<!-- Begin Body --> 
<form  role="form" id="buyer_status_monitoring_form" class="form-horizontal">
<div class="container-fluid" style="padding-top:120px; height:550px">
	<div class="row"><br/></div>
	<div class="row">
		<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
			<fieldset> 
				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_fullname"><small>Buyer</small></label>
					<div class="col-md-7"><input type="text" id="bsm_fullname" readonly placeholder="Buyer" value="" class="form-control text-left"></div>
				</div>

				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_fullname"><small>Broker</small></label>
					<div class="col-md-7"><input type="text" id="bsm_fullname" readonly placeholder="Broker" value="" class="form-control text-left"></div>
				</div>

				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_fullname"><small>Agent</small></label>
					<div class="col-md-7"><input type="text" id="bsm_fullname" readonly placeholder="Agent" value="" class="form-control text-left"></div>
				</div>
				
				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_phase"><small>Reservation</small></label>
					<div class="col-md-7"><input type="text" id="bsm_phase" readonly placeholder="Reservation" value="" class="form-control text-left"></div>
				</div>

				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>Less CA</small></label>
					<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="Less CA" value="" class="form-control text-left"></div>
				</div>
				
				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small></small></label>
					<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="" value="" class="form-control text-left"></div>
				</div>


				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>TCP</small></label>
					<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="TCP" value="" class="form-control text-left"></div>
				</div>


				<div class="form-group">
					<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>Less Discount</small></label>
					<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="Less Discount" value="" class="form-control text-left"></div>
				</div>
			</fieldset>
		</div>
		<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
			<fieldset> 
				<div class="form-group">
					<label class="col-md-6 control-label text-right" for="bsm_block"><small>Block</small></label>
					<div class="col-md-6"><input type="text" id="bsm_block" readonly placeholder="Block" value="" class="form-control text-left"></div>
				</div>
 				 
			</fieldset>
		</div>
		<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
			<fieldset> 
				<div class="form-group">
					<label class="col-md-4 control-label text-right" for="bsm_lot"><small>Lot</small></label>
					<div class="col-md-8"><input type="text" id="bsm_lot" readonly placeholder="Lot" value="" class="form-control text-left"></div>
				</div>			

				<div class="form-group">
					<label class="col-md-4 control-label text-right" for="bsm_lot"><small>&nbsp;</small></label>
					<div class="col-md-8">&nbsp;</div>
				</div>			

				<div class="form-group">
					<label class="col-md-4 control-label text-right" for="bsm_lot"><small>&nbsp;</small></label>
					<div class="col-md-8">&nbsp;</div>
				</div>			


				<div class="form-group">
					<label class="col-md-4 control-label text-right" for="bsm_lot"><small>Date RF Deposited</small></label>
					<div class="col-md-8"><input type="text" id="bsm_lot" readonly placeholder="&nbsp;" value="" class="form-control text-left"></div>
				</div>			


			</fieldset>
		</div>
	</div>
 
	<div class="row">
		<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
			<fieldset>
				
					<div class="form-group">
						<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>Misc Expenses</small></label>
						<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="Misc Expenses" value="" class="form-control text-left"></div>
					</div>

					<div class="form-group">
						<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>Basis of Commission</small></label>
						<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="Basis of Commission" value="" class="form-control text-left"></div>
					</div>

					<div class="form-group">
						<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>Rate</small></label>
						<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="Rate" value="" class="form-control text-left"></div>
					</div>

					<div class="form-group">
						<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small>Commission</small></label>
						<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="Commission" value="" class="form-control text-left"></div>
					</div>
			</fieldset>
		</div>

		<div class="col-lg-4 col-md-4 col-sm-4 col-xs-12">
			<fieldset> 
					<div class="form-group">
						<label class="col-md-5 control-label text-right" for="bsm_lot_size"><small></small></label>
						<div class="col-md-7"><input type="text" id="bsm_lot_size" readonly placeholder="" value="" class="form-control text-left"></div>
					</div>
			</fieldset>
		</div>			
	</div>	

	<div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><br></div></div>
	<div class="row"><div class="col-lg-12 col-md-12 col-sm-12 col-xs-12"><br></div></div>

	<div class="row">
		<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
			<fieldset> 
				<div class="table-responsive"> 
				<table cellpadding="0" cellspacing="0" width="100%" class="table table-bordered table-condense table-striped">
					<tr>
						<td class="center text-center">&nbsp;</td>
						<td>&nbsp;</td>
						<td class="center text-center">&nbsp;</td>
						<td class="center text-center">Withholding Tax 10% <a href="#" style="cursor:hand; text-decoration:none" class="glyphicon glyphicon-pencil"></a><input type="text" readonly class="form-control"></td>
						<td class="center text-center">&nbsp;</td>
						<td class="center text-center">&nbsp;</td>
						<td class="center text-center">&nbsp;</td>
						<td class="center text-center">&nbsp;</td>
					</tr>
					<tr>
						<td class="center text-center" width="10%">Releases</td>
						<td>&nbsp;</td>
						<td class="center text-center">Amount</td>
						<td class="center text-center">WHT</td>
						<td class="center text-center">Cash Advance</td>
						<td class="center text-center">Net Comm</td>
						<td class="center text-center">Date Processed</td>
						<td class="center text-center">Check No.</td>
					</tr>
					<tr>
						<td><input type="checkbox">&nbsp;1st Release<br/>
							&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="checkbox">&nbsp;CA</td>
						<td>20%</td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
					</tr>
					<tr>
						<td><input type="checkbox">&nbsp;2nd Release</td>
						<td>20%</td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
					</tr>
					<tr>
						<td><input type="checkbox">&nbsp;3rd Release</td>
						<td>60%</td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
						<td><input type="text" class="form-control"></td>
					</tr>
					<tr>
						<td>Total</td>
						<td>100%</td>
						<td><input readonly type="text" class="form-control"></td>
						<td><input readonly type="text" class="form-control"></td>
						<td><input readonly type="text" class="form-control"></td>
						<td><input readonly type="text" class="form-control"></td>
						<td>&nbsp;</td>
						<td>&nbsp;</td>
					</tr>
				</table>
				</div>
			</fieldset>
		</div>
	</div>
	
	<div class="row">
		<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
			<fieldset> 
				<div class="form-group">
					<label class="col-md-1 control-label text-right" for="bsm_fullname"><small>Status</small></label>
					<div class="col-md-2"><input type="text" id="bsm_fullname" readonly placeholder="Status" value="" class="form-control text-left"></div>
				</div>
			</fieldset>	
		</div> 
	</div> 

	<div class="row">
		<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
			<fieldset> 
				<div class="form-group">
					<label class="col-md-1 control-label text-left left" for="bsm_fullname"><small>Remarks</small></label>
					<div class="col-md-5">
						<textarea cols="10" row="5" class="form-control"></textarea>
					</div>
				</div>
			</fieldset>	
		</div> 
	</div> 
	  
	  
</div>
</form>