<!DOCTYPE html>
<html>
<head>
<title>Title of the document</title>
<style>
div {
margin-bottom: 10px;
}
label {
display: inline-block;
width: 120px;
}
fieldset {
background: #e1eff2;
}
legend {
padding: 20px 0;
font-size: 22px;
}
</style>
</head>
<body>
<form>
<fieldset disabled>
<legend>Personal Information:</legend>
<div>
<label>First Name:</label>
<input type="text">
</div>
<div>
<label>Last Name:</label>
<input type="text">
</div>
<div>
<label>Date of birth:</label>
<input type="text">