<header class="jumbotron masthead">
  <div class="inner"><form action="/" method="post">
    <h1><!--Povolení.ru--><a href="/"><img src="/img/logo_{%language%}.png" alt="{%site_name_full%}" title="{%site_name_full%}" /></a></h1>
    <!--<p>Автоматическая проверка состояния заявления на ВНЖ/ПМЖ в МВД Чехии</p>-->
	<p style="font-size:20px;">OAM-</span></span><input type="text" id="code" name="code" value="{%code%}" maxlength="10">/<select style="width:55px" id="type" name="type">{%skin_html_type%}</select>-<select style="width:70px" id="year" name="year">{%skin_html_year%}</select></p>
	<p style="font-size:20px;">{%index_email%} <input type="text" name="email" id="email" value="{%email%}">
    <p class="download-info">
      <button class="btn btn-primary btn-large" type="submit">{%index_check%}</button>
    </p></form>
  </div> 
</header>