Collect data via form, create a PDF and send it by mail

I need a small system that has these features: A form whose fields are: - choice of 4 png images (required to check 1 to 4. For example radio button. The images are saved in a folder on the server) - Name (Control entered only text data) - Surname (Control entered only text data) - Email (regex and html5 and if the email exists example as Http://[login to view URL]) - Date of birth (click to view the calendar for date selection or pre-formatted example 01/12/1980) - Gender (F / M [login to view URL]) - Serial number (check if start with two static letter for example FA, only letter and number, max length 12. Ex. FA0123456789) Each entry error should be displayed under the box with an error and highlight the box where the error occurred. All fields are required. When the user clicks the submit button: - send the data of the form to a table of db (mysql) - created a pdf (with graphics that will be provided) with all the data in the form and with the image chosen in the form (it can be inserted other static texts and images that i will send you) - sent an email to the administrator, using the server's SMTP with the form data and static text and attached the pdf created earlier - sent an email to the email entered in the form, using the server's SMTP server with the form data and static text and attached the pdf created earlier A confirmation message must be visible under the form. All have to work on a LAMP system. All in php, html5, css3, jQuery, mysql. See the image below for more informations about the form