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<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nome :</span></td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Cognome</span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"> :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;087a9c2a&quot; data_label=&quot;Nome&quot; data_map_field=&quot;nom&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;f1d9a812&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;002cb93f&quot; data_label=&quot;Cognome&quot; data_map_field=&quot;prenom&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;e7d938b6&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 style="width: 68%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Residente a :</span></td>
		</tr>
		<tr>
			<td style="width: 68%;">{% textinput_tag name=&quot;109d7745&quot; data_label=&quot;Residente a&quot; data_map_field=&quot;adresse&quot; maxlength=&quot;100&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 style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Codice postale :</span></td>
			<td style="width: 55%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Citt&agrave; :</span></td>
			<td style="width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Paese :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% textinput_tag name=&quot;f5e66571&quot; data_label=&quot;Codice postale&quot; data_map_field=&quot;zipcode&quot; maxlength=&quot;10&quot; relation_ids_list=&quot;de0ac6cf&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;ed0a66fe&quot; data_label=&quot;Cit&agrave;&quot; data_map_field=&quot;ville&quot; maxlength=&quot;80&quot; relation_ids_list=&quot;729bba52&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;4e0fc70a&quot; placeholder=&quot;Italia&quot; data_label=&quot;Paese&quot; data_map_field=&quot;pays&quot; maxlength=&quot;50&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 style="vertical-align: middle; width: 30%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Codice fiscale :</span></td>
			<td style="vertical-align: middle; width: 40%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail :&nbsp;</span></td>
			<td style="vertical-align: middle; width: 30%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Telefono :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;3df53bc2&quot; data_label=&quot;Codice fiscale :&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;20&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 40%;">{% textinput_tag name=&quot;385a4815&quot; data_label=&quot;Email&quot; data_map_field=&quot;email&quot; maxlength=&quot;50&quot; relation_ids_list=&quot;70dab79e&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;e98e647c&quot; data_label=&quot;Telefono&quot; data_map_field=&quot;tel&quot; maxlength=&quot;25&quot; relation_ids_list=&quot;6dc1dd0c&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 style="vertical-align: middle; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Luogo di nascita :</span></td>
			<td style="vertical-align: middle; width: 30%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Data di nascita :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;67fe78de&quot; data_label=&quot;Luogo di nascita &quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Lieu de naissance&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% dateinput_tag name=&quot;f014d7d1&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Data di nascita&quot; data_map_field=&quot;date_naissance&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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		<tr>
			<td style="vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Per la quota di :</span></td>
			<td>{% textinput_tag name=&quot;7c13caa3&quot; data_label=&quot;Per la quota di :&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;20&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% radio_tag name=&quot;9177b295&quot; data_label=&quot;Propriet&agrave; :&quot; data_map_field=&quot;nomap&quot; data_choices=&quot;di piena propriet&agrave;&nbsp; &nbsp; |di piena propriet&agrave;; di usufrutto&nbsp; &nbsp; |di usufrutto; di nuda propriet&agrave;&nbsp; &nbsp; |di nuda propriet&agrave;; altro :&nbsp; &nbsp; |altro;&quot; %}</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td>{% textarea_tag name=&quot;b402be0c&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Propriet&agrave; altra :&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%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Altre informazioni utili&nbsp;:</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;d5f7398c&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Altre informazioni utili&quot; data_map_field=&quot;comment&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

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