<div class="form">

  <div class="row">

        <div class="col-md-5">

       <div class="md-form" data-cgbf-captcha="">

            <img src="https://www.uisge-beatha.eu/tmp/cache/php-captcha.jpg" width="200" height="60" alt="Visual Captcha">

       </div>

     </div>

    <div class="col-md-5">

        <span>Neem de tekens over</span>

        <div class="mt-1 md-form" data-cgbf-captcha-input="">

             <input name="cgbf_input_captcha" class="cgbf_input_captcha">

        </div>

     </div>

   </div>

</div>