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>

                    <!-- CloudFlare -->
                    <div class="col-sm-12 col-md-12">
                        <div class="form-group">
                            <label class="custom-switch">
                                <input type="checkbox" class="custom-switch-input" name="use_cloudflare" value="1">
                                <span class="custom-switch-indicator"></span>
                                <span class="custom-switch-description"><%= i18n('ssl', 'use-cloudflare') %></span>
                            </label>
                        </div>
                    </div>
                    <div class="col-sm-12 col-md-12 cloudflare">
                        <div class="form-group">
                            <label class="form-label">CloudFlare DNS API Token  <span class="form-required">*</span></label>
                            <input type="text" name="cloudflare_dns_api_token" class="form-control" id="input-domains" required>                            
                        </div>
                    </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 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 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 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>