benchmark.benefitcounsellor.com Open in urlscan Pro
34.246.83.201  Public Scan

Form analysis
1 forms found in the DOM

POST https://benchmark.benefitcounsellor.com/login

<form method="POST" action="https://benchmark.benefitcounsellor.com/login">
  <input type="hidden" name="_token" value="QeZrBN7WnNVt87Ozf4xt9rJOiN1JdkOR9hOeCIGU" autocomplete="off">
  <div class="form-group row">
    <div class="col-md-12 text-center">
      <label for="member_number">Enter your ID number/passport number below:</label>
      <input id="member_number" type="member_number" class="form-control " name="member_number" value="" placeholder="E.g. 9102207891234" required="">
    </div>
  </div>
  <div class="form-group row mb-0">
    <div class="col-md-12 text-center">
      <button type="submit" class="btn btn-primary btn-block">Continue</button>
    </div>
  </div>
</form>

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