Admin - Plateforme Administration Editions Préference

Contient un/plusieurs signataires

Reprise des signataires

Peut etre dupliqué

Nombre maximum de block

Texte du bouton 'ajouter'

Texte du bouton 'supprimer'

Ce block contient un

Contenu

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: bottom; width: 50%;">{% select_tag name=&quot;871c999a&quot; data_label=&quot;Civilit&eacute;&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|civilite; Madame|madame; Monsieur|monsieur;&quot; relation_ids_list=&quot;871c169a&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nom :</span></td>
			<td style="vertical-align: bottom; width: 50%; text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Pr&eacute;nom :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;dc28f4a7&quot; data_label=&quot;Nom du signataire&quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;79fc7ffa&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;95be4670&quot; data_label=&quot;Pr&eacute;nom du signataire&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Pr&eacute;nom du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;5185aba3&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail :&nbsp;</span></td>
			<td style="vertical-align: middle; width: 30%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">T&eacute;l :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;c5c85d31&quot; data_label=&quot;Email du signataire&quot; data_map_field=&quot;email&quot; data_help=&quot;Email du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;f4f59f87&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;b8d8459b&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;mobile&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;15&quot; relation_ids_list=&quot;f851d3d5&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="break-inside:avoid;width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance :</span></td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% dateinput_tag name=&quot;02bed29a&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de naissance&quot; data_map_field=&quot;date_naissance&quot; data_help=&quot;Date de naissance&quot; relation_ids_list=&quot;dfb8b19c&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 80%;">{% textinput_tag name=&quot;114146e5&quot; data_label=&quot;Lieu de naissance&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Lieu de naissance&quot; maxlength=&quot;80&quot; relation_ids_list=&quot;6b66c4c9&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Profession&nbsp;:</span></td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nationalit&eacute;&nbsp;:</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;9a8c47d2&quot; data_label=&quot;Profession &quot; data_map_field=&quot;job&quot; data_help=&quot;Profession &quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;c3df2ff9&quot; data_label=&quot;Nationalit&eacute; &quot; data_map_field=&quot;nationality&quot; data_help=&quot;Nationalit&eacute; &quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% checkbox_tag name=&quot;b7e64678&quot; data_label=&quot;R&eacute;sident fiscal&quot; data_map_field=&quot;nomap&quot; data_help=&quot;R&eacute;sident fiscal&quot; %} Ayant la qualit&eacute; de r&eacute;sident au sens de la r&egrave;glementation fiscale.</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 68%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Adresse :</span></td>
		</tr>
		<tr>
			<td style="width: 68%;">{% textinput_tag name=&quot;5fac123a&quot; data_label=&quot;Adresse postale du signataire&quot; data_map_field=&quot;adresse&quot; data_help=&quot;Adresse postale du signataire&quot; maxlength=&quot;100&quot; relation_ids_list=&quot;25917887&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Code postal :</span></td>
			<td style="width: 55%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Ville :</span></td>
			<td style="width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pays :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% numberinput_tag name=&quot;6ddfc3be&quot; data_label=&quot;Code Postal du signataire&quot; data_map_field=&quot;zipcode&quot; data_help=&quot;Code Postal du signataire&quot; maxlength=&quot;8&quot; relation_ids_list=&quot;44e85bf2&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;9cba88e8&quot; data_label=&quot;Ville du signataire&quot; data_map_field=&quot;ville&quot; data_help=&quot;Ville du signataire&quot; maxlength=&quot;80&quot; relation_ids_list=&quot;214789e4&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;579c3b00&quot; placeholder=&quot;France&quot; data_label=&quot;Pays du signataire&quot; data_map_field=&quot;pays&quot; data_help=&quot;Pays du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;25037fe9&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: bottom; width: 50%;">{% select_tag name=&quot;871c999e&quot; data_label=&quot;Civilit&eacute;&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|civilite; Madame|madame; Monsieur|monsieur;&quot; relation_ids_list=&quot;bcc24a80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nom :</span></td>
			<td style="vertical-align: bottom; width: 50%; text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Pr&eacute;nom :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;c06e38d8&quot; data_label=&quot;Nom du signataire&quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;e6c639a5&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;d7fc1859&quot; data_label=&quot;Pr&eacute;nom du signataire&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Pr&eacute;nom du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;89a0a9f9&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail :&nbsp;</span></td>
			<td style="vertical-align: middle; width: 30%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">T&eacute;l :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;4b14b8b9&quot; data_label=&quot;Email du signataire&quot; data_map_field=&quot;email&quot; data_help=&quot;Email du signataire&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;01a5a5db&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;3a23d466&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;mobile&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;15&quot; relation_ids_list=&quot;5ae0b27d&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="break-inside:avoid;width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance :</span></td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% dateinput_tag name=&quot;98ee8cf1&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de naissance&quot; data_map_field=&quot;date_naissance&quot; data_help=&quot;Date de naissance&quot; relation_ids_list=&quot;272d5f9d&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 80%;">{% textinput_tag name=&quot;c977ab47&quot; data_label=&quot;Lieu de naissance&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Lieu de naissance&quot; maxlength=&quot;80&quot; relation_ids_list=&quot;a2914ec1&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Profession&nbsp;:</span></td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nationalit&eacute;&nbsp;:</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;6798b3c1&quot; data_label=&quot;Profession &quot; data_map_field=&quot;job&quot; data_help=&quot;Profession &quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;61c0904f&quot; data_label=&quot;Nationalit&eacute; &quot; data_map_field=&quot;nationality&quot; data_help=&quot;Nationalit&eacute; &quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% checkbox_tag name=&quot;4458cdc5&quot; data_label=&quot;R&eacute;sident fiscal&quot; data_map_field=&quot;nomap&quot; data_help=&quot;R&eacute;sident fiscal&quot; %} Ayant la qualit&eacute; de r&eacute;sident au sens de la r&egrave;glementation fiscale.</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autres informations utiles :</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;259280f7&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Autres informations utiles&quot; data_map_field=&quot;comment&quot; data_help=&quot;Autres informations utiles&quot; relation_ids_list=&quot;0782e38f&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Situation familiale&nbsp;: </span></td>
			<td>{% textinput_tag name=&quot;23d722d7&quot; data_label=&quot;Situation familiale&quot; data_map_field=&quot;family_situation&quot; data_help=&quot;Pacs&eacute;, ...&quot; maxlength=&quot;70&quot; relation_ids_list=&quot;fef2f727&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-size:8px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><em>Vous avez la possibilit&eacute; de vous inscrire sur www.bloctel.gouv.fr pour vous opposer &agrave; tout d&eacute;marchage t&eacute;l&eacute;phonique conform&eacute;ment &agrave; l&#39;article L223-1 du Code de la consommation</em></span></span></td>
		</tr>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Ici pr&eacute;sent (non repr&eacute;sent&eacute;):&nbsp;{% radio_tag name=&quot;9be9dee9&quot; data_label=&quot;Pr&eacute;sent &agrave; l&#39;acte&quot; data_map_field=&quot;nomap&quot; data_help=&quot;signataire de l&#39;acte, pas de procuration&quot; data_choices=&quot;oui|oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

Mode Simplifié

<p><strong>{{871c999e}}&nbsp;{{dc28f4a7}}&nbsp;{{d7fc1859}}</strong> demeurant <strong>{{5fac123a}}&nbsp;{{6ddfc3be}}&nbsp;{{9cba88e8}}</strong>,<strong> {{579c3b00}}</strong>,<br />
email : <strong>{{c5c85d31}}</strong>, t&eacute;l&eacute;phone :&nbsp;<strong>{{b8d8459b}}&nbsp;</strong><br />
&bull; Lieu de naissance :&nbsp;<strong>{{114146e5}}</strong>, le <strong>{{02bed29a}}</strong>, de nationalit&eacute;&nbsp;: <strong>{{c3df2ff9}}&nbsp;</strong><br />
&bull; Profession : <strong>{{9a8c47d2}}&nbsp;&nbsp;</strong><br />
Ayant la qualit&eacute; de r&eacute;sident au sens de la r&eacute;glementation fiscale, {{b7e64678}}&nbsp;</p>

<p><strong>{{871c999a}}&nbsp;{{c06e38d8}}&nbsp;{{95be4670}}</strong> demeurant <strong>{{5fac123a}}&nbsp;{{6ddfc3be}}&nbsp;{{9cba88e8}}</strong>, <strong>{{579c3b00}}</strong>,<br />
email : <strong>{{4b14b8b9}}</strong>, t&eacute;l&eacute;phone :&nbsp;<strong>{{3a23d466}}&nbsp;</strong><br />
&bull; Lieu de naissance :&nbsp;<strong>{{c977ab47}}</strong>, le <strong>{{98ee8cf1}}</strong>, de nationalit&eacute;&nbsp;: <strong>{{61c0904f}}&nbsp;</strong><br />
&bull; Profession : <strong>{{6798b3c1}}&nbsp;</strong>&nbsp;<br />
Ayant la qualit&eacute; de r&eacute;sident au sens de la r&eacute;glementation fiscale, {{4458cdc5}}&nbsp;</p>

<p>Situation matrimoniale : {{23d722d7}}<br />
Autres informations utiles :&nbsp;{{259280f7}}&nbsp;</p>

<p>Ici pr&eacute;sent :&nbsp;{{9be9dee9}}&nbsp;</p>

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