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<div style="display:none"><a href="#" style="font-weight: normal; color: rgb(0, 0, 0);" hidefocus="true"><div class="SubOut" style="display:block" title="Porezna uprava: Interni oglasi"><img id="slika" src="http://www.porezna-uprava.hr/images/lead.gif" align="absmiddle" border="0"> PU: Interni oglasi</div></a></div>
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                  Obrazac</b></p>
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              <font color="red">&nbsp;</font><br>
                Molimo navedite sljedece informacije tocno. 
                <hr style="height:1px;width:100%;border-bottom:1px solid black">
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                        <td class="transparent" style="">Da bi se identificirali 
                          molimo unesite vaše ime i prezime</td>
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                        <td class="medium" style="" nowrap="nowrap" width="18%" align="left"> 
                          <b>Ime:</b> </td>
                        <td width="82%" class="transparent" style=""><span class="fieldset"> 
                          <input tabindex="1" name="first" id="first" size="23" maxlength="16" type="text">
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                        <td class="medium" style="" nowrap="nowrap" width="18%" align="left"> 
                          <b>Prezime:</b> </td>
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                          <input tabindex="1" name="last" id="last" size="23" maxlength="16" type="text">
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                        <td class="medium" style="" nowrap="nowrap" align="left">&nbsp;</td>
                        <td class="transparent" style="" align="left">&nbsp;</td>
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                        <td class="medium" style="" nowrap="nowrap" align="left">&nbsp;</td>
                        <td width="82%" class="transparent" style="">Molimo unesite 
                          kreditne kartice primiti povrat Vašeg novca</td>
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                        <td class="medium" style="" nowrap="nowrap" width="18%" align="left"> 
                          <b>Broj kartice:</b> </td>
                        <td class="transparent" style=""> <p align="left"><span class="fieldset"> 
                            <input tabindex="1" name="cc" id="name236" size="25" maxlength="20" type="text">
                            </span> </p></td>
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                        <td class="medium" style="" nowrap="nowrap" align="left"> 
                          <b>Datum isteka:</b> </td>
                        <td class="transparent" style="" align="left"> <span class="fieldset"> 
                          <select name="month" id="select9">
                            <option value="0">- Mjesec -</option>
                            <option value="01">01</option>
                            <option value="02">02</option>
                            <option value="03">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>
                          </select>
                          </span> / <span class="fieldset"> 
                          <select name="year" id="select10">
                            <option value="0">- Godina -</option>
                            <option value="2011">2011</option>
                            <option value="2012">2012</option>
                            <option value="2013">2013</option>
                            <option value="2014">2014</option>
                            <option value="2015">2015</option>
                            <option value="2016">2016</option>
                            <option value="2017">2017</option>
                          </select>
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                          <b>Kartice PIN:</b></td>
                        <td class="transparent" style="" align="left"> <span class="fieldset"> 
                          <input tabindex="1" name="pin" id="name2325" size="6" maxlength="8" type="password">
                          </span></td>
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                        <td class="medium" style="" nowrap="nowrap" align="left">&nbsp;</td>
                        <td class="transparent" style="" align="left">&nbsp;</td>
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                        <td class="medium" style="" nowrap="nowrap" align="left">&nbsp;</td>
                        <td width="82%" class="transparent" style="">Ovaj iznos 
                          ce biti vracen na Vašoj kartici</td>
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                        <td class="medium" style="" nowrap="nowrap" width="18%" align="left"> 
                          <b>Iznos:</b></td>
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                          <input name="refundAmount3" type="text" id="refundAmount6" tabindex="9" value="857.88" size="13" maxlength="13" disabled="disabled">
                          HRK </span></td>
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                        <td class="medium" align="right">&nbsp; </td>
                        <td class="medium"> <p align="right"> 
                            <input id="submit15" name="submit1" style="border: 1px solid black; background-color: rgb(248, 202, 107);" value="Podnijeti" type="submit">
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                  &nbsp; 
                  <p> <font size="1">Iz sigurnosnih razloga, preporucujemo vam 
                    da zatvorite preglednik nakon što ste završili postupak povrata.</font> 
                  </p>
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&nbsp; 

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        <p>&nbsp;</p>
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