mypension.bencon.co.zm Open in urlscan Pro
41.175.11.206  Public Scan

Form analysis
2 forms found in the DOM

POST #

<form action="#" method="POST" class="u-clearfix u-form-horizontal u-form-spacing-15 u-inner-form" style="padding: 15px;" source="custom" onsubmit="return false">
  <div class="u-form-group u-form-name">
    <label for="name-ef64" class="u-form-control-hidden u-label">Name</label>
    <input type="text" placeholder="Username/ Email" id="name-ef64" name="name" class="u-border-1 u-border-grey-30 u-input u-input-rectangle" required="">
  </div>
  <div class="u-form-email u-form-group">
    <label for="email-ef64" class="u-form-control-hidden u-label">Email</label>
    <div>
    </div>
    <input type="password" placeholder="Password" id="email-ef64" name="email" class="u-border-1 u-border-grey-30 u-input u-input-rectangle" required="">
    <span toggle="#password-field" onclick="toggleVisibility()" class="fa fa-fw fa-eye field-icon toggle-password" style="margin-left: -30px; margin-top: 0px; cursor: pointer;"></span>
  </div>
  <div class="u-form-group u-form-submit">
    <a href="#" class="u-btn u-btn-submit u-button-style">Log in<br>
                    </a>
    <input type="submit" value="submit" class="u-form-control-hidden" onclick="loginIndexPage()">
  </div>
  <div class="u-form-send-message u-form-send-success" style="visibility: hidden">#FormSendSuccess</div>
  <div class="u-form-send-error u-form-send-message" style="visibility: hidden">#FormSendError</div>
  <input type="hidden" value="" name="recaptchaResponse">
</form>

Name: form — POST #

<form action="#" method="POST" class="u-clearfix u-form-spacing-10 u-form-vertical u-inner-form" style="padding: 10px" source="custom" name="form" onsubmit="return false">
  <div class="u-form-group u-form-name u-form-group-1">
    <label for="name-da5f" class="u-form-control-hidden u-label">Name</label>
    <input type="text" placeholder="Enter your Name" id="name-da5f" name="name" class="u-border-1 u-border-grey-30 u-input u-input-rectangle u-white" required="">
  </div>
  <div class="u-form-email u-form-group u-form-group-2">
    <label for="email-da5f" class="u-form-control-hidden u-label">Email</label>
    <input type="email" placeholder="Enter a valid email address" id="email-da5f" name="email" class="u-border-1 u-border-grey-30 u-input u-input-rectangle u-white" required="">
  </div>
  <div class="u-form-email u-form-group u-form-group-2">
    <label for="phone" class="u-form-control-hidden u-label">Phone</label>
    <input type="text" placeholder="Enter Mobile Number" id="phone" name="phone" class="u-border-1 u-border-grey-30 u-input u-input-rectangle u-white" required="">
  </div>
  <div class="u-form-email u-form-group u-form-group-2">
    <label for="scheme-name" class="u-form-control-hidden u-label">Scheme Name</label>
    <input type="text" placeholder="Enter your Employer Name" id="scheme-name" name="schemeName" class="u-border-1 u-border-grey-30 u-input u-input-rectangle u-white" required="">
  </div>
  <div class="u-form-email u-form-group u-form-group-2">
    <label for="id-number" class="u-form-control-hidden u-label">National Identification Number</label>
    <input type="text" placeholder="Enter National ID Number" id="id-number" name="idNumber" class="u-border-1 u-border-grey-30 u-input u-input-rectangle u-white" required="">
  </div>
  <div class="u-form-group u-form-message u-form-group-3">
    <label for="message-da5f" class="u-form-control-hidden u-label">Message</label>
    <textarea placeholder="Enter your message" rows="4" cols="50" id="message-da5f" name="message" class="u-border-1 u-border-grey-30 u-input u-input-rectangle u-white" required=""></textarea>
  </div>
  <div class="u-form-group u-form-submit u-form-group-4">
    <a href="javascript:void(0)" class="u-btn u-btn-submit u-button-style u-gradient u-none u-text-body-alt-color u-btn-1" id="btn-support">Submit</a>
    <input type="submit" value="submit" class="u-form-control-hidden">
  </div>
  <div class="u-form-send-message u-form-send-success" id="sendingClbk" style="background-color: #000d1e!important;"> sending... </div>
  <div class="u-form-send-message u-form-send-success" id="supportmsgclbk"> Thank you! Your message has been sent. </div>
  <input type="hidden" value="" name="recaptchaResponse">
</form>

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