<div class="form-group is-required">
     <label for="fieldb">${FieldB}:</label>
     <input type="text" class="my-input" ng-model="c.data.fieldb" id="fieldb" placeholder="Enter Field B">
    </div>

     <div class="form-group is-required">
     <label for="fieldc">${FieldC}:</label>
     <input type="text" class="my-input" ng-model="c.data.fieldc" id="fieldc" placeholder="Enter Field C">
    </div>