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			<td colspan="2" style="padding: 6px; background-color: rgb(199, 0, 40); text-align: center; width: 50%; vertical-align: middle; border-color: rgb(199, 0, 40);"><span style="color:#ffffff;"><span style="line-height:2;"><span style="font-weight:600;"><span style="font-size:14px;"><span style="font-family: ITCAvantGardePro;">FICHE D&#39;INFORMATION</span></span></span></span></span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Inscription(s) hypoth&eacute;caire(s) et/ou saisies, droits r&eacute;els ou privil&egrave;ges:</span><br />
			&nbsp;</td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;143c9bf4&quot; data_label=&quot; Inscription(s) hypoth&eacute;caire(s) et/ou saisies, droits r&eacute;els ou privil&egrave;ges:&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;tails:</span></td>
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			<td>{% textarea_tag name=&quot;c84c5564&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;tails de l&#39;inscription(s) hypoth&eacute;caire(s) et/ou saisies, droits r&eacute;els ou privil&egrave;ges:&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: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Libre d&rsquo;occupation:</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;4ecb68c2&quot; data_label=&quot;Libre d&rsquo;occupation:&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;tails:</span></td>
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			<td>{% textarea_tag name=&quot;0df490bc&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;tails de Libre d&rsquo;occupation:&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: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Taxes de recouvrement:</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;ba1242f8&quot; data_label=&quot;Taxes de recouvrement:&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Objet et montant:</span></td>
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			<td>{% textarea_tag name=&quot;e85ff46d&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Objet et montant:&quot; data_map_field=&quot;nomap&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;">D&eacute;cret relatif au patrimoine immobilier:</span></p>

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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Patrimoine prot&eacute;g&eacute;?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;17df0146&quot; data_label=&quot;Patrimoine prot&eacute;g&eacute;?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Patrimoine inventori&eacute;?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;c82c7d23&quot; data_label=&quot;Patrimoine inventori&eacute;?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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<p style="margin-left: 40px;">{% checkbox_tag name=&quot;9ed55f29&quot; data_label=&quot;Patrimoine atlas des paysages&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">atlas des paysages</span></p>

<p style="margin-left: 40px;">{% checkbox_tag name=&quot;37450348&quot; data_label=&quot;inventaire des zones arch&eacute;ologique&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">inventaire des zones arch&eacute;ologique</span></p>

<p style="margin-left: 40px;">{% checkbox_tag name=&quot;3e60fe69&quot; data_label=&quot;inventaire du patrimoine architectural&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">inventaire du patrimoine architectural</span></p>

<p style="margin-left: 40px;">{% checkbox_tag name=&quot;7abed5f6&quot; data_label=&quot;inventaire des plantations ligneuses pr&eacute;sentant une valeur patrimoniale&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">inventaire des plantations ligneuses pr&eacute;sentant une valeur patrimoniale</span></p>

<p style="margin-left: 40px;">{% checkbox_tag name=&quot;186ee08c&quot; data_label=&quot;inventaire des jardins et parcs historiques&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">inventaire des jardins et parcs historiques</span></p>

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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Mesures d&rsquo;expropriation?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;0b3fafec&quot; data_label=&quot;Mesures d&rsquo;expropriation?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Les biens est-il situ&eacute; dans une zone &agrave; risque d&rsquo;inondation?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;6babccb4&quot; data_label=&quot;Les biens est-il situ&eacute; dans une zone &agrave; risque d&rsquo;inondation?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien est-il situ&eacute; partiellement ou totalement dans une zone sensible aux inondations, dans une zone inondable d&eacute;limit&eacute;e ou dans une zone de rivage d&eacute;limit&eacute;e?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;41eec313&quot; data_label=&quot;Le bien est-il situ&eacute; partiellement ou totalement dans une zone sensible aux inondations, dans une zone inondable d&eacute;limit&eacute;e ou dans une zone de rivage d&eacute;limit&eacute;e?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien est-il touch&eacute; par une limite de parcelle ou un projet de limite de parcelle ?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;4d02cf33&quot; data_label=&quot;Le bien est-il touch&eacute; par une limite de parcelle ou un projet de limite de parcelle ?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un droit de pr&eacute;emption l&eacute;gal ou conventionnel trouve-t-il &agrave; s&rsquo;appliquer?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;450b7a42&quot; data_label=&quot;Un droit de pr&eacute;emption l&eacute;gal ou conventionnel trouve-t-il &agrave; s&rsquo;appliquer?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;tails:</span></td>
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			<td>{% textarea_tag name=&quot;48ff5c0f&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;tails du droit de pr&eacute;emption l&eacute;gal ou conventionnel&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: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un droit de rachat trouve-t-il &agrave; s&rsquo;appliquer?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;5adb6b86&quot; data_label=&quot;Un droit de rachat trouve-t-il &agrave; s&rsquo;appliquer?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;tails:</span></td>
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			<td>{% textarea_tag name=&quot;f3b57634&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;tails du droit de rachat&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: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien est-il consid&eacute;r&eacute; comme un immeuble vide ou inoccup&eacute; ?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;0dc4aa6e&quot; data_label=&quot;Le bien est-il consid&eacute;r&eacute; comme un immeuble vide ou inoccup&eacute; ?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">La vente se fait-elle sous le r&eacute;gime de la TVA?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;19cfc258&quot; data_label=&quot;La vente se fait-elle sous le r&eacute;gime de la TVA?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien fait-il l&rsquo;objet:</span></p>

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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">d&rsquo;un permis d&rsquo;urbanisme?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;6d7dc905&quot; data_label=&quot;Le bien fait l&#39;objet d&rsquo;un permis d&rsquo;urbanisme?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">d&rsquo;un permis de lotissement?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;4cd41dc1&quot; data_label=&quot;Le bien fait l&#39;objet d&rsquo;un permis de lotissement?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui|oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Des infractions ont-elles &eacute;t&eacute; commises et/ou constat&eacute;es lors de la construction?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;8edc5b8f&quot; data_label=&quot;Des infractions ont-elles &eacute;t&eacute; commises et/ou constat&eacute;es lors de la construction?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;tails:</span></td>
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			<td>{% textarea_tag name=&quot;f896f902&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;tails des infractions commises et/ou constat&eacute;es lors de la construction&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: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Une activit&eacute; &agrave; risque figurant dans la liste du Vlarebo est-elle ou a-t-elle &eacute;t&eacute; exerc&eacute;e sur le bien?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;ff5bf542&quot; data_label=&quot;Une activit&eacute; &agrave; risque figurant dans la liste du Vlarebo est-elle ou a-t-elle &eacute;t&eacute; exerc&eacute;e sur le bien?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le cas &eacute;ch&eacute;ant, le donneur d&rsquo;ordre s&rsquo;engage-t-il &agrave; se conformer aux dispositions du d&eacute;cret d&rsquo;assainissement des sols, et d&rsquo;entreprendre tout le n&eacute;cessaire afin de pouvoir r&eacute;aliser la cession du bien?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;090b6f1c&quot; data_label=&quot;Le cas &eacute;ch&eacute;ant, le donneur d&rsquo;ordre s&rsquo;engage-t-il &agrave; se conformer aux dispositions du d&eacute;cret d&rsquo;assainissement des sols, et d&rsquo;entreprendre tout le n&eacute;cessaire afin de pouvoir r&eacute;aliser la cession du bien?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">La r&eacute;glementation sur les d&eacute;tecteurs de fum&eacute;e a-t-elle &eacute;t&eacute; respect&eacute;e?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;127a59be&quot; data_label=&quot;La r&eacute;glementation sur les d&eacute;tecteurs de fum&eacute;e a-t-elle &eacute;t&eacute; respect&eacute;e?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Une cuve &agrave; mazout est pr&eacute;sente sur le bien:</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;c9d55a57&quot; data_label=&quot;Une cuve &agrave; mazout est pr&eacute;sente sur le bien:&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Si oui: &ndash; plus de 5000 litres &ndash; si plus, contenance:</span>{% textinput_tag name=&quot;f1957516&quot; data_label=&quot;Si oui: &ndash; plus de 5000 litres &ndash; si plus, contenance:&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;70&quot; style=&quot;max-width:250px;min-width:250px;width:250px;&quot; fixedwidth=&quot;250&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 80%; text-align: justify;">
			<p style="margin-left: 160px;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">a&eacute;rienne(s)</span></p>
			</td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;1b13a4c6&quot; data_label=&quot;Si plus de 5000 l, a&eacute;rienne(s)&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;">
			<p style="margin-left: 160px;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">sous-terraine(s)</span></p>
			</td>
			<td style="text-align: right;">
			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;88bf2fd3&quot; data_label=&quot;si plus de 5000 l, sous-terraine(s)&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></p>
			</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;">
			<p style="margin-left: 160px;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">attestation(s) d&rsquo;inspection et/ou de conformit&eacute; disponible(s)</span></p>
			</td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;0c0932cb&quot; data_label=&quot;Si plus de 5000 l, attestation(s) d&rsquo;inspection et/ou de conformit&eacute; disponible(s)&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un certificat de performance &eacute;nerg&eacute;tique portant le num&eacute;ro </span>{% textinput_tag name=&quot;17b87efb&quot; data_label=&quot;S&#39;il y a un certificat de performance &eacute;nerg&eacute;tique, le num&eacute;ro est :&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; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> &eacute;labor&eacute; le </span>{% dateinput_tag name=&quot;728a5ae4&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Un certificat de performance &eacute;nerg&eacute;tique &eacute;tabli le&quot; data_map_field=&quot;nomap&quot; style=&quot;max-width:70px;min-width:70px;width:70px;&quot; fixedwidth=&quot;70&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> a &eacute;t&eacute; d&eacute;livr&eacute; pour le bien.</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;45501d07&quot; data_label=&quot;Un certificat de performance &eacute;nerg&eacute;tique a &eacute;t&eacute; d&eacute;livr&eacute; pour le bien.&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le donneur d&rsquo;ordre s&rsquo;engage &agrave; demander un certificat de performance &eacute;nerg&eacute;tique</span></td>
			<td style="text-align: right;">
			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;428f1470&quot; data_label=&quot;Le donneur d&rsquo;ordre s&rsquo;engage &agrave; demander un certificat de performance &eacute;nerg&eacute;tique&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></p>
			</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le donneur d&rsquo;ordre donne l&rsquo;agent immobilier le pouvoir de demander un certificat de performance &eacute;nerg&eacute;tique</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;bab12ce9&quot; data_label=&quot;Le donneur d&rsquo;ordre donne l&rsquo;agent immobilier le pouvoir de demander un certificat de performance &eacute;nerg&eacute;tique&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Une attestation de conformit&eacute; est-elle disponible (Codex flamand du logement)?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;ceed05e7&quot; data_label=&quot;Une attestation de conformit&eacute; est-elle disponible (Codex flamand du logement)?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td>{% textarea_tag name=&quot;90bb6608&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;tails de l&#39;attestation de conformit&eacute; (Codex flamand du logement)?&quot; data_map_field=&quot;nomap&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: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un dossier des interventions ult&eacute;rieures est-il disponible (ann&eacute;e de construction ou de r&eacute;novation apr&egrave;s le 1/5/2001)?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;00e78427&quot; data_label=&quot;Un dossier des interventions ult&eacute;rieures est-il disponible (ann&eacute;e de construction ou de r&eacute;novation apr&egrave;s le 1/5/2001)?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">La mission de courtage a-t-elle d&eacute;j&agrave; &eacute;t&eacute; confi&eacute;e &agrave; un autre agent immobilier?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;d5e68c97&quot; data_label=&quot;La mission de courtage a-t-elle d&eacute;j&agrave; &eacute;t&eacute; confi&eacute;e &agrave; un autre agent immobilier?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Des proc&eacute;dures judiciaires sont-elles en cours concernant le bien?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;f5a7c416&quot; data_label=&quot;Des proc&eacute;dures judiciaires sont-elles en cours concernant le bien?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Une attestation d&rsquo;inspection &eacute;lectrique est-elle disponible (logement) ?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;265f7ed5&quot; data_label=&quot;Une attestation d&rsquo;inspection &eacute;lectrique est-elle disponible (logement) ?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un dossier d&rsquo;installation &eacute;lectrique non-domestique est-il disponible (immeuble commercial):</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;da1597b8&quot; data_label=&quot;Un dossier d&rsquo;installation &eacute;lectrique non-domestique est-il disponible (immeuble commercial):&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Choix du notaire:<br />
			le donneur d&rsquo;ordre choisit comme notaire:</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;995e8b81&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;le donneur d&rsquo;ordre choisit comme notaire:&quot; data_map_field=&quot;nomap&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: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Demander les renseignements &eacute;num&eacute;r&eacute;s &agrave; l&rsquo;article 3.94 &sect; 1 du Livre3 du C. civ. aupr&egrave;s du syndic&nbsp;</span>{% textinput_tag name=&quot;7018948b&quot; data_label=&quot;Demander les renseignements &eacute;num&eacute;r&eacute;s &agrave; l&rsquo;article 3.94 &sect; 1 du Livre3 du C. civ. aupr&egrave;s du syndic (nom du syndic)&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;70&quot; style=&quot;max-width:250px;min-width:250px;width:250px;&quot; fixedwidth=&quot;250&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;d85b1552&quot; data_label=&quot;Demander les renseignements &eacute;num&eacute;r&eacute;s &agrave; l&rsquo;article 3.94 &sect; 1 du Livre3 du C. civ. aupr&egrave;s du syndic&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">En cas de vente pendant la p&eacute;riode d&#39;obligation de r&eacute;novation (https://www.vlaanderen.be/een-woning-kopen/renovatieverplichting-voor-residentiele-gebouwen-vanaf-2023), l&#39;obligation passe &agrave; l&#39;acheteur. Ce bien est-il assorti d&#39;une obligation de r&eacute;novation ?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;86402ef7&quot; data_label=&quot;En cas de vente pendant la p&eacute;riode d&#39;obligation de r&eacute;novation (https://www.vlaanderen.be/een-woning-kopen/renovatieverplichting-voor-residentiele-gebouwen-vanaf-2023), l&#39;obligation passe &agrave; l&#39;acheteur. Ce bien est-il assorti d&#39;une obligation de r&eacute;novation ?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un inventaire amiante est-il disponible ?</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;82c16bf9&quot; data_label=&quot;Un inventaire amiante est-il disponible ?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;">
			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Un certificat amiante est-il disponible ?</span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Si oui, avec le code unique </span>{% textinput_tag name=&quot;f9000a12&quot; data_label=&quot;Si un certificat amiante est disponible le code unique est&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;70&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; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> &eacute;labor&eacute; le&nbsp;</span>{% dateinput_tag name=&quot;d4138a70&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Si certificat amiante disponible, date d&#39;&eacute;laboration&quot; data_map_field=&quot;nomap&quot; style=&quot;max-width:70px;min-width:70px;width:70px;&quot; fixedwidth=&quot;70&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</p>
			</td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;eca0d32b&quot; data_label=&quot;Un certificat amiante est-il disponible ?&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le donneur d&rsquo;ordre s&rsquo;engage &agrave; demander </span>{% checkbox_tag name=&quot;750d4829&quot; data_label=&quot;Le donneur d&rsquo;ordre s&rsquo;engage &agrave; demander un inventaire amiante&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">un inventaire amiante/ </span>{% checkbox_tag name=&quot;21116d17&quot; data_label=&quot;Le donneur d&rsquo;ordre s&rsquo;engage &agrave; demander un certificat amiante:&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">un certificat amiante:</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;e52d3648&quot; data_label=&quot;Le donneur d&rsquo;ordre s&rsquo;engage &agrave; demander un inventaire amiante/ un certificat amiante:&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 80%; text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le donneur d&rsquo;ordre donne l&rsquo;agent immobilier :<br />
			le pouvoir de demander&nbsp;</span>{% checkbox_tag name=&quot;5f8877db&quot; data_label=&quot;Le donneur d&rsquo;ordre donne l&rsquo;agent immobilier le pouvoir de demander un inventaire amiante&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">un inventaire amiante / </span>{% checkbox_tag name=&quot;633ebe3a&quot; data_label=&quot;Le donneur d&rsquo;ordre donne l&rsquo;agent immobilier le pouvoir de demander un certificat amiante:&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">un certificat amiante:</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;02a6a897&quot; data_label=&quot;Le donneur d&rsquo;ordre donne l&rsquo;agent immobilier le pouvoir de demander un inventaire amiante/ un certificat amiante:&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;oui&nbsp; &nbsp; |oui; non|non;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<p style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le donneur d&rsquo;ordre confirme que les d&eacute;clarations qu&rsquo;il a faites sont exactes et il d&eacute;charge l&rsquo;agent immobilier de toute responsabilit&eacute; due &agrave; des circonstances d&eacute;favorables qui ne lui ont pas &eacute;t&eacute; communiqu&eacute;es.</span></p>

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