<label> Your Name (required)
[text* your-name] </label>
<label> Your Last Name (required)
[text* lastname] </label>
<label> PAN No.
[text* PANNo.] </label>
<label><label> Date Of Birth (dd/mm/yyyy)
[text* DOB]</label>
<label> Assessment Year (dd/mm/yyyy)
[text* assessmentyear “2016-2017”]</label>
<label> Mobile No (dd/mm/yyyy)
[text* MobileNo]</label>
<label> Upload Intimation
[file* file-160 limit:5000]</label>
<label> Form 16
[file* Form16 limit:5000]</label>
<label> ITR V
[file* ITR-V limit:5000]</label>
<label> Message
[textarea textarea-88]</label>
<label> Email ID
[email* email]</label>
<label> Terms & Conditions
[email* email]</label>[acceptance TermsCondition default:on]
[submit “Send”]
