Application Form (HTML Only)

This is a basic HTML-based application form built using only HTML and inline CSS. It includes multiple sections that simulate a health insurance form with a variety of input fields such as text, date, radio buttons, tables, and fieldsets for better grouping and structure.

🌐 Live Site: Click here to view the project

🚀 Features

• Clean and straightforward HTML structure
• Inline CSS for simple styling
• Multiple sections divided using <fieldset>
• Semantic form grouping
• Required fields to ensure data completeness
• Responsive input types including:
  • Text inputs
  • Radio buttons
  • Date pickers
  • Email and number inputs
  • Tabular form entries

🧾 Sections in the Form

1. General Questions

   • Name, Birth Date, Gender, Address, Phone, Email, ID, Status, Occupation, Retiree status

2. Type of Health Coverage

   • Health coverage options for Employee, Spouse, and Children
   • Plan Choice fields
   • Table for additional dependent info (Name, SSN, Relationship, etc.)

3. The Policy

   • Units, Premiums, Payment Mode
   • Signature and Date
   • Cash with Application and Modal Premium

📚 Built With

• HTML5
• Inline CSS

Note: This project is intended as a beginner-level exercise and doesn't include form validation, backend logic, or styling frameworks.

📁 File Structure

📦 html-landing-page
 ┣ 📄 index.html
 ┣ 📄 README.md
 ┗ 📄 LICENSE

🛠️ How to Run Locally

1. Clone this repository:

   git clone https://github.com/huzaifa-frontend/html-form.git

2. Open index.html in your browser.

📄 License

This project is licensed under the MIT License - see the LICENSE file for details.

✍️ Author

Muhammad Huzaifa Karim
GitHub Profile

🔄 Deployment

This project is deployed via GitHub Pages. Any changes pushed to the main branch will automatically update the live site.

📬 Contact

For any queries or collaboration requests, feel free to reach out via GitHub.

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© 2025 Muhammad Huzaifa Karim