<div class="col-md-6 form-group payment_neft">
<?=
simbanic_input('Transfer ID', 'transfer_id', isset($transfer_id) ? $transfer_id : '');
?>
</div>
</div>
<div class="row">
<div class="col-md-6 form-group">
<?=
simbanic_input('Release Date', 'date', isset($date) ? $date : '', $date_data);
?>
</div>
<div class="col-md-6 form-group">
<?=
simbanic_textarea('Remark', 'remark', isset($remark) ? $remark : '');
?>
</div>
</div>
<div class="row">
<?php
if($this->ion_auth->is_admin())
{
?>
<div class="col-md-6 form-group">
<?=
simbanic_input('Confirm Date', 'confirm_date', isset($confirm_date) && $confirm_date != '01-01-1970' && $confirm_date != '30-11--0001' ? $confirm_date : '', $date_data);
?>
</div>
<?php
<div class="col-md-6 form-group">
<?=
simbanic_input('Date of Birth', 'dob', isset($dob) ? $dob : '');
?>
</div>
</div>
<div class="row">
<div class="col-md-6 form-group">
<?=
simbanic_textarea('Home Address', 'home_address', isset($home_address) ? $home_address : '');
?>
</div>
<div class="col-md-6 form-group">
<?=
simbanic_textarea('Work Address', 'work_address', isset($work_address) ? $work_address : '');
?>
</div>
</div>
<?php
$home_state = array(
'onchange' => 'getDistrict(this)',
);
$home_district = array(
'onchange' => 'getArea(this)',
);
?>
<div class="row">
