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			<td colspan="5" style="vertical-align: middle; width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p" style="font-size: 18px; font-weight: 900;">SITUATION - D&Eacute;SIGNATION ET CONSISTANCE DES LOCAUX</span></span><br />
			<span style="font-size:14px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><span style="font-weight:600;">Local principal :</span></span></span></td>
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			<td style="vertical-align: middle; width: 15%;">{% checkbox_tag name=&quot;6b6dfcc0&quot; data_label=&quot;Appartement&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Appartement&quot; data_ancien_ids=&quot;6559,970,4178&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> Appartement</span></td>
			<td style="vertical-align: middle; width: 10%;">{% checkbox_tag name=&quot;d6a43999&quot; data_label=&quot;Maison&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Maison&quot; data_ancien_ids=&quot;6606,1019,4202&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Maison</span></td>
			<td style="vertical-align: middle; width: 12%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;</span>{% checkbox_tag name=&quot;a96372d3&quot; data_label=&quot;Boutique&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Boutique&quot; data_ancien_ids=&quot;6653,1068,4226&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Boutique</span></td>
			<td style="width: 3%; vertical-align: middle;">{% checkbox_tag name=&quot;7d24bae9&quot; data_label=&quot;Autre d&eacute;signation&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Local principale&quot; data_ancien_ids=&quot;6700,1117,&quot; %}</td>
			<td style="width: 60%;">{% textinput_tag name=&quot;9e619632&quot; data_label=&quot;Autre d&eacute;signation&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;D&eacute;signation autre&quot; maxlength=&quot;50&quot; data_ancien_ids=&quot;1093,6677&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td colspan="4" rowspan="1" style="vertical-align: middle; width: 11%;"><span style="font-size:14px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><span style="font-weight:600;">Annexe(s) :</span></span></span></td>
			<td style="width: 3%; vertical-align: middle;">&nbsp;</td>
			<td style="width: 52%;">&nbsp;</td>
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			<td style="vertical-align: middle; width: 11%;">{% checkbox_tag name=&quot;0a0d8aae&quot; data_label=&quot;Garage&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Garage&quot; data_ancien_ids=&quot;6819,1240,4274&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Garage n&deg;</span></td>
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			<p>{% textinput_tag name=&quot;9d5831cb&quot; data_label=&quot;Garage n&deg;&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Garage n&deg;&quot; maxlength=&quot;15&quot; data_ancien_ids=&quot;6843,1264,14726&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</p>
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			<td style="vertical-align: middle; width: 10%;">&nbsp;{% checkbox_tag name=&quot;27eecfc0&quot; data_label=&quot;Cave n&deg;&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Cave n&deg;&quot; data_ancien_ids=&quot;6890,1313,4222&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Cave n&deg; </span></td>
			<td style="vertical-align: middle; width: 12%;">{% textinput_tag name=&quot;e9b5b8de&quot; data_label=&quot;N&deg; cave&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;N&deg; cave&quot; maxlength=&quot;15&quot; data_ancien_ids=&quot;6913,1337,4250&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 3%; vertical-align: middle;">&nbsp;{% checkbox_tag name=&quot;b5f649ac&quot; data_label=&quot;&nbsp;Autre annexe&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Annexe autre&quot; data_ancien_ids=&quot;6771,1191&quot; %}</td>
			<td style="width: 52%;">{% textinput_tag name=&quot;031ad069&quot; data_label=&quot;Annexe autre&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Annexe autre&quot; maxlength=&quot;60&quot; data_ancien_ids=&quot;6748,1167,4130&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td><span style="font-family: ITCAvantGardePro; font-size: 12px;">Immeuble sis &agrave; :</span></td>
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			<td>{% textarea_tag name=&quot;202bd211&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du bien&quot; data_map_field=&quot;full_address&quot; data_help=&quot;Adresse du bien&quot; data_ancien_ids=&quot;1362,4080&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;signation :</span></td>
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			<td>{% textarea_tag name=&quot;826da781&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;signation du bien&quot; data_map_field=&quot;realty_name&quot; data_help=&quot;D&eacute;signation du bien&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Si location d&rsquo;habitation principale soumise &agrave; la loi 6 juillet 1989, identifiant fiscal du logement et de ses d&eacute;pendances (logement, cave, parking, autres d&eacute;pendances&hellip;) :&nbsp;</span>{% textinput_tag name=&quot;bb9df3ed&quot; data_label=&quot;Num&eacute;ro Identifiant Fiscal du logement&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;50&quot; style=&quot;max-width:150px;min-width:150px;width:150px;&quot; fixedwidth=&quot;150&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 85%; vertical-align: bottom;"><span style="font-size:14px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><span style="font-weight:600;">&Eacute;quipements d&#39;acc&egrave;s aux technologies de l&#39;information et de la communication :</span></span></span></td>
			<td style="text-align: right; vertical-align: bottom; width: 15%;">&nbsp;</td>
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				<li style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Information concernant les modalit&eacute;s de r&eacute;ception des services de t&eacute;l&eacute;vision, conform&eacute;ment &agrave; la loi n&deg;89-462 du 06/07/89, art. 3-2 :&nbsp;</span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">possibilit&eacute; de recevoir en clair les services nationaux de t&eacute;l&eacute;vision par voie hertzienne terrestre en mode num&eacute;rique :&nbsp;</span></li>
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			<td style="text-align: right; vertical-align: bottom; width: 15%;">{% checkbox_tag name=&quot;cbc7370b&quot; data_label=&quot;Possibilit&eacute; de recevoir en clair les services nationaux&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Oui&quot; data_ancien_ids=&quot;7356,1435,4348&quot; %} <span style="font-weight:500;"><span style="font-family: ITCAvantGardePro; font-size: 12px;">Oui</span></span>&nbsp; &nbsp;{% checkbox_tag name=&quot;234f8868&quot; data_label=&quot;Impossibilit&eacute; de recevoir en clair les services nationaux&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Non&quot; data_ancien_ids=&quot;7379,1459,4397&quot; %} <span style="font-weight:500;"><span style="font-family: ITCAvantGardePro; font-size: 12px;">Non</span></span></td>
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				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autre :</span></li>
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			<p style="margin-left: 40px;">{% textarea_tag name=&quot;f189f290&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Autre &eacute;quipement d&#39;acc&egrave;s aux technologies...&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Autre &eacute;quipement d&#39;acc&egrave;s aux technologies de l&#39;information et de la communication&quot; data_ancien_ids=&quot;7402,1483,8559&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</p>
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			<td colspan="2" style="width: 85%; vertical-align: bottom;"><span style="font-size:14px;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro;">D&eacute;clarations&nbsp;du bailleur</span></span></span></td>
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				<li style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien, objet des pr&eacute;sentes, a-t-il subi un sinistre ayant donn&eacute; lieu au versement d&#39;une indemnit&eacute; d&#39;assurance garantissant :&nbsp;</span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">les risques de catastrophes mini&egrave;res,&nbsp;naturelles ou technologiques, vis&eacute;es &agrave; l&#39;art. L 125-2 du Code des assurances ? :</span></li>
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			<td style="vertical-align: bottom; width: 15%; text-align: right;">{% checkbox_tag name=&quot;cffd7b64&quot; data_label=&quot;Le bien a subi un sinistre&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Oui&quot; data_ancien_ids=&quot;7450,1556&quot; %} <span style="font-weight:500;"><span style="font-family: ITCAvantGardePro; font-size: 12px;">Oui&nbsp;</span></span>&nbsp; {% checkbox_tag name=&quot;2cf8bfc9&quot; data_map_field=&quot;nomap&quot;&nbsp;data_label=&quot;Le bien n&#39;a pas subi de sinistre&quot; data_help=&quot;Non&quot; data_ancien_ids=&quot;1580,7496&quot; %}<span style="font-weight:500;"><span style="font-family: ITCAvantGardePro; font-size: 12px;"> Non</span></span></td>
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				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le logement est-il &eacute;quip&eacute; d&#39;au moins un d&eacute;tecteur de fum&eacute;e en bon&nbsp;&eacute;tat de fonctionnement :</span></li>
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			<td style="text-align: right; vertical-align: middle; width: 15%;">{% checkbox_tag name=&quot;20e49565&quot; data_label=&quot;Le logement est &eacute;quip&eacute; d&#39;un d&eacute;tecteur de fum&eacute;e&quot; data_map_field=&quot;nomap&quot;&nbsp;data_help=&quot;Oui&quot; data_ancien_ids=&quot;7473,1556&quot; %}<span style="font-weight:500;"><span style="font-family: ITCAvantGardePro; font-size: 12px;">&nbsp;Oui&nbsp; &nbsp;</span></span>{% checkbox_tag name=&quot;f000eb10&quot; data_map_field=&quot;nomap&quot;&nbsp;data_label=&quot;Le logement n&#39;est pas &eacute;quip&eacute; d&#39;un d&eacute;tecteur de fum&eacute;e&quot; data_help=&quot;Non&quot; data_ancien_ids=&quot;7519,1604&quot; %}<span style="font-weight:500;"><span style="font-family: ITCAvantGardePro; font-size: 12px;"> Non</span></span></td>
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				<li style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Indiquer la nature et le montant des travaux effectu&eacute;s depuis la fin du dernier contrat ou depuis le dernier renouvellement du bail :</span></li>
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			<td>{% textarea_tag name=&quot;eaad6432&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Nature et montant des travaux depuis le dernier contrat&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nature et montant des travaux depuis le dernier contrat&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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