<?php include 'header.php';?>
        <!-- page-title -->
        <div class="ttm-page-title-row wfbg2">
            <div class="container">
                <div class="row"> 
                    <div class="col-md-12"> 
                        <div class="title-box ttm-textcolor-white">
                            <div class="page-title-heading">
                                <h1 class="title">Start Recovery</h1>
                            </div><!-- /.page-title-captions -->
                            <div class="breadcrumb-wrapper"> 
                                <span>
                                    <a title="Homepage" href="index.php"><i class="ti ti-home"></i>&nbsp;&nbsp;Home</a>
                                </span>
                                <span class="ttm-bread-sep">&nbsp; | &nbsp;</span>
                                <span>Start Recovery </span> 
                            </div>  
                        </div>
                    </div><!-- /.col-md-12 -->  
                </div><!-- /.row -->  
            </div><!-- /.container -->                      
        </div><!-- page-title end-->
    <!--site-main start-->
 <section >
     <div class="container p-5 pri "style="margin-top:30px; border-radius:20px;background-color:#e0eeff;">
      
         
          <div class="row">
              <div class="col-lg-12"> 
                        <div class="map-col-bg ttm-bgcolor-skincolor spacing-7" style="margin-top:10px !important;">
                            <!-- section title -->
                            <div class="section-title text-left with-desc clearfix">
                                <div class="title-header">
                                    <h2 class="title">Start Recovery</h2>
                                   
                                </div>
                            </div>
                             <form id="ttm-contactform" class="ttm-contactform wrap-form clearfix" method="post" action="#">
                                <div class="row">
                                    <div class="col-md-12">
                                        <label style="font-weight:500; font-size:18px;">Share Holders Name  
                                            </label>
                                        
                                    </div>
                                    <div class="col-md-4">
                                        <label>
                                            <span class="text-input">
                                                <input name="your-name" type="text" value="" placeholder="First" required="required">
                                            </span>
                                            </label>
                                        
                                    </div>
                                    <div class="col-md-4">
                                        <label style="font-weight:500; font-size:18px;">
                                          
                                            <span class="text-input">
                                                <input name="text" type="text" value="" placeholder="Middle" required="required">
                                            </span>
                                        </label>
                                    </div>
                                     <div class="col-md-4">
                                        <label style="font-weight:500; font-size:18px;">
                                            <span class="text-input">
                                                <input name="text" type="text" value="" placeholder="Last" required="required">
                                            </span>
                                        </label>
                                    </div>
                                     <div class="col-md-12">
                                        <label style="font-weight:500; font-size:18px;">
                                          Address *
                                            <span class="text-input">
                                                <input name="text" type="text" value="" placeholder="Steet Address" required="required">
                                            </span>
                                        </label>
                                    </div>
                                      <div class="col-md-6">
                                        <label style="font-weight:500; font-size:18px;">
                                          
                                            <span class="text-input">
                                                <input name="text" type="text" value="" placeholder="City" required="required">
                                            </span>
                                        </label>
                                    </div>
                                    <div class="col-md-6">
                                        <label style="font-weight:500; font-size:18px;">
                                          
                                            <span class="text-input">
                                                <input name="text" type="text" value="" placeholder="State/Region/Province" required="required">
                                            </span>
                                        </label>
                                    </div>
                                      <div class="col-md-6">
                                        <label style="font-weight:500; font-size:18px;">
                                          
                                            <span class="text-input">
                                                <input name="text" type="text" value="" placeholder="Postal / Zip Code" required="required">
                                            </span>
                                        </label>
                                    </div>
                                    <!--<div class="col-md-6">-->
                                    <div class="form-group col-md-6">
                                      <label for="inputState">State</label>
                                      <select id="inputState" class="form-control">
                                        <option selected>Choose...</option> 
                                        <option>...</option>
                                      </select>
                                    </div>
                                    
                                     <div class="form-group col-md-6">
                                      <label for="inputState">Phone*
                                      <select id="inputState" class="form-control">
                                        <option selected> 91+123456789</option> 
                                        <option>91+00000000</option>
                                      </select>
                                     <p style="font-size:10px;"> Preferably share your WhatsApp number for faster communication</p>
                                      </label>
                                    </div>
                                     <div class="col-md-6">
                                        <label style="font-weight:500; font-size:18px;">
                                          
                                            <span class="text-input">
                                                <input name="text" type="Email" value="" placeholder="Email" required="required">
                                            </span>
                                        </label>
                                    </div>
                                    
                                     <div class="col-md-6">
                                      <label for="inputState">Type of investment to be recovered
                                      <select id="inputState" class="form-control">
                                        <option selected>select</option> 
                                        <option>IEPF Claim</option>
                                         <option>Lost and forgotten Shares</option>
                                          <option>Transmission of shares</option>
                                           <option>Mutual Funds</option>
                                            <option>Insurance Policy</option>
                                             <option>PPF / EPF</option>
                                             <option>Land / Property</option>
                                             
                                      </select>
                                       <p style="font-size:10px;">Please select the investment you need our help with</p>
                                      </label>
                                    </div>
                                    
                                     <div class="col-md-6">
                                        <label style="font-weight:500; font-size:18px;">
                                          
                                            <span class="text-input">
                                                <input name="text" type="Email" value="" placeholder="verification code" required="required">
                                            </span>
                                        </label>
                                    </div>
                                    
                                   
                                    <!--</div>-->
                                </div>
                                
                                <div class="row">
                                    <div class="col-12">
                                         <input name="submit" type="submit" id="submit" class="submit ttm-btn ttm-btn-size-md ttm-btn-shape-square ttm-btn-bgcolor-darkgrey btn-block" value="Submit">
                                    </div>
                                  
                                </div>
                                <!--<label>-->
                                <!--    <span class="text-input">-->
                                <!--        <textarea name="message" cols="40" rows="3" placeholder="Message" required="required"></textarea>-->
                                <!--    </span>-->
                                <!--</label>-->
                               
                            </form>
                            
                         

          
                        </div>
                        
                    </div>
         </div>
      
         
     </div>
 </section>
 

  <?php include 'footer.php';?>