Need to convert a word form document into html page using data driver from JSON

Hi, Attached is a word form document that needs to be converted into an HTML page. The project involves populating JSON structure with all the data so that HTML document (rendered using JSON structure) looks exactly like word document. Logic to render HTML document based on JSON is already implemented. Both HTML page and Javascript to do it is also attached in this project. What I need is someone to look at the word document and manually create JSON objects to HTML Page is rendered exactly like word document. Fix any formatting issues. Also, please look at this site to get an idea on how this will work: [login to view URL] The left side is what shold have data as shown in word document. The JS logic drives the functionality that happens when a check box is checked. Thanks