I had to do a reset. I copied your image and enlarged it width wise and then made the back ground transparent. The image is on photo bucket, but is not cleaned up. You can get is and work with it yourself.
Code:
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<title>New document</title>
<style type="text/css">
html, body, div, span {
margin: 0;
padding: 0;
border: 0;
}
.first{
width: 220px;
text-align:right;
padding-right: 15px;
}
.second{
text-align:left;
padding-left: 15px;
}
table{
margin-top: 25px;
}
#banner{
position: absolute;
top: 13px;
}
#container{
width: 712px;
height: 400px;
margin: auto;
}
</style>
</head>
<body>
<div id="container">
<table width="700" border="1">
<tr><td class="first">Admission Date</td><td class="second">July 20, 2012</td></tr>
<tr><td class="first">Date of Birth</td><td class="second">July 20, 2007</td></tr>
<tr><td class="first">Blood Group</td><td class="second"></td></tr>
<tr><td class="first">Gender</td><td class="second">Male</td></tr>
<tr><td class="first">Nationality</td><td class="second">India</td></tr>
<tr><td class="first">Language</td><td class="second"></td></tr>
<tr><td class="first">Catagory</td><td class="second">Hispanic</td></tr>
<tr><td class="first">Religion</td><td class="second"></td></tr>
<tr><td class="first">Address</td><td class="second"></td></tr>
<tr><td class="first">City</td><td class="second"></td></tr>
<tr><td class="first">State</td><td class="second"></td></tr>
<tr><td class="first">PIN Code</td><td class="second"></td></tr>
</table>
<img id="banner" src="http://i815.photobucket.com/albums/zz74/sunfighter41/detail.png" border="0" alt="Photobucket"></a>
</div>
</body>
</html>