<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title></title>

    <!-- Loading Bootstrap -->
    <link href="css/vendor/bootstrap.min.css" rel="stylesheet">

    <!-- Loading Flat UI -->
    <link href="css/flat-ui.min.css" rel="stylesheet">

    <!-- Costum files -->
    <link rel="stylesheet" href="css/style.css">
    <script src="js/main.js" charset="utf-8"></script>

    <!-- HTML5 shim, for IE6-8 support of HTML5 elements. All other JS at the end of file. -->
    <!--[if lt IE 9]>
      <script src="js/vendor/html5shiv.js"></script>
      <script src="js/vendor/respond.min.js"></script>
    <![endif]-->
  </head>
  <body>
    <div class="container">
        <form align="center">
          <input type="text" class="form-control" placeholder="Nama.."><br>
          <input type="number" class="form-control" placeholder="No BPJS.."><br>
          <input type="submit" class="btn btn-info" value="Daftar">
        </form>
    </div>
    <!-- /.container -->


    <!-- jQuery (necessary for Flat UI's JavaScript plugins) -->
    <script src="js/vendor/jquery.min.js"></script>

  </body>
</html>

<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <title></title>

    <!-- Loading Bootstrap -->
    <link href="css/vendor/bootstrap.min.css" rel="stylesheet">

    <!-- Loading Flat UI -->
    <link href="css/flat-ui.min.css" rel="stylesheet">

    <!-- Costum files -->
    <link rel="stylesheet" href="css/style.css">
    <script src="js/main.js" charset="utf-8"></script>

    <!-- HTML5 shim, for IE6-8 support of HTML5 elements. All other JS at the end of file. -->
    <!--[if lt IE 9]>
      <script src="js/vendor/html5shiv.js"></script>
      <script src="js/vendor/respond.min.js"></script>
    <![endif]-->
  </head>
  <body>
    <div class="container">
        <form align="center">
          <input type="text" class="form-control" placeholder="Nama"><br>
          <input type="number" class="form-control" placeholder="No BPJS"><br>
          <input type="submit" class="btn btn-info" value="Daftar">
        </form>
    </div>
    <!-- /.container -->


    <!-- jQuery (necessary for Flat UI's JavaScript plugins) -->
    <script src="js/vendor/jquery.min.js"></script>

  </body>
</html>

Remove .. from input placeholder
Remove .. from input placeholder
