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			<td><em><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 12px;">(Personne physique)</span></span></em></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;5f0c9a12&quot; data_label=&quot;Civili&eacute; repr&eacute;sentant du syndic&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Civili&eacute; repr&eacute;sentant du syndic&quot; data_choices=&quot;Mr |mr; Mme |mme;&quot; %}&nbsp;&nbsp;<em>(nom de famille, pr&eacute;nom)</em> :</span></td>
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			<td>{% textarea_tag name=&quot;0154b323&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;nom de famille, pr&eacute;nom du syndic&quot; data_map_field=&quot;nomap&quot; data_help=&quot;nom de famille, pr&eacute;nom du syndic&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;">Adresse du principal &eacute;tablissement :</span></td>
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			<td>{% textarea_tag name=&quot;aa9c7d47&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;adresse du principal &eacute;tablissement&quot; data_map_field=&quot;nomap&quot; data_help=&quot;adresse du principal &eacute;tablissement&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;">Exer&ccedil;ant en qualit&eacute; de syndic professionnel</span></td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Immatricul&eacute; (e) au registre du commerce et des soci&eacute;t&eacute;s de :&nbsp;&nbsp;</span>{% textinput_tag name=&quot;616f96b2&quot; data_label=&quot;lieu immatriculation RCS&quot; data_map_field=&quot;nomap&quot; data_help=&quot;lieu immatriculation RCS&quot; maxlength=&quot;50&quot; style=&quot;max-width:450px;min-width:450px;width:450px;&quot; fixedwidth=&quot;450&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;">sous le num&eacute;ro :&nbsp; </span>{% textinput_tag name=&quot;ee21b7f8&quot; data_label=&quot;num&eacute;ro RCS&quot; data_map_field=&quot;nomap&quot; data_help=&quot;num&eacute;ro RCS&quot; maxlength=&quot;20&quot; style=&quot;max-width:150px;min-width:125px;width:125px;&quot; fixedwidth=&quot;150&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; et dont le num&eacute;ro unique d&rsquo;identification est :&nbsp;&nbsp;</span>{% textinput_tag name=&quot;a68d956f&quot; data_label=&quot;num&eacute;ro unique d&#39;identification RCS&quot; data_map_field=&quot;nomap&quot; data_help=&quot;num&eacute;ro unique d&#39;identification RCS&quot; maxlength=&quot;20&quot; style=&quot;max-width:150px;min-width:125px;width:125px;&quot; fixedwidth=&quot;150&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
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