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<form id="ajax_form" action="{{ url(route) }}" method="post">
  {{ get_hidden_inputs(url_params) }}

  <fieldset class="pma-fieldset input">
    <table>
      <tr>
        <td>{% trans 'From' %}</td>
        <td>
          <input type="text" name="from_prefix" id="initialPrefix">
        </td>
      </tr>
      <tr>
        <td>{% trans 'To' %}</td>
        <td>
          <input type="text" name="to_prefix" id="newPrefix">
        </td>
      </tr>
    </table>
  </fieldset>
</form>