friendica/view/templates/settings/removeme.tpl

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<div class="generic-page-wrapper">
{{include file="section_title.tpl" title=$l10n.title}}
<div id="remove-account-wrapper">
<div id="remove-account-desc">{{$l10n.desc nofilter}}</div>
<form action="settings/removeme" autocomplete="off" method="post">
{{include file="field_password.tpl" field=$password}}
<div class="form-group pull-right settings-submit-wrapper">
<button type="submit" name="submit" class="btn btn-primary" value="{{$l10n.title}}"><i class="fa fa-trash fa-fw"></i>&nbsp;{{$l10n.title}}</button>
</div>
<div class="clear"></div>
</form>
</div>
</div>