<div class="page page-account_edit" data-name="account_edit">

    <div class="navbar navbar-large">

      <div class="navbar-bg"></div>

      <div class="navbar-inner">

        <div class="left">

          <a href="#" class="link back">

            <i class="icon f7-icons arrow-back">arrow_left</i>

          </a>

        </div>

      <div class="title">Edit Account</div>

      <div class="title-large">

        <div class="title-large-text">Edit Account</div>

      </div>

        <div class="right">          

        </div>

      </div>

    </div>

    <div class="page-content">

    <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>

  </div>

</div>