<table>
    <tr>
        <td width='4'></td>
    </tr>
    <tr>
        <td rowspan='2'></td>
    </tr>
    <tr>
        <td rowspan='2'></td>
    </tr>
    <tr>
        <td colspan='2'>
            <table border='2'>
                <tr>
                    <td></td>
                    <td>
                        <input type='text' value="hello" />
                    </td>
                </tr>
            </table>
        </td>
    </tr>
</table>

