Extract data using CustomInput form

Hi All,

I have created a form from which I am extracting data using CustomInput activity in UiPath.
After click No radio button…when I am running it as custom input in UiPATH bot IS NOT showing values after clicking submit…actually after submit the Uipath shows the result which is not happening… please check my form and supportHTMLPage1.html (16.5 KB)

Please check manually without Uipath, as per my knowledge submit button not functioning.