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3 -&nbsp;&nbsp;Communication par un organisme de l&rsquo;identit&eacute; des personnes d&eacute;sign&eacute;es pour transmettre 
&nbsp; &nbsp; &nbsp;&nbsp;des Communications Syst&eacute;matiques d&rsquo;Informations

&nbsp; &nbsp; &nbsp; NB : Remplir ce tableau uniquement pour les personnes diff&eacute;rentes des d&eacute;clarants d&eacute;sign&eacute;s au point 1 ci-dessus.

&nbsp;

<table border="1" cellpadding="10" cellspacing="0" style="width:100%;">
	<tbody>
		<tr>
			<td style="padding: 10px; width: 15%; text-align: center;">Nom et pr&eacute;nom du communiquant</td>
			<td style="padding: 10px; width: 15%; text-align: center;">Fonction</td>
			<td style="padding: 10px; width: 12%; text-align: center;">T&eacute;l&eacute;phone</td>
			<td style="padding: 10px; width: 12%; text-align: center;">Fax</td>
			<td style="padding: 10px; width: 15%;">
			Courriel
			</td>
			<td style="padding: 10px; width: 20%; text-align: center;">s&rsquo;il s&rsquo;agit du remplacement, indiquez le nom de la (ou les) personne(s) qui n&rsquo;est plus en activit&eacute;</td>
		</tr>
		<tr>
			<td style="padding: 10px; width: 15%;">{% textarea_tag name=&quot;2yyb20ee&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Nom et pr&eacute;nom du communiquant 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nom et pr&eacute;nom du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 15%;">{% textarea_tag name=&quot;34yy2a25&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Fonction du communiquant 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Fonction du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 12%;">{% textarea_tag name=&quot;17yy302a&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;T&eacute;l&eacute;phone du communiquant 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;T&eacute;l&eacute;phone du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 12%;">{% textarea_tag name=&quot;80yy10cd&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Fax du communiquant 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Fax communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 15%;">{% textarea_tag name=&quot;20yy8b56&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Courriel du&nbsp;communiquant 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Courriel du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 20%;">{% textarea_tag name=&quot;f6yy6971&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Rempla&ccedil;ant du communiquant 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Rempla&ccedil;ant du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="padding: 10px; width: 15%;">{% textarea_tag name=&quot;2d7x20yy&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Nom et pr&eacute;nom du communiquant 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nom et pr&eacute;nom du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 15%;">{% textarea_tag name=&quot;34xe2ayy&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Fonction du communiquant 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Fonction du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 12%;">{% textarea_tag name=&quot;17x530yy&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;T&eacute;l&eacute;phone du communiquant 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;T&eacute;l&eacute;phone communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 12%;">{% textarea_tag name=&quot;807x10yy&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Fax du communiquant 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Fax communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 15%;">{% textarea_tag name=&quot;20x78byy&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Courriel du communiquant 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Courriel du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="padding: 10px; width: 20%;">{% textarea_tag name=&quot;f6xb69yy&quot; data_width=&quot;100&quot; rows=&quot;2&quot; data_label=&quot;Rempla&ccedil;ant du communiquant 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Rempla&ccedil;ant du communiquant&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

&nbsp;

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