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			<p><font face="ITCAvantGardePro"><span style="font-size:18px"><b>COH&Eacute;RENCE DU FINANCEMENT</b></span></font></p>

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				<li><span style="font-size:12px"><span style="font-family:ITCAvantGardePro"><span style="font-weight:200"><font face="ITCAvantGardePro">le bien est vendu :</font></span></span></span></li>
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			<td>{% checkbox_tag name=&quot;d584b9a8&quot; data_label=&quot;Libre de toute occupation&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Libre de toute occupation&quot; data_ancien_ids=&quot;27174,27356,21869&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">libre</span> &nbsp; &nbsp;{% checkbox_tag name=&quot;a6472ebf&quot; data_label=&quot;Occup&eacute;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Occup&eacute;&quot; data_ancien_ids=&quot;27221,27379,21893&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">occup&eacute;</span> &nbsp;{% checkbox_tag name=&quot;005cb309&quot; data_label=&quot;lou&eacute;&quot; data_map_field=&quot;nomap&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">lou&eacute; </span>&nbsp;{% checkbox_tag name=&quot;d9da6afe&quot; data_label=&quot;autre&quot; data_map_field=&quot;nomap&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">autre</span>&nbsp;:</td>
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			<td>{% textarea_tag name=&quot;ea7cd1c5&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;autre description&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 18%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">prix de vente :</span></td>
			<td>{% textinput_tag name=&quot;e0bb6a6a&quot; data_label=&quot;prix de vente&quot; data_map_field=&quot;sell_price&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 18%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">le prix de vente est :</span></td>
			<td>{% select_tag name=&quot;334f4f39&quot; data_label=&quot;prix de vente selon le march&eacute;&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;coh&eacute;rent par rapport au march&eacute;|coh&eacute;rent par rapport au march&eacute;; sous-&eacute;valu&eacute; par rapport au march&eacute;|sous-&eacute;valu&eacute; par rapport au march&eacute;; sur-&eacute;valu&eacute; par rapport au march&eacute;|sur-&eacute;valu&eacute; par rapport au march&eacute;;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 18%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">frais d&#39;acte :</span></td>
			<td>{% textinput_tag name=&quot;fafe1745&quot; data_label=&quot;montant frais d&#39;acte&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 18%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">honoraires :</span></td>
			<td>{% textinput_tag name=&quot;0235f00e&quot; data_label=&quot;montant des honoraires&quot; data_map_field=&quot;fees&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;</td>
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			<td style="width: 18%;">&nbsp;</td>
			<td>{% checkbox_tag name=&quot;c3bdf1bc&quot; data_label=&quot;vendeur&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">vendeur</span>&nbsp;{% checkbox_tag name=&quot;ef060cc3&quot; data_label=&quot;acqu&eacute;reur&quot; data_map_field=&quot;nomap&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">acqu&eacute;reur</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">montant estim&eacute; du mobilier</span>&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">(compris dans le prix de vente, liste d&eacute;taill&eacute;e &agrave; joindre en annexe) :</span></td>
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			<td>{% textinput_tag name=&quot;f51102a0&quot; data_label=&quot;montant estim&eacute; du mobilier&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td colspan="5" style="width: 3%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p">L&#39;apport personnel, provenance et montants :</span></span></td>
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			<td style="width: 3%;">{% checkbox_tag name=&quot;0cf344c3&quot; data_label=&quot;&eacute;pargne&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;&eacute;pargne</span></td>
			<td style="width: 40%;">{% textinput_tag name=&quot;daf5b9b2&quot; data_label=&quot;montant &eacute;pargne&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 30%;">&nbsp;</td>
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			<td style="width: 3%;">{% checkbox_tag name=&quot;1b64d8b7&quot; data_label=&quot;&eacute;pargne salariale&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&eacute;pargne salariale</span></td>
			<td style="width: 40%;">{% textinput_tag name=&quot;5e7aecac&quot; data_label=&quot;montant &eacute;pargne salariale&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 30%;">&nbsp;</td>
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			<td style="width: 3%;">{% checkbox_tag name=&quot;2074c3e5&quot; data_label=&quot;donation/succession&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">donation/succession</span></td>
			<td style="width: 40%;">{% textinput_tag name=&quot;db9a99d8&quot; data_label=&quot;montant donation/succession&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">lien de parent&eacute; :&nbsp;</span></td>
			<td style="width: 30%;">{% textinput_tag name=&quot;ada2b171&quot; data_label=&quot;lien de parent&eacute; pour la donation/succession&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 3%;">{% checkbox_tag name=&quot;6ce96dc0&quot; data_label=&quot;prix de vente r&eacute;investi&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">prix de vente r&eacute;investi</span></td>
			<td style="width: 40%;">{% textinput_tag name=&quot;1fc5f429&quot; data_label=&quot;montant du prix de vente r&eacute;investi&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 30%;">&nbsp;</td>
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			<td style="width: 3%;">{% checkbox_tag name=&quot;de7e572d&quot; data_label=&quot;revenus mensuels de l&#39;acqu&eacute;reur&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">revenus mensuels de l&#39;acqu&eacute;reur</span></td>
			<td style="width: 40%;">{% textinput_tag name=&quot;e06efdae&quot; data_label=&quot;montant revenus mensuels de l&#39;acqu&eacute;reur&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 30%;">&nbsp;</td>
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			<td style="width: 3%;">{% checkbox_tag name=&quot;1b5c0971&quot; data_label=&quot;autre&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">autre</span></td>
			<td style="width: 40%;">{% textinput_tag name=&quot;d9439832&quot; data_label=&quot;description autre&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 30%;">&nbsp;</td>
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			<td colspan="2" style="vertical-align: bottom; width: 22%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le pr&ecirc;t, nom de la banque, montant de l&#39;emprunt et dur&eacute;e :</span></td>
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			<ul>
				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">nom de la banque :</span></li>
			</ul>
			</td>
			<td style="width: 78%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;</span>{% textinput_tag name=&quot;fcf91a75&quot; data_label=&quot;nom de la banque&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">montant de l&#39;emprunt :</span></li>
			</ul>
			</td>
			<td style="width: 78%;">{% textinput_tag name=&quot;bf4d9f7b&quot; data_label=&quot;montant de l&#39;emprunt&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">dur&eacute;e de l&#39;emprunt :</span></li>
			</ul>
			</td>
			<td style="width: 78%;">{% textinput_tag name=&quot;bbcee3bd&quot; data_label=&quot;dur&eacute;e de l&#39;emprunt&quot; data_map_field=&quot;nomap&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;">Le financement vient de l&#39;&eacute;tranger :&nbsp;</span></td>
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			<td>{% checkbox_tag name=&quot;b558ac82&quot; data_label=&quot;UE&quot; data_map_field=&quot;nomap&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">UE</span>&nbsp;{% checkbox_tag name=&quot;995b6f98&quot; data_label=&quot;hors UE&quot; data_map_field=&quot;nomap&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> hors UE</span>&nbsp;{% checkbox_tag name=&quot;6f138d11&quot; data_label=&quot;pays &agrave; risque&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">pays &agrave; risque</span>&nbsp;{% checkbox_tag name=&quot;3d406e1f&quot; data_label=&quot;compte situ&eacute; dans un pays &agrave; fiscalit&eacute; privil&eacute;gi&eacute;e&quot; data_map_field=&quot;nomap&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;compte situ&eacute; dans un pays &agrave; fiscalit&eacute; privil&eacute;gi&eacute;e</span>&nbsp;{% checkbox_tag name=&quot;c3d1d65e&quot; data_label=&quot;autre&quot; data_map_field=&quot;nomap&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">autres :</span>&nbsp;</td>
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			<td>{% textinput_tag name=&quot;e88d016b&quot; data_map_field=&quot;nomap&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;">Consultation de diff&eacute;rents sites :</span></td>
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			<td>{% checkbox_tag name=&quot;f76401f4&quot; data_label=&quot;registre gel et avoirs&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">registre gel et avoirs</span>&nbsp;&nbsp;{% checkbox_tag name=&quot;acbdf12c&quot; data_label=&quot;site d&#39;Interpol&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">site d&#39;Interpol</span>&nbsp;{% checkbox_tag name=&quot;6085c884&quot; data_label=&quot;autre&quot; data_map_field=&quot;nomap&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">autre :</span>&nbsp;</td>
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			<td>{% textarea_tag name=&quot;4c0ef817&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;autres sites consult&eacute;s&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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