Survey form. I do not know where should I put these informations

So I am doing the “survey form” code, and there are requirements to enter my name and e-mail into the code, but I do not really understand where should I enter it. If someone may help me, that would be great) Should I put it in placeholder, or should I put it in different place?

Is not to put your email. You must just make something similar

Can i see your code??