<?php
include("home_top.php");

?>

<div class="container mt-5">
  <h1 class="text-center mb-4">Form Permohonan Kartu Keluarga</h1>
  <form>
    <div class="mb-3">
      <label for="nama" class="form-label">Nama Lengkap</label>
      <input type="text" class="form-control" id="nama" placeholder="Masukkan nama lengkap">
    </div>
    <div class="mb-3">
      <label for="alamat" class="form-label">Alamat</label>
      <textarea class="form-control" id="alamat" rows="3" placeholder="Masukkan alamat lengkap"></textarea>
    </div>
    <div class="mb-3">
      <label for="nik" class="form-label">Nomor NIK</label>
      <input type="text" class="form-control" id="nik" placeholder="Masukkan nomor NIK">
    </div>
    <div class="mb-3">
      <label for="tanggal_lahir" class="form-label">Tanggal Lahir</label>
      <input type="date" class="form-control" id="tanggal_lahir">
    </div>
    <div class="mb-3">
      <label for="pekerjaan" class="form-label">Pekerjaan</label>
      <input type="text" class="form-control" id="pekerjaan" placeholder="Masukkan pekerjaan">
    </div>
    <div class="mb-3">
      <label for="foto_ktp" class="form-label">Foto KTP</label>
      <input type="file" class="form-control" id="foto_ktp">
    </div>
    <button type="submit" class="btn btn-primary">Submit</button>
  </form>
</div>

<?php
include("home_bottom.php");
?>