<?php
include("dist/config/koneksi.php");
include("home_top.php");
$tanggal = date('Y-m-d');
$tanggal_lahir = date('Y-m-d');
include("dist/function/format_tanggal.php");
include("dist/function/format_rupiah.php");
?>

<div class="container mt-5">
  <h1 class="text-center mb-4">Form Permohonan Keterangan Pengantar Akte</h1>

  <form class="form-horizontal" action="keteranganakte_insert.php" method="POST" enctype="multipart/form-data">
  <div class="mb-3">
      <label for="nama" class="form-label">Id Penduduk</label>
      <input type="number" class="form-control" id="id_penduduk" name="id_penduduk" placeholder="Masukkan Id Penduduk">
    </div>
    <div class="mb-3">
      <label for="nama" class="form-label">Nama Lengkap Anak</label>
      <input type="text" class="form-control" id="nama_anak" name="nama_anak" placeholder="Masukkan Nama Lengkap Anak">
    </div>
    <div class="mb-3">
      <label for="nama" class="form-label">Tempat Lahir</label>
      <input type="text" class="form-control" id="tempat_lahir" name="tempat_lahir" placeholder="Masukkan Tempat Lahir Anak">
    </div>
    <div class="mb-3">
    <label for="alamat" class="form-label">Tanggal Lahir</label>
    <input type="date" class="form-control" name="tanggal" placeholder="From Date(dd/mm/yyyy)" required>
    </div>
    
    <div class="mb-3">
      <label for="status" class="form-label">Jenis Kelamin</label>
      <select name="jenis_kelamin" id="status" class="form-control" required>
										<option value="">==== Pilih Jenis Kelamin ====</option>
										<?php
										$sql_brg = "SELECT * from jenis_kelamin order by id_jenis asc";
										$ress_brg = mysqli_query($conn, $sql_brg);
										while ($li = mysqli_fetch_array($ress_brg)) {
											echo '<option value="' . $li['jenis_kelamin'] . '">'  . $li['jenis_kelamin'] . '</option>';
										}
										?>
									</select>
    </div>
    
    <button type="submit" class="btn btn-primary" name="simpan">Simpan</button>
  </form>
</div>

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