2 sentences

1. 请在表格中填写你的出生地。

   qǐng zài biǎo​gé zhōng tián​xiě nǐ de chū​shēng​dì.

   Please fill in your place of birth on the form.

   Source: Dong Chinese Dictionary

2. 请在表格上填写你出生地的地名。

   qǐng zài biǎo​gé shàng tián​xiě nǐ chū​shēng​dì de dì​míng.

   Please fill in the name of your birthplace on the form.

   Source: Dong Chinese Dictionary