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<p style="text-align: justify;"><span class="titre_p" style="font-family:ITCAvantGardePro;font-size:18px;font-weight:900;">CAUTION SIGNATAIRE DU PR&Eacute;SENT ENGAGEMENT</span></p>

<table cellpadding="1" cellspacing="1" style="width: 100%;">
	<caption>
	<p style="text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nom et Pr&eacute;noms :</span></p>
	</caption>
	<tbody>
		<tr>
			<td>{% textinput_tag name=&quot;2b24ea76&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Nom et Pr&eacute;noms : &quot; data_help=&quot;Nom et Pr&eacute;noms : &quot; data_ancien_ids=&quot;5833&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%; break-inside: avoid;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance :</span></td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% dateinput_tag name=&quot;7abc5256&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot; Date de naissance :&quot; data_help=&quot; Date de naissance :&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 80%;">{% textinput_tag name=&quot;5f34688a&quot; data_label=&quot;Lieu de naissance :&quot; data_help=&quot;Lieu de naissance :&quot; maxlength=&quot;80&quot; data_ancien_ids=&quot;21911&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%;">
	<caption>
	<p style="text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Domicile :</span></p>
	</caption>
	<tbody>
		<tr>
			<td>{% textarea_tag name=&quot;1838fbe1&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Domicile :&quot; data_help=&quot;Domicile :&quot; data_ancien_ids=&quot;21964&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%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 6%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail :</span></td>
			<td style="width: 65%;">{% textinput_tag name=&quot;79c77dc2&quot; data_label=&quot;E-mail du garant&quot; data_help=&quot;e-mail du garant&quot; maxlength=&quot;65&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 4%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">T&eacute;l :</span></td>
			<td style="width: 25%;">{% textinput_tag name=&quot;d39f50f4&quot; data_label=&quot;T&eacute;l&eacute;phone du&nbsp; garant&quot; data_help=&quot;tel garant&quot; maxlength=&quot;25&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<p><span style="font-size:8px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><em>Vous avez la possibilit&eacute; de vous inscrire sur www.bloctel.gouv.fr pour vous opposer &agrave; tout d&eacute;marchage t&eacute;l&eacute;phonique conform&eacute;ment &agrave; l&#39;article L223-1 du Code de la consommation.</em></span></span></p>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
	<caption>
	<p style="text-align: left;"><span class="titre_p" style="font-family:ITCAvantGardePro;font-size:18px;font-weight:900;">SITUATION PROFESSIONNELLE</span></p>
	</caption>
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 13%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; &bull; Employeur :</span></td>
			<td style="width: 87%;">{% textinput_tag name=&quot;02842116&quot; data_label=&quot;Employeur de la caution&quot; data_help=&quot;Employeur de la caution&quot; maxlength=&quot;80&quot; data_ancien_ids=&quot;22071&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 13%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; &bull; Profession :</span></td>
			<td style="width: 87%;">{% textinput_tag name=&quot;40f59adb&quot; data_label=&quot;Profession de la caution&quot; data_help=&quot;Profession de la caution&quot; maxlength=&quot;80&quot; data_ancien_ids=&quot;22047&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%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 66%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; &bull; Contrat &agrave; dur&eacute;e :&nbsp;&nbsp;</span>{% checkbox_tag name=&quot;2c31df72&quot; data_label=&quot;CDI&quot; data_help=&quot;Type de contrat&quot; data_ancien_ids=&quot;5974&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;ind&eacute;termin&eacute;e &nbsp; &nbsp; &nbsp; </span>{% checkbox_tag name=&quot;2718418a&quot; data_label=&quot;CDD&quot; data_help=&quot;Type de contrat&quot; data_ancien_ids=&quot;5996&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;d&eacute;termin&eacute;e ; &bull; date de fin du contrat :</span></td>
			<td>{% dateinput_tag name=&quot;8f5cf72a&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de fin de contrat&quot; data_help=&quot;Date de fin de contrat&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%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 25%;">&nbsp; &bull;&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Salaire mensuel net :</span></td>
			<td>{% textarea_tag name=&quot;c142f139&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Salaire mensuel net&quot; data_help=&quot;Salaire mensuel net&quot; data_ancien_ids=&quot;22124&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 25%;">&nbsp; &bull;&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autres revenus :</span></td>
			<td>{% textarea_tag name=&quot;9e8be7ed&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Autres revenus&quot; data_help=&quot;Autres revenus&quot; data_ancien_ids=&quot;22176&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 25%;">&nbsp; &bull;&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span style="font-weight:600;">Soit au total</span>&nbsp;(net par mois)</span></td>
			<td>{% textarea_tag name=&quot;84dd79a9&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Total revenus, net par mois&quot; data_help=&quot;Total revenus, net par mois&quot; data_ancien_ids=&quot;22226&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="4" style="break-inside:avoid;width:100%;">
	<caption>
	<p style="text-align: left;"><span class="titre_p" style="font-family:ITCAvantGardePro;font-size:18px;font-weight:900;">Pi&egrave;ces &agrave; fournir</span></p>
	</caption>
	<tbody>
		<tr>
			<td style="width: 33%;">{% checkbox_tag name=&quot;90029611&quot; data_label=&quot;pi&egrave;ce d&rsquo;identit&eacute;&quot; data_help=&quot;Pi&egrave;ce d&rsquo;identit&eacute;&quot; data_ancien_ids=&quot;6376&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; pi&egrave;ce d&rsquo;identit&eacute;</span></td>
			<td style="width: 33%;">{% checkbox_tag name=&quot;aebcb6b3&quot; data_label=&quot;Justificatif de domicile&quot; data_help=&quot;justificatif de domicile&quot; data_ancien_ids=&quot;6353&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; justificatif de domicile</span></td>
			<td style="width: 33%;">{% checkbox_tag name=&quot;37ec799f&quot; data_label=&quot;Trois derniers bulletins de salaire&nbsp;&quot; data_help=&quot;trois derniers bulletins de salaire&nbsp;&quot; data_ancien_ids=&quot;6331&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; trois derniers bulletins de salaire&nbsp;</span></td>
		</tr>
		<tr>
			<td style="width: 33%;">{% checkbox_tag name=&quot;ec432cf0&quot; data_label=&quot;Justificatif des autres revenus&quot; data_help=&quot;justificatif des autres revenus&quot; data_ancien_ids=&quot;6664&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; justificatif des autres revenus</span></td>
			<td style="width: 33%;">{% checkbox_tag name=&quot;4bfa48ab&quot; data_label=&quot;Dernier avis d&rsquo;imposition sur le revenu&quot; data_help=&quot;dernier avis d&rsquo;imposition sur le revenu&quot; data_ancien_ids=&quot;6420&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; dernier avis d&rsquo;imposition sur le revenu</span></td>
			<td style="width: 33%;">&nbsp;</td>
		</tr>
	</tbody>
</table>

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