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There is a problem with this code. When the user selects a country from the list, it displays the name of the country in Arabic

There is a problem with this code. When the user selects a country from the list, it displays the name of the country in Arabic and English and the countrys code in the other three fields. The problem is that when the user clicks on the submit button, it sends the fields empty with no data! What is the solution ?
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