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<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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			<td colspan="2" style="width: 27%; vertical-align: middle;"><span style="font-size:16px"><font face="ITCAvantGardePro"><b>INFORMATIONS RELATIVES A L&#39;OBJET ET A LA NATURE DE LA RELATION D&#39;AFFAIRES :&nbsp;</b></font></span></td>
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			<td style="width: 27%; vertical-align: middle;"><span style="font-size:16px;"><span style="font-family:ITCAvantGardePro;"><strong>Finalit&eacute; de l&#39;acquisition :</strong></span></span></td>
			<td>{% select_tag name=&quot;46a52eb3&quot; data_label=&quot;destination du bien pour l&#39;acqu&eacute;reur&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;r&eacute;sidence principale ou acquisition accessoire|r&eacute;sidence principale; investissement locatif|investissement locatif; revente|revente; autre|autre;&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>{% textinput_tag name=&quot;e0f77544&quot; data_label=&quot;autre finalit&eacute;&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">
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		<tr>
			<td colspan="3" style="vertical-align: bottom;"><span style="font-size:16px"><font face="ITCAvantGardePro"><b>mode de financement :</b></font></span></td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;26986079&quot; data_label=&quot;revenus professionnels&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">revenus professionnels</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;ebb932d6&quot; data_label=&quot;montant revenus professionnels&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;1b64d8b7&quot; data_label=&quot;revenus locatifs&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">revenus locatifs</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;5e7aecac&quot; data_label=&quot;montant revenus locatifs&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;0cf344c3&quot; data_label=&quot;&eacute;pargne&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;&eacute;pargne</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;daf5b9b2&quot; data_label=&quot;montant &eacute;pargne&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;2074c3e5&quot; data_label=&quot;succession&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">succession</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;db9a99d8&quot; data_label=&quot;montant succession&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;6ce96dc0&quot; data_label=&quot;donation&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">donation</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;1fc5f429&quot; data_label=&quot;montant de la donation&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;de7e572d&quot; data_label=&quot;produit de vente immobili&egrave;re ant&eacute;rieure&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">produit de vente immobili&egrave;re ant&eacute;rieure</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;e06efdae&quot; data_label=&quot;montant produit de vente immobili&egrave;re ant&eacute;rieure&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
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			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;d56a773c&quot; data_label=&quot;pr&ecirc;t bancaire&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">pr&ecirc;t bancaire</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;d2062110&quot; data_label=&quot;pr&ecirc;t bancaire&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: bottom;">{% checkbox_tag name=&quot;1b5c0971&quot; data_label=&quot;autre&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="vertical-align: bottom;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">autre</span></td>
			<td style="width: 60%;">{% textinput_tag name=&quot;d9439832&quot; data_label=&quot;description autre&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%;">
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			<td colspan="8"><span style="font-size:16px"><font face="ITCAvantGardePro"><b>mode de remboursement, en cas de pr&ecirc;t bancaire&nbsp;:</b></font></span></td>
		</tr>
		<tr>
			<td>{% checkbox_tag name=&quot;fc4eb92f&quot; data_label=&quot;revenus professionnels&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">revenus professionnels</span></td>
			<td>{% checkbox_tag name=&quot;b26c7be2&quot; data_label=&quot;revenus locatifs&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">revenus locatifs</span></td>
			<td>{% checkbox_tag name=&quot;43ccc9ef&quot; data_label=&quot;produit de vente ult&eacute;rieure&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">produit de vente ult&eacute;rieure</span></td>
			<td>{% checkbox_tag name=&quot;a2d24f9b&quot; data_label=&quot;autres&quot; data_map_field=&quot;nomap&quot; %}</td>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">autres</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td>{% textarea_tag name=&quot;268efa6b&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;autre mode de remboursement&quot; data_map_field=&quot;nomap&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

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