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="1" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% select_tag name=&quot;833391fc&quot; data_label=&quot;Civilit&eacute; &quot; data_map_field=&quot;civilite&quot; data_help=&quot;Choisissez la civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|civilite; Monsieur|monsieur; Madame|madame;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>&nbsp;</strong>Nom :</span></td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pr&eacute;nom :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;087a9c2a&quot; data_label=&quot;Nom du signataire &quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire, indiquer le nom de jeune fille le cas &eacute;ch&eacute;ant&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;002cb93f&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; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" 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;7a4b4c6f&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; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;ed7c9998&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;tel&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;25&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance :</span></td>
			<td style="vertical-align: middle; width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 20%;">{% dateinput_tag name=&quot;f014d7d1&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; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="vertical-align: middle; width: 80%;">{% textinput_tag name=&quot;67fe78de&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; data_ancien_ids=&quot;21911&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" 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;109d7745&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; 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%;">{% textinput_tag name=&quot;f5e66571&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;10&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;ed0a66fe&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; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;4e0fc70a&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; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% select_tag name=&quot;550e32cc&quot; data_label=&quot;Civilit&eacute; &quot; data_map_field=&quot;civilite&quot; data_help=&quot;Choisissez la civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|civilite; Monsieur|monsieur; Madame|madame;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>&nbsp;</strong>Nom :</span></td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pr&eacute;nom :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;3d948d74&quot; data_label=&quot;Nom du signataire &quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire, indiquer le nom de jeune fille le cas &eacute;ch&eacute;ant&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;322861a6&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;6be847fb&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;ac7e9636&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" 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;30cf5700&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;627736e1&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;153395a3&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;tel&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;25&quot; relation_ids_list=&quot;382a5e67&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance :</span></td>
			<td style="vertical-align: middle; width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 20%;">{% dateinput_tag name=&quot;af71a231&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; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="vertical-align: middle; width: 80%;">{% textinput_tag name=&quot;48b8b7d8&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; data_ancien_ids=&quot;21911&quot; relation_ids_list=&quot;412d69a0&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%;">{% textinput_tag name=&quot;f5e66571&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;10&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;ed0a66fe&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;12099384&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;4e0fc70a&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; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="2" style="width: 100%;">
	<tbody>
		<tr>
			<td><em><span style="font-size:8px;"><span style="font-family: ITCAvantGardePro;">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.</span></span></em>&nbsp;</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="5" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date et lieu de mariage&nbsp;: </span></td>
			<td>{% textinput_tag name=&quot;377a5647&quot; data_label=&quot;Date et lieu de mariage&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Date et lieu de mariage&quot; maxlength=&quot;70&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">R&eacute;gime matrimonial &nbsp;:</span></td>
			<td>{% textinput_tag name=&quot;f24e2d99&quot; data_label=&quot;R&eacute;gime matrimonial&quot; data_map_field=&quot;nomap&quot; data_help=&quot;R&eacute;gime matrimonial&quot; maxlength=&quot;70&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

Mode Simplifié

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>{{833391fc}}&nbsp;{{087a9c2a}}&nbsp;{{002cb93f}}</strong> demeurant <strong>{{109d7745}}&nbsp;{{f5e66571}}&nbsp;{{ed0a66fe}}</strong>, <strong>{{4e0fc70a}}</strong>,<br />
&bull; email : <strong>{{7a4b4c6f}}</strong>&nbsp;&bull;&nbsp;t&eacute;l&eacute;phone :&nbsp;<strong>{{ed7c9998}}&nbsp;</strong><br />
&bull; Lieu de naissance :&nbsp;<strong>{{67fe78de}}</strong>, le <strong>{{f014d7d1}}</strong><br />
Et</span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>{{550e32cc}}&nbsp;{{3d948d74}}&nbsp;{{6be847fb}}</strong> demeurant <strong>{{109d7745}}&nbsp;{{f5e66571}}&nbsp;{{ed0a66fe}}</strong>, <strong>{{4e0fc70a}}</strong>,<br />
&bull; email : <strong>{{30cf5700}}</strong>&nbsp;&bull;&nbsp;t&eacute;l&eacute;phone :&nbsp;<strong>{{153395a3}}</strong>&nbsp;<br />
&bull; Lieu de naissance :&nbsp;<strong>{{48b8b7d8}}</strong>, le <strong>{{af71a231}}</strong></span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date et lieu de mariage : <strong>{{377a5647}}</strong> sous le r&eacute;gime de <strong>{{f24e2d99}}</strong></span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autres informations utiles :&nbsp;<strong>{{f69daf9e}}</strong></span></p>

Version PDF Version mobile