This illustration shows a completed web form.

In the top left is a print icon. 

Below that is the Name free-form text field. Below that is the Phone, Email, and Travel Amount free-form text fields, listed left to right.

Below them are the Trip Details (selected) and Expenses tabs. 

On the Trip Details tab, the Travel Date (text field), and the Country and City (drop-down lists) fields are listed left to right.

Below them are the Purpose of Travel (options) and Other Details (free-form text) fields listed top to bottom. 

All fields have values except for Travel Amount.