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pdf_1.html
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<!doctype html>
<html lang="zh-Hant" class="no-js">
<head>
<meta name="robots" content="noindex" /><!-- 使用 noindex 禁止 Google 搜尋建立索引，套版時請工程師刪掉這行 -->
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>外交部領事事務局護照預約申請</title>
<!--HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries [if lt IE 9]>
<script src="js/html5shiv.js"></script>
<script src="js/respond.min.js"></script>
<![endif]-->
<!-- CSS -->
<link rel="stylesheet" href="css/PDF.css">
<!-- favicon -->
<link href="images/favicon.png" rel="icon" type="image/x-icon">
</head>
<body style="background: #ddd;">
<section class="PDF">
<div class="flex-1-2">
<div class="col note">送件旅行社<br>請於本欄蓋章</div>
<div class="col flex-2-1">
<div class="col">
<h2>簡式護照資料表</h2>
<p>首次申請護照<br>戶所一站式收件/人別確認專用</p>
</div>
<div class="col note">備註欄</div>
<p class="note">(申請人應填寫資料，請以黑筆填寫)</p>
</div>
</div>
<section>
<table>
<tbody>
<tr>
<th>申辦項目</th>
<td colspan="3" class="">
<div class="col"><input type="checkbox" name="" value=""><b>一站式服務<span>(在戶所送件)</span></b></div>
<div class="col"><input type="checkbox" name="" value=""><b>人別確認<span>(到領務局或外交部四辦事處送件)</span></b></div>
</td>
</tr>
<tr>
<th width="20%">身分證字號</th>
<td width="55%" colspan="2">A123456789</td>
<td width="25%" rowspan="3" class="foto" height="220"><b>照片浮貼處<span class="note">注意：相片請另詳參外交部領事事務局「晶片護照相片規格」</span></b></td>
</tr>
<tr>
<th width="20%">姓 名</th>
<td width="55%" colspan="2">123</td>
</tr>
<tr>
<th width="20%">外文姓名<span>(姓在前，名在後，<br>並以「，」區隔)</span></th>
<td width="55%" colspan="2" class="foreign_name">123<span class="focus">倘外文姓名有特別需求，請於備註欄敘明原因，並簽名具結</span></td>
</tr>
<tr>
<th width="20%">外文別名<span>(非必要填寫)</span></th>
<td width="55%" colspan="4">123</td>
</tr>
<tr>
<th colspan="2" width="50%">一站式領照方式</th>
<th colspan="2" width="50%">人別確認注意事項</th>
</tr>
<tr>
<td colspan="2" width="50%">
<div class="col" style="width: 100%;"><input type="checkbox" name="" value=""><b>至戶所領件<span>(不須另付郵資)</span></b></div>
<div class="col" style="width: 100%;"><input type="checkbox" name="" value=""><b>郵寄至指定地址<span>(貨到自付郵資)：</span></b>
<br><textarea name="" id="address" cols="30" rows="10"></textarea>
</div>
</td>
<td colspan="2" width="50%" style="vertical-align: top;">
<p class="note" style="border-bottom: 1px solid #ddd; padding-bottom: 10px;">經戶所辦理人別確認之資料表，須於6個月內持憑向外交部領事事務局或中、南、東部、雲嘉南辦事處申請護照，逾期申請者須重新辦理人別確認。</p>
<span style="width: 30%;"><b>受理日期：</b><br><time>2021/11/12</time></span>
<span style="width: 60%;"><b>戶所專用章：</b></span>
</td>
</tr>
</tbody>
</table>
<table>
<tr>
<td rowspan="5" width="5%">聯絡方式</td>
</tr>
<tr>
<td width="15%" align="right">電話</td>
<td colspan="4">123</td>
</tr>
<tr>
<td align="right">電子郵件</td>
<td colspan="4">123</td>
</tr>
<tr>
<td rowspan="2" align="right">地址</td>
<td colspan="4"><input type="checkbox" name="" value="">同戶籍地址（勾選本欄者，免填）</td>
</tr>
<tr>
<td colspan="4"><input type="checkbox" name="" value="">如右：<span class="field">123</span></td>
</tr>
<tr>
<td colspan="2" rowspan="2" align="right">緊急聯絡人</td>
<td width="12%" align="right">姓名</td>
<td>123</td>
<td width="12%" align="right">關係</td>
<td>123</td>
</tr>
<tr>
<td width="12%" align="right">電話</td>
<td colspan="3">123</td>
</tr>
</table>
</section>
<h3>茲聲明本資料表所填資料，所附證件及照片俱確實無訛，如有不實，願負法律責任。</h3>
<div class="flex-2">
<div class="col">
<b>護照申請人簽名：</b><span class="sign"> </span>
</div>
<div class="col">
<b>日期：</b><span class="sign"><b> </b>年<b> </b>月<b> </b>日</span>
</div>
</div>
<h4 class="note">一站式<b>領照時間為繳費後8個工作天。不及等候擬申請速件處理者，不適用戶政事務所代送件服務。</b>申請人可選擇辦理人別確認後持本資料表委託他人至外交部領事事務局或外交部中、南、東部或雲嘉南辦事處申請護照。</h4>
<div class="flex">
<time>填表日期：<span>110年10月10日</span><span>12:59:59</span></time>
<img src="images/bar_code.jpg" alt="">
</div>
</section>
</body>