>
          <option value="Azerbaijan">Azerbaijan</option>
          <option value="Bahamas">Bahamas</option>
          <option value="Bahrain">Bahrain</option>
          <option value="Bangladesh">Bangladesh</option>
          <option value="Barbados">Barbados</option>
          <option value="Belarus">Belarus</option>
          <option value="Belgium">Belgium</option>
          <option value="Belize">Belize</option>
          <option value="Benin">Benin</option>
          <option value="Bermuda">Bermuda</option>
          <option value="Bhutan">Bhutan</option>
          <option value="Bolivia">Bolivia</option>
          <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
          <option value="Botswana">Botswana</option>
          <option value="Bouvet Island">Bouvet Island</option>
          <option value="Brazil">Brazil</option>
          <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
          <option value="Brunei Darussalam">Brunei Darussalam</option>
          <option value="Bulgaria">Bulgaria</option>
          <option value="Burkina Faso">Burkina Faso</option>
          <option value="Burundi">Burundi</option>
          <option value="Cambodia">Cambodia</option>
          <option value="Cameroon">Cameroon</option>
          <option value="Canada">Canada</option>
          <option value="Cape Verde">Cape Verde</option>
          <option value="Cayman Islands">Cayman Islands</option>
          <option value="Central African Republic">Central African Republic</option>
          <option value="Chad">Chad</option>
          <option value="Chile">Chile</option>
          <option value="China">China</option>
          <option value="Christmas Island">Christmas Island</option>
          <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
          <option value="Colombia">Colombia</option>
          <option value="Comoros">Comoros</option>
          <option value="Democratic Republic of the Congo">Democratic Republic of the Congo</option>
          <option value="Republic of Congo">Republic of Congo</option>
          <option value="Cook Islands">Cook Islands</option>
          <option value="Costa Rica">Costa Rica</option>
          <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>
          <option value="Cuba">Cuba</option>
          <option value="Cyprus">Cyprus</option>
          <option value="Czech Republic">Czech Republic</option>
          <option value="Denmark">Denmark</option>
          <option value="Djibouti">Djibouti</option>
          <option value="Dominica">Dominica</option>
          <option value="Dominican Republic">Dominican Republic</option>
          <option value="East Timor">East Timor</option>
          <option value="Ecuador">Ecuador</option>
          <option value="Egypt">Egypt</option>
          <option value="El Salvador">El Salvador</option>
          <option value="Equatorial Guinea">Equatorial Guinea</option>
          <option value="Eritrea">Eritrea</option>
          <option value="Estonia">Estonia</option>
          <option value="Ethiopia">Ethiopia</option>
          <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
          <option value="Faroe Islands">Faroe Islands</option>
          <option value="Fiji">Fiji</option>
          <option value="Finland">Finland</option>
          <option value="France">France</option>
          <option value="France, Metropolitan">France, Metropolitan</option>
          <option value="French Guiana">French Guiana</option>
          <option value="French Polynesia">French Polynesia</option>
          <option value="French Southern Territories">French Southern Territories</option>
          <option value="Gabon">Gabon</option>
          <option value="Gambia">Gambia</option>
          <option value="Georgia">Georgia</option>
          <option value="Germany">Germany</option>
          <option value="Ghana">Ghana</option>
          <option value="Gibraltar">Gibraltar</option>
          <option value="Guernsey">Guernsey</option>
          <option value="Greece">Greece</option>
          <option value="Greenland">Greenland</option>
          <option value="Grenada">Grenada</option>
          <option value="Guadeloupe">Guadeloupe</option>
          <option value="Guam">Guam</option>
          <option value="Guatemala">Guatemala</option>
          <option value="Guinea">Guinea</option>
          <option value="Guinea-Bissau">Guinea-Bissau</option>
          <option value="Guyana">Guyana</option>
          <option value="Haiti">Haiti</option>
          <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>
          <option value="Honduras">Honduras</option>
          <option value="Hong Kong">Hong Kong</option>
          <option value="Hungary">Hungary</option>
          <option value="Iceland">Iceland</option>
          <option value="India">India</option>
          <option value="Isle of Man">Isle of Man</option>
          <option value="Indonesia">Indonesia</option>
          <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>
          <option value="Iraq">Iraq</option>
          <option value="Ireland">Ireland</option>
          <option value="Israel">Israel</option>
          <option value="Italy">Italy</option>
          <option value="Ivory Coast">Ivory Coast</option>
          <option value="Jersey">Jersey</option>
          <option value="Jamaica">Jamaica</option>
          <option value="Japan">Japan</option>
          <option value="Jordan">Jordan</option>
          <option value="Kazakhstan">Kazakhstan</option>
          <option value="Kenya">Kenya</option>
          <option value="Kiribati">Kiribati</option>
          <option value="Korea, Democratic ">Korea, Democratic </option>
          <option value="Korea, Republic of">Korea, Republic of</option>
          <option value="Kosovo">Kosovo</option>
          <option value="Kuwait">Kuwait</option>
          <option value="Kyrgyzstan">Kyrgyzstan</option>
          <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
          <option value="Latvia">Latvia</option>
          <option value="Lebanon">Lebanon</option>
          <option value="Lesotho">Lesotho</option>
          <option value="Liberia">Liberia</option>
          <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
          <option value="Liechtenstein">Liechtenstein</option>
          <option value="Lithuania">Lithuania</option>
          <option value="Luxembourg">Luxembourg</option>
          <option value="Macau">Macau</option>
          <option value="North Macedonia">North Macedonia</option>
          <option value="Madagascar">Madagascar</option>
          <option value="Malawi">Malawi</option>
          <option value="Malaysia">Malaysia</option>
          <option value="Maldives">Maldives</option>
          <option value="Mali">Mali</option>
          <option value="Malta">Malta</option>
          <option value="Marshall Islands">Marshall Islands</option>
          <option value="Martinique">Martinique</option>
          <option value="Mauritania">Mauritania</option>
          <option value="Mauritius">Mauritius</option>
          <option value="Mayotte">Mayotte</option>
          <option value="Mexico">Mexico</option>
          <option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
          <option value="Moldova, Republic of">Moldova, Republic of</option>
          <option value="Monaco">Monaco</option>
          <option value="Mongolia">Mongolia</option>
          <option value="Montenegro">Montenegro</option>
          <option value="Montserrat">Montserrat</option>
          <option value="Morocco">Morocco</option>
          <option value="Mozambique">Mozambique</option>
          <option value="Myanmar">Myanmar</option>
          <option value="Namibia">Namibia</option>
          <option value="Nauru">Nauru</option>
          <option value="Nepal">Nepal</option>
          <option value="Netherlands">Netherlands</option>
          <option value="Netherlands Antilles">Netherlands Antilles</option>
          <option value="New Caledonia">New Caledonia</option>
          <option value="New Zealand">New Zealand</option>
          <option value="Nicaragua">Nicaragua</option>
          <option value="Niger">Niger</option>
          <option value="Nigeria">Nigeria</option>
          <option value="Niue">Niue</option>
          <option value="Norfolk Island">Norfolk Island</option>
          <option value="Northern Mariana Islands">Northern Mariana Islands</option>
          <option value="Norway">Norway</option>
          <option value="Oman">Oman</option>
          <option value="Pakistan">Pakistan</option>
          <option value="Palau">Palau</option>
          <option value="Palestine">Palestine</option>
          <option value="Panama">Panama</option>
          <option value="Papua New Guinea">Papua New Guinea</option>
          <option value="Paraguay">Paraguay</option>
          <option value="Peru">Peru</option>
          <option value="Philippines">Philippines</option>
          <option value="Pitcairn">Pitcairn</option>
          <option value="Poland">Poland</option>
          <option value="Portugal">Portugal</option>
          <option value="Puerto Rico">Puerto Rico</option>
          <option value="Qatar">Qatar</option>
          <option value="Reunion">Reunion</option>
          <option value="Romania">Romania</option>
          <option value="Russian Federation">Russian Federation</option>
          <option value="Rwanda">Rwanda</option>
          <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
          <option value="Saint Lucia">Saint Lucia</option>
          <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
          <option value="Samoa">Samoa</option>
          <option value="San Marino">San Marino</option>
          <option value="Sao Tome and Principe">Sao Tome and Principe</option>
          <option value="Saudi Arabia">Saudi Arabia</option>
          <option value="Senegal">Senegal</option>
          <option value="Serbia">Serbia</option>
          <option value="Seychelles">Seychelles</option>
          <option value="Sierra Leone">Sierra Leone</option>
          <option value="Singapore">Singapore</option>
          <option value="Slovakia">Slovakia</option>
          <option value="Slovenia">Slovenia</option>
          <option value="Solomon Islands">Solomon Islands</option>
          <option value="Somalia">Somalia</option>
          <option value="South Africa">South Africa</option>
          <option value="South Georgia ">South Georgia </option>
          <option value="South Sudan">South Sudan</option>
          <option value="Spain">Spain</option>
          <option value="Sri Lanka">Sri Lanka</option>
          <option value="St. Helena">St. Helena</option>
          <option value="St. Pierre and Miquelon">St. Pierre and Miquelon</option>
          <option value="Sudan">Sudan</option>
          <option value="Suriname">Suriname</option>
          <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>
          <option value="Swaziland">Swaziland</option>
          <option value="Sweden">Sweden</option>
          <option value="Switzerland">Switzerland</option>
          <option value="Syrian Arab Republic">Syrian Arab Republic</option>
          <option value="Taiwan">Taiwan</option>
          <option value="Tajikistan">Tajikistan</option>
          <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
          <option value="Thailand">Thailand</option>
          <option value="Togo">Togo</option>
          <option value="Tokelau">Tokelau</option>
          <option value="Tonga">Tonga</option>
          <option value="Trinidad and Tobago">Trinidad and Tobago</option>
          <option value="Tunisia">Tunisia</option>
          <option value="Turkey">Turkey</option>
          <option value="Turkmenistan">Turkmenistan</option>
          <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
          <option value="Tuvalu">Tuvalu</option>
          <option value="Uganda">Uganda</option>
          <option value="Ukraine">Ukraine</option>
          <option value="United Arab Emirates">United Arab Emirates</option>
          <option value="United Kingdom">United Kingdom</option>
          <option value="United States minor islands">United States minor islands</option>
          <option value="Uruguay">Uruguay</option>
          <option value="Uzbekistan">Uzbekistan</option>
          <option value="Vanuatu">Vanuatu</option>
          <option value="Vatican City State">Vatican City State</option>
          <option value="Venezuela">Venezuela</option>
          <option value="Vietnam">Vietnam</option>
          <option value="Virgin Islands (British)">Virgin Islands (British)</option>
          <option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)</option>
          <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>
          <option value="Western Sahara">Western Sahara</option>
          <option value="Yemen">Yemen</option>
          <option value="Zambia">Zambia</option>
          <option value="Zimbabwe">Zimbabwe</option>
        </select>
      </div>
      <div class="form-control">
        <label class="header">Passport Number<span style="font-size:14px; color:red;">*</span> </label>
        <input type="text" id="name" maxlength="9" value="" name="pass_num" placeholder="" title="Please enter your Passport Number" required="" onkeyup="this.value = this.value.toUpperCase();">
      </div>
      <div class="form-control">
        <label class="header">Upload Passport</label>
        <input type="file" id="name" name="pass_file_button" value="Upload File" placeholder="" title="Please upload passport file">
      </div>
    </div>
  </div>
</form>

Text Content

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H1-B REGISTRATION FORM

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Date of Birth* (Format: MM/DD/YYYY)
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Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia
Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus
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African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands
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of Man Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Ivory
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Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea
Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion
Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint
Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia
Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon
Islands Somalia South Africa South Georgia South Sudan Spain Sri Lanka St.
Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands
Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania,
United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia
Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab
Emirates United Kingdom United States minor islands Uruguay Uzbekistan Vanuatu
Vatican City State Venezuela Vietnam Virgin Islands (British) Virgin Islands
(U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Country of Citizenship* Select Country India Afghanistan Albania Algeria
American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina
Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados
Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina
Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam
Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands
Central African Republic Chad Chile China Christmas Island Cocos (Keeling)
Islands Colombia Comoros Democratic Republic of the Congo Republic of Congo Cook
Islands Costa Rica Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark
Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador
Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe
Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia
French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar
Guernsey Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau
Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland
India Isle of Man Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy
Ivory Coast Jersey Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea,
Democratic Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic
Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein
Lithuania Luxembourg Macau North Macedonia Madagascar Malawi Malaysia Maldives
Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico
Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro
Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands
Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue
Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine
Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal
Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and
Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and
Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia
Slovenia Solomon Islands Somalia South Africa South Georgia South Sudan Spain
Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan
Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan
Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and
Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda
Ukraine United Arab Emirates United Kingdom United States minor islands Uruguay
Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (British)
Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia
Zimbabwe
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Current Visa Status* Select Option F1 L1 L2 EAD H4 H4 EAD TN VISA Not Applicable
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School Name*
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Are you in OPT/CPT?* Select Option OPT STEM OPT 1st SEMESTER CPT 2nd SEMESTER
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Note: All our registrations and H1B sponsorships are sponsored by Company as per
the USCIS Guidelines.
Please send an email to visa@o2inc.net if you have any questions.