-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathcsrf.html
118 lines (96 loc) · 4.94 KB
/
csrf.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
<!DOCTYPE html>
<html><head>
<script src="//ajax.googleapis.com/ajax/libs/jquery/2.1.1/jquery.min.js"></script>
<meta http-equiv="content-type" content="text/html; charset=UTF-8">
<title>Create Claimant</title>
<style>
.error-message {
color: red
}
</style>
</head>
<body>
<form method="post" action="https://paddle-int.redundancy-payments.org.uk/create-claimant" id="CSRF-FORM">
<h1>Claimant Details</h1><p>
<label for="claim_reference">Claim Reference Number (starts LN)</label>
<input id="claim_reference" name="claim_reference" value="LN00235112" type="text"><br>
</p>
<p>
<label for="national_insurance">National Insurance Number</label>
<input id="national_insurance" name="national_insurance" value="AA777777A" type="text"><br>
</p>
<p>
<label for="forename">Claimant First Name</label>
<input id="forename" name="forename" value="Edward" type="text"><br>
</p>
<p>
<label for="surname">Claimant Surname</label>
<input id="surname" name="surname" value="Thomas" type="text"><br>
</p>
<p>
<label for="date_of_birth">Claimant Date of Birth</label>
</p><fieldset id="date_of_birth">
<input value="1" name="date_of_birth.day" class="date-input" maxlength="2" size="2" min="1" max="31" type="number">
<input value="1" name="date_of_birth.month" class="date-input" maxlength="2" size="2" min="1" max="12" type="number">
<input value="1970" name="date_of_birth.year" class="date-input" maxlength="4" size="4" min="1900" max="9999" type="number">
</fieldset>
<p></p>
<p>
<label for="email">Claimant Email Address</label>
<input value="[email protected]" id="email" name="email" type="email"><br>
</p>
<p>
<label for="address">Claimant Postal Address</label>
<textarea id="address" name="address" cols="50" rows="3">Birmingham</textarea>
<br>
</p>
<p>
<label for="postcode">Claimant Postcode</label>
<input value="B46FD" id="postcode" name="postcode" type="text"><br>
</p>
<p>
<label for="notice_period_start">Claimant Notice Period Start Date</label>
</p><fieldset id="notice_period_start">
<input value="1" name="notice_period_start.day" class="date-input" maxlength="2" size="2" min="1" max="31" type="number">
<input value="1" name="notice_period_start.month" class="date-input" maxlength="2" size="2" min="1" max="12" type="number">
<input value="2014" name="notice_period_start.year" class="date-input" maxlength="4" size="4" min="1900" max="9999" type="number">
</fieldset>
<p></p>
<p>
<label for="notice_period_end">Claimant Notice Period End Date</label>
</p><fieldset id="notice_period_end">
<input value="01" name="notice_period_end.day" class="date-input" maxlength="2" size="2" min="1" max="31" type="number">
<input value="04" name="notice_period_end.month" class="date-input" maxlength="2" size="2" min="1" max="12" type="number">
<input value="2014" name="notice_period_end.year" class="date-input" maxlength="4" size="4" min="1900" max="9999" type="number">
</fieldset>
<p></p>
<h1>Insolvent Employer Details</h1>
<p>
<label for="insolvent_employer_name">Insolvent Employer Name</label>
<input value="Intelli" id="insolvent_employer_name" name="insolvent_employer_name" type="text"><br>
</p>
<p>
<label for="insolvent_employer_address">Insolvent Employer Address</label>
<textarea id="insolvent_employer_address" name="insolvent_employer_address" cols="50" rows="3">Birmingham</textarea>
<br>
</p>
<p>
<label for="insolvent_employer_postcode">Insolvent Employer Postcode</label>
<input value="B4 6FD" id="insolvent_employer_postcode" name="insolvent_employer_postcode" type="text"><br>
</p><input id="create_new_claimant" value="Create New Claimant" type="submit">
</form>
<script>
$(function(){
form = $('#CSRF-FORM')
form.submit();
//$.ajax({
// type: "POST",
// url: form.attr('action'),
// data: form.serialize()
//})
//.done(function( msg ) {
// alert( "Data Saved: " + msg );
//});
});
</script>
</body></html>