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<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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			<td><span class="titre_p" style="font-family:ITCAvantGardePro;font-size:18px;font-weight:900;">Bail :&nbsp;</span></td>
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			<td>{% textarea_tag name=&quot;c62ff846&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;&nbsp;Situation locative&quot; data_map_field=&quot;nomap&quot; data_help=&quot;&nbsp;Situation locative&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
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</table>

<p>{% checkbox_tag name=&quot;edcc4a84&quot; data_label=&quot;Bien vendu occup&eacute;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Bien vendu occup&eacute;&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien est actuellement occup&eacute; par un locataire, et sera vendu occup&eacute;. </span></p>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
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			<td style="vertical-align: middle; width: 15%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Montant du loyer :</span></td>
			<td>{% textinput_tag name=&quot;d48dd9c6&quot; data_label=&quot;montant du loyer&quot; data_map_field=&quot;rent_price&quot; data_help=&quot;montant du loyer&quot; maxlength=&quot;75&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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</table>

<p>{% checkbox_tag name=&quot;747c2253&quot; data_label=&quot;Bien actuellement occup&eacute; vendu vide&quot; data_help=&quot;Bien actuellement occup&eacute;&nbsp;vendu vide&quot; data_map_field=&quot;nomap&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien est actuellement occup&eacute; par un locataire et sera vendu vide. Cong&eacute; d&eacute;livr&eacute; le :&nbsp;</span>{% dateinput_tag name=&quot;8f795d03&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date du cong&eacute;&quot; data_help=&quot;Date du cong&eacute;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; data_map_field=&quot;nomap&quot; %}</p>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
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			<td style="vertical-align: middle; width: 5%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Par :&nbsp;</span></td>
			<td style="width: 25%;">{% textinput_tag name=&quot;ab0a6a5a&quot; data_label=&quot;Cong&eacute; d&eacute;livr&eacute; par&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Cong&eacute; d&eacute;livr&eacute; par&quot; maxlength=&quot;25&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 15%; text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Montant du loyer : </span></td>
			<td>{% textinput_tag name=&quot;e8a5d259&quot; data_label=&quot;Montant du loyer&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Montant du loyer&quot; maxlength=&quot;20&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Sinistre en cours sur la location (impay&eacute; ou litige)</span></td>
			<td style="text-align: right;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;a9b88478&quot; data_label=&quot;Sinistre en cours sur la location&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Sinistre en cours sur la location&quot; data_choices=&quot;OUI|oui; NON|non; *NC|non communiqu&eacute; non concern&eacute;;&quot; %}</span></td>
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</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Si oui, pr&eacute;ciser :</span></td>
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			<td>{% textarea_tag name=&quot;45f37e49&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;litige&quot; data_map_field=&quot;nomap&quot; data_help=&quot;litige&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
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</table>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
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			<td style="width: 75%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Le bien &eacute;tait lou&eacute; ant&eacute;rieurement ?</span></td>
			<td style="text-align: right; width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;2185e0ee&quot; data_label=&quot;Le bien &eacute;tait lou&eacute; ant&eacute;rieurement ?&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Le bien &eacute;tait lou&eacute; ant&eacute;rieurement ?&quot; data_choices=&quot;OUI|oui; NON|non; *NC|non communiqu&eacute; non concern&eacute;;&quot; %}</span></td>
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			<td style="width: 75%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Avez-vous d&eacute;livr&eacute; un cong&eacute; &agrave; votre pr&eacute;c&eacute;dent locataire ?</span></td>
			<td style="text-align: right; width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;cbe8fcf9&quot; data_label=&quot;Cong&eacute; au locataire&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Cong&eacute; au locataire&quot; data_choices=&quot;OUI|oui; NON|non; *NC|non communiqu&eacute; non concern&eacute;;&quot; %}</span></td>
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</table>

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