<form class="mt-40 mb-20">
  <input type="hidden" id="a2_id" placeholder="Id" value="">
  <label data-lang="gelar" for="r_gelar">Gelar</label>
  <p id="r_gelar"></p>
  <div class="grid grid-cols-2 grid-gap grid-no-margin">
    <div>
      <label data-lang="first_name" for="firstname">First Name</label>
      <input type="text" data-ph_lang="first_name" id="a2_first_name" name="firstname" placeholder="First Name">
    </div>
    <div>
      <label data-lang="last_name" for="lastname">Last Name</label>
      <input type="text" data-ph_lang="last_name" id="a2_last_name" name="lastname" placeholder="Last Name">
    </div>
  </div>
  <label data-lang="sex" for="r_sex">Jenis Kelamin</label>
  <p id="r_sex"></p>
  <label for="a2_dob" data-lang="dob">Tgl Lahir</label>
  <input type="date" id="a2_dob" data-ph_lang="dob" placeholder="Tgl Lahir" value="">
  <label for="a2_no_telp" data-lang="phone">No Telp</label>
  <input type="text" id="a2_no_telp" data-ph_lang="phone" placeholder="No Telp" value="">
  <label for="a2_alamat" data-lang="address">Alamat</label>
  <input type="text" id="a2_alamat" data-ph_lang="address" placeholder="Alamat" value="">
  <label for="a2_kodepos" data-lang="postcode">Kodepos</label>
  <input type="text" id="a2_kodepos" data-ph_lang="postcode" placeholder="Kodepos" value="">
  <div class="grid grid-cols-2 grid-gap grid-no-margin">
    <div>
      <label data-lang="rt" for="rt">RT</label>
      <input data-ph_lang="rt" type="text" id="a2_rt" name="rt" placeholder="RT">
    </div>
    <div>
      <label data-lang="rw" for="rw">RW</label>
      <input type="text" data-ph_lang="rw" id="a2_rw" name="rw" placeholder="RW">
    </div>
  </div>
  <label data-lang="village" for="a2_kelurahan">Kelurahan</label>
  <input type="text" data-ph_lang="village" id="a2_kelurahan" placeholder="Kelurahan" value="">
  <label data-lang="distict" for="a2_kecamatan">Kecamatan</label>
  <input data-ph_lang="distict" type="text" id="a2_kecamatan" placeholder="Kecamatan" value="">
  <label data-lang="city" for="a2_kabupaten">Kabupaten</label>
  <input data-ph_lang="city" type="text" id="a2_kabupaten" placeholder="Kabupaten" value="">
  <div class="centered-text">
    <a href="#" id="account_edit_button" class="button button-fill mb-30" data-lang="save">Save</a>
  </div>
</form>