<html>
<body>
<table>
<tr>
<td width='1'></td>
</tr>
<tr>
<td colspan='2' rowspan='2'></td>
</tr>
<tr>
<td rowspan='2'></td>
</tr>
<tr>
<td colspan='2'>
<table>
<tr>
<td></td>
<td>
<input type='text' />
</td>
</tr>
</table>
</td>
</tr>
</table>
</body>
</html>