How to display Checkboxes in *.rtf output using rtf xml template in BI Publisher

I want to display check boxes in my rtf output document, user check in the check box based upon his satisfaction and sends the document for further process. Now we are sending this rtf document to the users using XML Bursting process, now we want to display the check boxes in the same document where user can rate it.

Can anyone guide me to achieve the solution.

Thank,

MR.