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<table border="0" cellpadding="1" cellspacing="2" style="width:100%;">
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			<td style="width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Bedrijfsnaam:</span></td>
			<td style="width: 30%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Soort bedrijf:</span></td>
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			<td style="width: 70%;">{% textinput_tag name=&quot;fe4918c7&quot; data_label=&quot;Bedrijfsnaam&quot; data_map_field=&quot;societe&quot; data_help=&quot;Bedrijfsnaam&quot; maxlength=&quot;100&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 30%;">{% textinput_tag name=&quot;ae91c87b&quot; data_label=&quot;Soort&quot; data_map_field=&quot;company_type&quot; data_help=&quot;NV, BV, VOF...&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Geregistreerd in:</span></td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Onder nummer:</span></td>
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			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;5b386f55&quot; data_label=&quot;Registratieplaats&quot; data_map_field=&quot;rcs_place&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;876a688c&quot; data_label=&quot;Nummer&quot; data_map_field=&quot;rcs_num&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">met een kapitaal van:</span></td>
			<td>{% textinput_tag name=&quot;55cd98bd&quot; data_label=&quot;Maatschappelijk kapitaal&quot; data_map_field=&quot;capital&quot; data_help=&quot;Maatschappelijk kapitaal&quot; maxlength=&quot;70&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Vertegenwoordigd als bestuurder door:</span>&nbsp;</p>

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			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>&nbsp;</strong></span>{% select_tag name=&quot;87a7391fd&quot; data_label=&quot;Aanspreektitel&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Kies de aanspreektitel&quot; data_choices=&quot;Aanspreektitel|civilite; De heer|monsieur; Mevrouw|madame;&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;">Achternaam:</span></td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Voornaam:</span></td>
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			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;d368006f&quot; data_label=&quot;Achternaam&quot; data_map_field=&quot;nom&quot; data_help=&quot;Achternaam van de ondertekenaar&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;ad756ce1&quot; data_label=&quot;Voornaam&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Voornaam van de ondertekenaar&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 68%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">waarvan het statutair adres is gevestigd:</span></td>
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			<td style="width: 68%;">{% textinput_tag name=&quot;88cf7082&quot; data_label=&quot;Adres van de statutaire zetel&quot; data_map_field=&quot;adresse&quot; data_help=&quot;Adres van de statutaire zetel&quot; maxlength=&quot;100&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Postcode:</span></td>
			<td style="width: 55%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Plaats:</span></td>
			<td style="width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Land:</span></td>
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			<td style="width: 20%;">{% textinput_tag name=&quot;b5154f50&quot; data_label=&quot;Postcode&quot; data_map_field=&quot;zipcode&quot; data_help=&quot;Postcode&quot; maxlength=&quot;10&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;72230b87&quot; data_label=&quot;Plaats&quot; data_map_field=&quot;ville&quot; data_help=&quot;Plaats&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;72ba8a88&quot; placeholder=&quot;Nederland&quot; data_label=&quot;Land&quot; data_map_field=&quot;pays&quot; data_help=&quot;Land&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<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;">Telefoonnummer :&nbsp;&nbsp;</span></td>
		</tr>
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			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;c4f61172&quot; data_label=&quot;E-mail van de ondertekenaar&quot; data_map_field=&quot;email&quot; data_help=&quot;E-mail van de ondertekenaar&quot; maxlength=&quot;50&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;86e4290d&quot; data_label=&quot;Telefoonnummer van de ondertekenaar&quot; data_map_field=&quot;tel&quot; data_help=&quot;Telefoonnummer van de ondertekenaar&quot; maxlength=&quot;25&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;">Andere nuttige informatie:&nbsp;</span></td>
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			<td>{% textarea_tag name=&quot;201f4031&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Andere nuttige informatie&quot; data_map_field=&quot;comment&quot; data_help=&quot;Andere nuttige informatie&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;">De verkoper verkoopt hierbij aan de koper, die {% checkbox_tag name=&quot;cc0cbfd3&quot; data_label=&quot;koopt voor zichzelf&quot; data_map_field=&quot;nomap&quot; %} voor zichzelf / {% checkbox_tag name=&quot;d538d4c8&quot; data_label=&quot;koopt voor een bedrijf in oprichting onder de waarschijnlijke naam&quot; data_map_field=&quot;nomap&quot; %} voor een bedrijf in oprichting onder de waarschijnlijke naam van {% textinput_tag name=&quot;e6696092&quot; data_label=&quot;naam van het bedrijf in oprichting&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;70&quot; style=&quot;max-width:200px;min-width:200px;width:200px;&quot; fixedwidth=&quot;200&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %} / {% checkbox_tag name=&quot;4ef0df9b&quot; data_label=&quot;aankoop met mogelijkheid tot het doen van een koopverklaring&quot; data_map_field=&quot;nomap&quot; %} met de mogelijkheid om een koopverklaring te doen / {% checkbox_tag name=&quot;5c0e1530&quot; data_label=&quot;aankoop onder toepassing van een clausule van verhoging genoemd in het contract&quot; data_map_field=&quot;nomap&quot; %} onder toepassing van een clausule van verhoging genoemd in het contract / {% checkbox_tag name=&quot;1a1704ea&quot; data_label=&quot;aankoop in de volgende verhouding&quot; data_map_field=&quot;nomap&quot; %} in de volgende verhouding:</span></td>
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<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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			<td>{% textarea_tag name=&quot;a6b26dd6&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;aankoop in de volgende verhouding&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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<table border="0" cellpadding="2" cellspacing="5" style="width: 100%;">
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			<td>{% checkbox_tag name=&quot;fdcad145&quot; data_label=&quot;andere medebeheerder&quot; data_map_field=&quot;nomap&quot; data_help=&quot;andere medebeheerder&quot; %} <span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">andere medebeheerder</span></td>
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