<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title>Account Registration - NATIONAL BANK</title>
    <style>
        body {
            font-family: Arial, sans-serif;
            line-height: 1.6;
            color: #333;
            max-width: 600px;
            margin: 0 auto;
            padding: 20px;
        }
        
        h1 {
            color: #2c3e50;
            text-align: center;
            margin-bottom: 30px;
        }
        
        .form-group {
            margin-bottom: 20px;
        }
        
        label {
            display: block;
            margin-bottom: 5px;
            font-weight: bold;
        }
        
        input[type="text"],
        input[type="date"],
        input[type="tel"],
        input[type="email"],
        textarea {
            width: 100%;
            padding: 10px;
            border: 1px solid #ddd;
            border-radius: 4px;
            box-sizing: border-box;
        }
        
        .account-type {
            margin: 15px 0;
        }
        
        .account-type-options {
            display: flex;
            flex-wrap: wrap;
            gap: 15px;
            margin-top: 10px;
        }
        
        .account-type-options label {
            font-weight: normal;
            display: flex;
            align-items: center;
            gap: 5px;
        }
        
        .other-currency {
            margin-top: 10px;
            display: flex;
            align-items: center;
            gap: 5px;
        }
        
        .other-currency input {
            width: auto;
        }
        
        .confirmation {
            margin: 25px 0;
        }
        
        .signature-date {
            display: flex;
            justify-content: space-between;
            margin-top: 40px;
        }
        
        .signature, .date {
            width: 45%;
        }
        
        .signature-line {
            border-bottom: 1px solid #333;
            height: 30px;
            margin-top: 5px;
        }
        
        .bank-logo {
            text-align: center;
            margin-top: 40px;
            font-size: 24px;
            font-weight: bold;
            color: #2c3e50;
        }
        
        .submit-btn {
            background-color: #2c3e50;
            color: white;
            border: none;
            padding: 12px 20px;
            border-radius: 4px;
            cursor: pointer;
            font-size: 16px;
            width: 100%;
            margin-top: 20px;
        }
        
        .submit-btn:hover {
            background-color: #1a252f;
        }
    </style>
</head>
<body>
    <h1>Account Registration Form</h1>
    
    <form>
        <div class="form-group">
            <label for="fullName">Full Name</label>
            <input type="text" id="fullName" name="fullName" required>
        </div>
        
        <div class="form-group">
            <label for="dob">Date of Birth</label>
            <input type="date" id="dob" name="dob" required>
        </div>
        
        <div class="form-group">
            <label for="phone">Phone Number</label>
            <input type="tel" id="phone" name="phone" required>
        </div>
        
        <div class="form-group">
            <label for="address">Residential Address</label>
            <textarea id="address" name="address" rows="3" required></textarea>
        </div>
        
        <div class="form-group account-type">
            <label>Preferred Account Type</label>
            <div class="account-type-options">
                <label><input type="radio" name="accountType" value="savings" required> Savings</label>
                <label><input type="radio" name="accountType" value="checking"> Checking</label>
                <label><input type="radio" name="accountType" value="joint"> Joint Account</label>
            </div>
            
            <div class="other-currency">
                <label><input type="radio" name="accountType" value="other"> Other:</label>
                <input type="text" name="otherCurrency" placeholder="Specify currency">
            </div>
        </div>
        
        <div class="confirmation">
            <label>
                <input type="checkbox" required> 
                I confirm that the information provided is accurate and agree to the terms and conditions of the bank.
            </label>
        </div>
        
        <div class="signature-date">
            <div class="signature">
                <label>Signature</label>
                <div class="signature-line"></div>
            </div>
            
            <div class="date">
                <label>Date</label>
                <input type="date" name="signatureDate" required>
            </div>
        </div>
        
        <button type="submit" class="submit-btn">Submit Application</button>
    </form>
    
    <div class="bank-logo">NATIONAL BANK</div>
</body>
</html>