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Document &agrave; t&eacute;l&eacute;charger via la plateforme Ermes accessible <a href="https://tracfin.finances.gouv.fr/Pages/Subscription/Mentions.aspx">ici</a>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td>Libell&eacute; de l&rsquo;organisme :&nbsp;</td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;34614991&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot; Libell&eacute; de l&rsquo;organisme&quot; data_map_field=&quot;nomap&quot; data_help=&quot; Libell&eacute; de l&rsquo;organisme&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td>Secteur professionnel :</td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;703766d0&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Secteur professionnel&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Secteur professionnel&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td>Adresse :</td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;5a489034&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse de l&#39;organisme&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Adresse de l&#39;organisme&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td>Code Postal :&nbsp; {% textinput_tag name=&quot;d4ff3684&quot; data_label=&quot;Code postal de l&#39;organisme&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Code postal de l&#39;organisme&quot; maxlength=&quot;7&quot; style=&quot;max-width:55px;min-width:55px;width:55px;&quot; fixedwidth=&quot;55&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp; Ville :&nbsp;&nbsp;{% textinput_tag name=&quot;b296b56c&quot; data_label=&quot;Ville de l&#39;organisme&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Ville de l&#39;organisme&quot; maxlength=&quot;70&quot; style=&quot;max-width:300px;min-width:300px;width:300px;&quot; fixedwidth=&quot;300&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td>N&deg; de t&eacute;l&eacute;phone de l&rsquo;organisme :&nbsp; {% textinput_tag name=&quot;cf8d813d&quot; data_map_field=&quot;nomap&quot; data_label=&quot;Num&eacute;ro de t&eacute;l&eacute;phone de l&#39;organisme&quot; data_help=&quot;Num&eacute;ro de t&eacute;l&eacute;phone de l&#39;organisme&quot; maxlength=&quot;14&quot; style=&quot;max-width:112px;min-width:112px;width:112px;&quot; fixedwidth=&quot;112&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp; N&deg; de fax de l&rsquo;organisme (envoi des AR) :&nbsp; &nbsp;{% textinput_tag name=&quot;cf8x813d&quot; data_label=&quot;Num&eacute;ro de fax de l&#39;organisme&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Num&eacute;ro de fax de l&#39;organisme&quot; maxlength=&quot;14&quot; style=&quot;max-width:112px;min-width:112px;width:112px;&quot; fixedwidth=&quot;112&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;</td>
		</tr>
	</tbody>
</table>

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