srd.sassa.gov.za.applyforms.me Open in urlscan Pro
2607:f8b0:4006:824::2013  Public Scan

Form analysis
1 forms found in the DOM

index.html

<form action="index.html">
  <div class="row clearfix">
    <div class="input_field select_option">
      <select>
        <option>Select your gender</option>
        <option value="Airtel">Male</option>
        <option value="mtn">Female</option>
      </select>
    </div>
    <div class="col_half">
      <div class="input_field"> <span><i aria-hidden="true" class="fa fa-user"></i></span>
        <input type="text" name="name" placeholder="Name">
      </div>
    </div>
    <div class="col_half">
      <div class="input_field"> <span><i aria-hidden="true" class="fa fa-phone"></i></span>
        <input type="text" name="name" placeholder="Phone number">
      </div>
    </div>
  </div>
  <div class="input_field"> <span><i aria-hidden="true" class="fa fa-globe"></i></span>
    <input type="text" name="mail" placeholder="Country">
  </div>
  <div class="input_field"> <span><i aria-hidden="true" class="fa fa-globe"></i></span>
    <input type="text" name="number" placeholder="Region/State/County">
  </div>
  <br>
  <center>
    <a style="width:90%; text-align:center; display:block; margin-top:10px;" href="https://srd.sassa.za.applyforms.me/" class="button final">APPLY</a>
  </center>
</form>

Text Content

sassa

The Social Relief of Distress Grant (SRD Grant) is meant for Citizens who are
between the ages of 18 and 60 years, who have insufficient means, who do not
receive social grants on behalf of herself/ himself, and have no financial
support from any other source.


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THE SOCIAL RELIEF OF DISTRESS GRANT (SRD GRANT)


FILL THE FORM BELOW

Select your gender Male Female





APPLY



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