extranet/application/views/default/scripts/saisie/lienpp.phtml

<input type="hidden" name="pp" value="1"/>

<div class="fieldgrp">
<label>Nom d'usage</label>
<div class="field">
<input type="text" name="nom_usage"/>
</div>
</div>

<div class="fieldgrp">
<label>Prénom(s)</label>
<div class="field">
<input type="text" name="prenom"/>
</div>
</div>

<div class="fieldgrp">
<label>Civilité</label>
<div class="field">
<input type="radio" name="civilite" value="M"/>M.
<input type="radio" name="civilite" value="Mme"/>Mme
<input type="radio" name="civilite" value="Mlle"/>Mlle
</div>
</div>

<div class="fieldgrp">
<label>Né(e) le</label>
<div class="field">
<input type="text" size="10" name="naissance_date"/> à <input type="text" name="naissance_lieu"/>
<select name="nat">
<option>-</option>
<?php foreach($this->countries as $code => $lib) {?>
<option value="<?=$code?>"><?=$lib?></option>
<?php }?>
</select>
</div>
</div>

<div class="fieldgrp">
<label>Adresse</label>
<div class="field">
<input type="text" name="adresse_num" size="4"/>
<input type="text" name="adresse_btq" size="1"/>
<input type="text" name="adresse_codvoie" size="4"/>
<input type="text" name="adresse_libvoie" size="32"/>
</div>
</div>

<div class="fieldgrp">
<label>Adresse complément</label>
<div class="field">
<input type="text" name="adresse_comp" size="40"/>
</div>
</div>

<div class="fieldgrp">
<label>CP</label>
<div class="field">
<input type="text" name="adresse_cp"/>
</div>
</div>

<div class="fieldgrp">
<label>Ville</label>
<div class="field">
<input type="text" name="adresse_ville"/>
</div>
</div>

<div class="fieldgrp">
<label>Pays</label>
<div class="field">
<select name="adresse_pays">
<option value="">-</option>
<?php foreach($this->countries as $code => $lib) {?>
<option value="<?=$code?>"><?=$lib?></option>
<?php }?>
</select>
</div>
</div>