paniers/public_html_admin/templates/lieux/lieu_form.tpl

<div class="modaLoader"></div>
<div class="row">
    <div class="col-md-12">
        <div class="form-group">
            <label>nom :</label>
            <input type="text" class="form-control" name="nom" placeholder="nom">
        </div>
    </div>
</div>