{"status":"success","response":"<div id=\"custom_forms\">\n\n<div class=\"report_row\" id=\"custom_field_row_2\"><h4>Site of Harrassment <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > On a bus <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"On a bus\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > In  train <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"In  train\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > At a Taxi stand <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"At a Taxi stand\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > At a Auto stand <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"At a Auto stand\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > Market <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"Market\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > Park <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"Park\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > Isolated lane <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"Isolated lane\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > Whilst walking on a footpath <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"Whilst walking on a footpath\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > In your building or near residence <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"In your building or near residence\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > On a station platform <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"On a station platform\" id=\"custom_field_2\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[2]\" > Bridge or subway <\/label><input type=\"radio\" name=\"custom_field[2]\" value=\"Bridge or subway\" id=\"custom_field_2\" \/><\/span><\/div><div class=\"report_row\" id=\"custom_field_row_3\"><h4>Profile of Harasser <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Youth <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Youth\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Co-worker\/student <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Co-worker\/student\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Stranger\/s <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Stranger\/s\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Police or other authority <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Police or other authority\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Drivers or conductors <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Drivers or conductors\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Family\/relative <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Family\/relative\" id=\"custom_field_3\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[3]\" > Boss or Superior <\/label><input type=\"radio\" name=\"custom_field[3]\" value=\"Boss or Superior\" id=\"custom_field_3\" \/><\/span><\/div><div class=\"report_row\" id=\"custom_field_row_4\"><h4>Your Gender<span class='required'> *<\/span> <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Male <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Male\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Female <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Female\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Transgender <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Transgender\" id=\"custom_field_4\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[4]\" > Other <\/label><input type=\"radio\" name=\"custom_field[4]\" value=\"Other\" id=\"custom_field_4\" \/><\/span><\/div><div class=\"report_row\" id=\"custom_field_row_5\"><h4>Your Age<span class='required'> *<\/span> <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Younger than 13 years <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Younger than 13 years\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Between 13 and 18 years <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Between 13 and 18 years\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Between 19 and 25 years <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Between 19 and 25 years\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Between 26 and 45 years <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Between 26 and 45 years\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Between 46 to 56 years <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Between 46 to 56 years\" id=\"custom_field_5\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[5]\" > Older than 57 years <\/label><input type=\"radio\" name=\"custom_field[5]\" value=\"Older than 57 years\" id=\"custom_field_5\" \/><\/span><\/div><div class=\"report_row\" id=\"custom_field_row_6\"><h4>Name of Road <\/h4><input type=\"text\" name=\"custom_field[6]\" value=\"\" id=\"custom_field_6\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_7\"><h4>Landmark <\/h4><input type=\"text\" name=\"custom_field[7]\" value=\"\" id=\"custom_field_7\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_8\"><h4>Area <\/h4><input type=\"text\" name=\"custom_field[8]\" value=\"\" id=\"custom_field_8\" class=\"text custom_text\" \/><\/div><div class=\"report_row\" id=\"custom_field_row_11\"><h4>Name the Zone <\/h4><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > South Mumbai <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"South Mumbai\" id=\"custom_field_11\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > Northern Suburbs <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"Northern Suburbs\" id=\"custom_field_11\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > Central Mumbai <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"Central Mumbai\" id=\"custom_field_11\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > Western Suburbs <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"Western Suburbs\" id=\"custom_field_11\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > Thane <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"Thane\" id=\"custom_field_11\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > Navi Mumbai <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"Navi Mumbai\" id=\"custom_field_11\" \/><\/span><span class=\"custom-field-option\"><label for=\"custom_field[11]\" > Other <\/label><input type=\"radio\" name=\"custom_field[11]\" value=\"Other\" id=\"custom_field_11\" \/><\/span><\/div><\/div>"}