<table width="100%"  border="0" cellspacing="4" cellpadding="4" class="panel">
  <tr>
    <td>TAHAPAN PERKARA </td>
  </tr>
  <tr>
    <td><form name="form1" method="post" action="">
        <table width="100%"  border="0" cellspacing="4" cellpadding="4">
          <tr>
            <td width="25%">P17</td>
            <td width="1%">:</td>
            <td width="74%"><select name="select14">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select14">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select14">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P18</td>
            <td>:</td>
            <td><select name="select13">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select13">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select13">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P19</td>
            <td>:</td>
            <td><select name="select7">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select7">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select7">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P20</td>
            <td>:</td>
            <td><select name="select8">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select8">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select8">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P21</td>
            <td>:</td>
            <td><select name="select9">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select9">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select9">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P21A</td>
            <td>:</td>
            <td><select name="select10">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select10">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select10">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P31</td>
            <td>:</td>
            <td><select name="select11">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select11">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select11">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>P48</td>
            <td>:</td>
            <td><select name="select12">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select12">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select12">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>BA-20</td>
            <td>&nbsp;</td>
            <td><select name="select15">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03" selected>03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
              </select>
                <select name="select15">
                  <option value="1">JANUARI</option>
                  <option value="2">FEBRUARI</option>
                  <option value="3" selected>MARET</option>
                  <option value="4">APRIL</option>
                  <option value="5">MEI</option>
                  <option value="6">JUNI</option>
                  <option value="7">JULI</option>
                  <option value="8">AGUSTUS</option>
                  <option value="9">SEPTEMBER</option>
                  <option value="10">OKTOBER</option>
                  <option value="11">NOPEMBER</option>
                  <option value="12">DESEMBER</option>
                </select>
                <select name="select15">
                  <option value="2015">2015</option>
                  <option value="2016" selected>2016</option>
                  <option value="2017">2017</option>
                  <option value="2018">2018</option>
              </select></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
            <td><input type="submit" name="Submit2" value="Kirim"></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
        </table>
    </form></td>
  </tr>
</table>
