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  <table width="873" border="1" align="center">
    <tr bgcolor="#FFFF00">
      <td width="835" bgcolor="#000099"><div align="left" class="style18">
        <div align="center" class="style29">MAKLUMAT PENDAFTARAN  </div>
      </div></td>
    </tr>
    <tr bgcolor="#99FFFF">
      <td bgcolor="#33FFCC">
        <div align="center">
          <table width="823" border="0" bgcolor="#FFFFFF">
            <tr>
              <td width="196" bgcolor="#33FFCC">No Akaun  Pendaftaran </td>
              <td width="585" bgcolor="#33FFCC">              Jenis Tuntutan : [  ] </td>
            </tr>
            <tr>
              <td bgcolor="#33FFCC">Kod / No Pelajar</td>
              <td bgcolor="#33FFCC"></td>
            </tr>
            <tr>
              <td bgcolor="#33FFCC">Tarikh Mula : </td>
              <td bgcolor="#33FFCC"> [  ] 
                 Tarikh Tamat : [  ]
              <span class="style27"> </span></td>
            </tr>
            <tr>
              <td bgcolor="#33FFCC">Yuran Bulanan : </td>
              <td bgcolor="#33FFCC"> [  ] 
                Diskaun (Jika Ada...) : [
               ] </td>
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