custom filter on the list

Hi Team, 

i have a list which is going to update daily through a workflow. Now i want to add a custom filter on this list such as a user can enter a month and year to filter the respondents based on month and year. 

This is my list : 

So i want to add a filter on the "date" column so based on month and year of that date we need to show the results in the list. 

For example : Like in the screenshot below there should be a month drop down and year input box where a user can enter and based on the month and year of the date column we need to filter the results of list. 

I have clicked advanced filter on the list and this is the query i am taking : 

i have clicked on save button on the right and it gave me below : 

i clicked on form : It seems the code here should be written in xml or html so what code i need to write here for displaying month field with month dropdown and year feild input box. 

When i click on preview i am getting some error : 

Can anyone help on this.