--- /dev/null
+<table align="center" valign="middle" border="0" cellspacing="0" cellpadding="0" class="wrapper dataTable">
+ <tr>
+ <td class="DataTD"><?=_Country where you want to visit the TTP?></td>
+ <td class="DataTD"><select size="1" name="country">
+ <? foreach($countries) {?>
+ <option value="<?=$i?>"><?=$country?></option>
+ <? } ?>
+ </select></td>
+ </tr>
+<!-- <tr>
+ <td class="DataTD"><?=_I want to take part in the TTP Topup programme?></td>
+ <td class="DataTD"><input type="checkbox" name="ttptopup" value="1"></td>
+ </tr>-->
+ <tr>
+ <td colspan="2" >
+ <input type="submit" name="ttp" value="<?=_I need a TTP assurance?>">
+ </td>
+ </tr>
+</table>