[md-form]
[md-text label="Surname"]

[/md-text]

[md-text label="First Name"]

[/md-text]

[md-text label="Other Name"]

[/md-text]

[md-text label="Date of Birth"]

[/md-text]

[md-checkbox label="Gender"]
FemaleMale
[/md-checkbox]

[md-checkbox label="Marital Status"]
SingleMarriedWidowedDivorcedSeparated
[/md-checkbox]

[md-text label="Citizen Of"]

[/md-text]

[md-text label="Your Phone Number"]

[/md-text]

[md-text label="Your WhatsApp Number"]

[/md-text]

[md-text label="Your Email Address"]

[/md-text]

[md-textarea label="Residential Address"]

[/md-textarea]

[md-text label="City/Province"]

[/md-text]

[md-text label="State"]

[/md-text]

[md-text label="Country"]

[/md-text]

[md-text label="Your Highest Level of Education"]

[/md-text]

[md-text label="Occupation"]

[/md-text]

[md-text label="Name of Employer"]

[/md-text]

[md-textarea label="Address of Place of Work"]

[/md-textarea]

[md-text label="Years of Working Experience"]

[/md-text]

[md-text label="Country Destination"]

[/md-text]

[md-checkbox label="Purpose of Travel"]
TourismBusinessWorkMedicalOthers
[/md-checkbox]

[md-text label="No of Travel Companion"]

[/md-text]

[md-text label="Planned Day/Month/Year of Travel"]

[/md-text]

[md-text label="Period of Stay"]

[/md-text]

[md-text label="Intended Date of Departure"]

[/md-text]

[md-checkbox label="Long Term Visa"]
Health & Care Worker VisaMinister of Religion VisaInternational Sportsperson Visa
[/md-checkbox]

[md-checkbox label="Short Term Visa"]
Temporary Work - Charity Worker VisaTemporary Work - Creative Worker VisaTemporary Work - Religious Worker VisaTemporary Work - Seasonal Worker Visa
[/md-checkbox]

[md-quiz label="Prove you're a human by answering the quiz below"]
What is 10 + 2?
[/md-quiz]
[md-submit]

[/md-submit]
[/md-form]