nginx-proxy-manager/frontend/js/app/nginx/certificates/form.ejs

<div class="modal-content">
    <div class="modal-header">
        <h5 class="modal-title"><%- i18n('certificates', 'form-title', {provider: provider}) %></h5>
        <button type="button" class="close cancel" aria-label="Close" data-dismiss="modal">&nbsp;</button>
    </div>
    <div class="modal-body">
        <form>
            <div class="row">
                <% if (provider === 'letsencrypt') { %>
                    <div class="col-sm-12 col-md-12">
                        <div class="form-group">
                            <label class="form-label"><%- i18n('all-hosts', 'domain-names') %> <span class="form-required">*</span></label>
                            <input type="text" name="domain_names" class="form-control" id="input-domains" value="<%- domain_names.join(',') %>" required>
                            <div class="text-blue"><i class="fe fe-alert-triangle"></i> <%- i18n('ssl', 'hosts-warning') %></div>
                        </div>
                    </div>
                    <div class="col-sm-12 col-md-12">
                        <div class="form-group">
                            <label class="form-label"><%- i18n('ssl', 'letsencrypt-email') %> <span class="form-required">*</span></label>
                            <input name="meta[letsencrypt_email]" type="email" class="form-control" placeholder="" value="<%- getLetsencryptEmail() %>" required>
                        </div>
                    </div>

                    <!-- DNS challenge -->
                    <div class="col-sm-12 col-md-12">
                        <div class="form-group">
                            <label class="custom-switch">
                                <input 
                                    type="checkbox" 
                                    class="custom-switch-input" 
                                    name="meta[dns_challenge]" 
                                    value="1" 
                                    <%- getUseDnsChallenge() ? 'checked' : '' %>
                                >
                                <span class="custom-switch-indicator"></span>
                                <span class="custom-switch-description"><%= i18n('ssl', 'dns-challenge') %></span>
                            </label>
                        </div>
                    </div>
                    <div class="col-sm-12 col-md-12">
                        <fieldset class="form-fieldset dns-challenge">
                            <div class="text-red mb-4"><i class="fe fe-alert-triangle"></i> <%= i18n('ssl', 'certbot-warning') %></div>

                            <!-- Certbot DNS plugin selection -->
                            <div class="row">
                                <div class="col-sm-12 col-md-12">
                                    <div class="form-group">
                                        <label class="form-label"><%- i18n('ssl', 'dns-provider') %> <span class="form-required">*</span></label>
                                        <select 
                                            name="meta[dns_provider]" 
                                            id="dns_provider"
                                            class="form-control custom-select"
                                        >
                                            <option 
                                                value="" 
                                                disabled 
                                                hidden
                                                <%- getDnsProvider() === null ? 'selected' : '' %>
                                            >Please Choose...</option>
                                            <% _.each(dns_plugins, function(plugin_info, plugin_name){ %>
                                            <option 
                                                value="<%- plugin_name %>"
                                                <%- getDnsProvider() === plugin_name ? 'selected' : '' %>
                                            ><%- plugin_info.display_name %></option>
                                            <% }); %>
                                        </select>
                                    </div>
                                </div>
                            </div>

                            <!-- Certbot credentials file content -->
                            <div class="row credentials-file-content">
                                <div class="col-sm-12 col-md-12">
                                    <div class="form-group">
                                        <label class="form-label"><%- i18n('ssl', 'credentials-file-content') %> <span class="form-required">*</span></label>
                                        <textarea 
                                            name="meta[dns_provider_credentials]" 
                                            class="form-control text-monospace" 
                                            id="dns_provider_credentials" 
                                        ><%- getDnsProviderCredentials() %></textarea>
                                        <div class="text-secondary small">
                                            <i class="fe fe-info"></i> 
                                            <%= i18n('ssl', 'credentials-file-content-info') %>
                                        </div>
                                    </div>
                                </div>
                            </div>

                            <!-- DNS propagation delay -->
                            <div class="row">
                                <div class="col-sm-12 col-md-12">
                                    <div class="form-group mb-0">
                                        <label class="form-label"><%- i18n('ssl', 'propagation-seconds') %></label>
                                        <input 
                                            type="number"
                                            min="0"
                                            name="meta[propagation_seconds]" 
                                            class="form-control" 
                                            id="propagation_seconds" 
                                            value="<%- getPropagationSeconds() %>"
                                        >
                                        <div class="text-secondary small">
                                            <i class="fe fe-info"></i> 
                                            <%= i18n('ssl', 'propagation-seconds-info') %>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </fieldset>
                    </div>

                    <div class="col-sm-12 col-md-12">
                        <div class="form-group">
                            <label class="custom-switch">
                                <input type="checkbox" class="custom-switch-input" name="meta[letsencrypt_agree]" value="1" required<%- getLetsencryptAgree() ? ' checked' : '' %>>
                                <span class="custom-switch-indicator"></span>
                                <span class="custom-switch-description"><%= i18n('ssl', 'letsencrypt-agree', {url: 'https://letsencrypt.org/repository/'}) %> <span class="form-required">*</span></span>
                            </label>
                        </div>
                    </div>
                <% } else if (provider === 'other') { %>
                    <!-- Other -->
                    <div class="col-sm-12 col-md-12">
                        <div class="form-group">
                            <label class="form-label"><%- i18n('str', 'name') %> <span class="form-required">*</span></label>
                            <input name="nice_name" type="text" class="form-control" placeholder="" value="<%- nice_name %>" required>
                        </div>
                    </div>
                    <div class="col-sm-12 col-md-12 other-ssl">
                        <div class="form-group">
                            <div class="form-label"><%- i18n('certificates', 'other-certificate-key') %><span class="form-required">*</span></div>
                            <div class="custom-file">
                                <input type="file" class="custom-file-input" name="meta[other_certificate_key]" id="other_certificate_key" required>
                                <label id="other_certificate_key_label" class="custom-file-label"><%- i18n('str', 'choose-file') %></label>
                            </div>
                        </div>
                    </div>
                    <div class="col-sm-12 col-md-12 other-ssl">
                        <div class="form-group">
                            <div class="form-label"><%- i18n('certificates', 'other-certificate') %><span class="form-required">*</span></div>
                            <div class="custom-file">
                                <input type="file" class="custom-file-input" name="meta[other_certificate]" id="other_certificate">
                                <label id="other_certificate_label" class="custom-file-label"><%- i18n('str', 'choose-file') %></label>
                            </div>
                        </div>
                    </div>
                    <div class="col-sm-12 col-md-12 other-ssl">
                        <div class="form-group">
                            <div class="form-label"><%- i18n('certificates', 'other-intermediate-certificate') %></div>
                            <div class="custom-file">
                                <input type="file" class="custom-file-input" name="meta[other_intermediate_certificate]" id="other_intermediate_certificate">
                                <label id="other_intermediate_certificate_label" class="custom-file-label"><%- i18n('str', 'choose-file') %></label>
                            </div>
                        </div>
                    </div>

                <% } %>
            </div>
        </form>
    </div>
    <div class="modal-footer">
        <button type="button" class="btn btn-secondary cancel" data-dismiss="modal"><%- i18n('str', 'cancel') %></button>
        <button type="button" class="btn btn-teal save"><%- i18n('str', 'save') %></button>
    </div>
</div>