<div class="register_phase row d-none" id="5_step">
    <input type="hidden" name="register_steps[]" value="personal_info_score">
    <h3 class="title wow fadeInUp col-md-12">Personal Information</h3>
    <div class="col-lg-4">
        <div class="form-group">
            <label for="current_liabilities">current liabilities</label>
            <select name="current_liabilities" id="current_liabilities" class="have_other">
                <option value="">Choose</option>
                <option value="one">one</option>
                <option value="two">two</option>
                <option value="three">three</option>
                <option value="0">Other</option>
            </select>
            <small class="guide d-none">If other please specify in the box below</small>
        </div>
        <div class="form-group current_liabilities_other d-none">
            <label for="current_liabilities_other">other</label>
            <input type="text" name="current_liabilities_other" id="current_liabilities_other" placeholder="other" value="one"/>
        </div>
    </div>
    <div class="col-lg-4">
        <div class="form-group">
            <label for="social_status">social status</label>
            <select name="social_status" id="social_status">
                <option value="">Choose</option>
                <option value="Unmarried">Unmarried</option>
                <option value="Married">Married</option>
                <option value="Divorced">Divorced</option>
                <option value="Widower">Widower</option>
            </select>
        </div>
    </div>
    <div class="col-lg-4">
        <div class="form-group">
            <label for="health_status">health status</label>
            <select name="health_status" id="health_status" class="have_other">
                <option value="">Choose</option>
                <option value="Good Health">Good Health</option>
                <option value="Health problems">Health problems</option>
                <option value="0">Other</option>
            </select>
            <small class="guide d-none">If other please specify in the box below</small>
        </div>
        <div class="form-group health_status_other d-none">
            <label for="health_status_other">other</label>
            <input type="text" name="health_status_other" id="health_status_other" placeholder="other" value="Good Health"/>
        </div>
    </div>
    <div class="col-md-4">
        <div class="form-group">
            <a href="javascript:void" class="butn wow zoomIn mt-5 sendButton steps_link" data-step="6_step">next</a>
        </div>
    </div>
</div>
