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Contient un/plusieurs signataires

Reprise des signataires

Peut etre dupliqué

Nombre maximum de block

Texte du bouton 'ajouter'

Texte du bouton 'supprimer'

Ce block contient un

Contenu

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: bottom; width: 50%;">{% select_tag name=&quot;871cxx9a&quot; data_label=&quot;Aanhef&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Aanhef&quot; data_choices=&quot;Aanhef|civilite; Mevrouw|madame; Mijnheer|monsieur;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %} Achternaam:</td>
			<td style="vertical-align: bottom; width: 50%; text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Voornaam :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;c3f8ff9f&quot; data_label=&quot;Achternaam van ondertekenaar&quot; data_map_field=&quot;nom&quot; data_help=&quot;Achternaam van ondertekenaar&quot; maxlength=&quot;50&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;67af634a&quot; data_label=&quot;Voornaam van ondertekenaar&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Voornaam van ondertekenaar&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: 70%;"><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;">Tel :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;0b645c7c&quot; data_label=&quot;E-mailadres van ondertekenaar&quot; data_map_field=&quot;email&quot; data_help=&quot;E-mailadres van ondertekenaar&quot; maxlength=&quot;50&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;28f36895&quot; data_label=&quot;Telefoonnummer van ondertekenaar&quot; data_map_field=&quot;tel&quot; data_help=&quot;Telefoonnummer van ondertekenaar&quot; maxlength=&quot;25&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="break-inside:avoid;width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;">
			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Geboortedatum:</span></p>
			</td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Geboorteplaats :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% dateinput_tag name=&quot;28fdeb1b&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de naissance&quot; data_map_field=&quot;date_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;01cb48dd&quot; data_label=&quot;Geboorteplaats&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Geboorteplaats&quot; maxlength=&quot;80&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: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Beroep&nbsp;:</span></td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nationaliteit&nbsp;:</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;fe0b74a6&quot; data_label=&quot;Beroep &quot; data_map_field=&quot;job&quot; data_help=&quot;Beroep &quot; maxlength=&quot;50&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;20b96f90&quot; data_label=&quot;Nationaliteit &quot; data_map_field=&quot;nationality&quot; data_help=&quot;Nationaliteit &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><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Andere nuttige informatie: :</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;51d7740f&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Andere nuttige informatie&quot; data_map_field=&quot;comment&quot; data_help=&quot;Andere nuttige informatie&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;">Adres :</span></td>
		</tr>
		<tr>
			<td style="width: 68%;">{% textinput_tag name=&quot;acdfc6e4&quot; data_label=&quot;Postadres van ondertekenaar&quot; data_map_field=&quot;adresse&quot; data_help=&quot;Postadres van ondertekenaar&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;">Postcode :</span></td>
			<td style="width: 55%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Stad :</span></td>
			<td style="width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Land :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% textinput_tag name=&quot;64baad57&quot; data_label=&quot;Postcode van ondertekenaar&quot; data_map_field=&quot;zipcode&quot; data_help=&quot;Postcode van ondertekenaar&quot; maxlength=&quot;10&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;8d0dbcc6&quot; data_label=&quot;Stad van ondertekenaar&quot; data_map_field=&quot;ville&quot; data_help=&quot;Stad van ondertekenaar&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;75e7cacb&quot; placeholder=&quot;Luxemburg&quot; data_label=&quot;Land van ondertekenaar&quot; data_map_field=&quot;pays&quot; data_help=&quot;Land van ondertekenaar&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: bottom; width: 50%;">{% select_tag name=&quot;871xsa9b&quot; data_label=&quot;Aanhef ondertekenaar&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Aanhef&quot; data_choices=&quot;Aanhef|civilite; Mevrouw|madame; Mijnheer|monsieur;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %} Achternaam:</td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Voornaam :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;aa8ce05b&quot; data_label=&quot;Achternaam van ondertekenaar&quot; data_map_field=&quot;nom&quot; data_help=&quot;Achternaam van ondertekenaar&quot; maxlength=&quot;50&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;611c25f9&quot; data_label=&quot;Voornaam van ondertekenaar&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Voornaam van ondertekenaar&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: 70%;"><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;">Tel :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;579ad53d&quot; data_label=&quot;E-mailadres van ondertekenaar&quot; data_map_field=&quot;email&quot; data_help=&quot;E-mailadres van ondertekenaar&quot; maxlength=&quot;50&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;89df3922&quot; data_label=&quot;Telefoonnummer van ondertekenaar&quot; data_map_field=&quot;tel&quot; data_help=&quot;Telefoonnummer van ondertekenaar&quot; maxlength=&quot;25&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="break-inside:avoid;width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Geboortedatum :</span></td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Geboorteplaats :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% dateinput_tag name=&quot;55880e87&quot; placeholder=&quot;dd/mm/jjjj&quot; data_label=&quot;Geboortedatum&quot; data_map_field=&quot;date_naissance&quot; data_help=&quot;Geboortedatum&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 80%;">{% textinput_tag name=&quot;9bd33ab4&quot; data_label=&quot;Geboorteplaats&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Geboorteplaats&quot; maxlength=&quot;80&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: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Beroep&nbsp;:</span></td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nationaliteit&nbsp;:</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;ff0bc36b&quot; data_label=&quot;Beroep&quot; data_map_field=&quot;job&quot; data_help=&quot;Beroep&quot; maxlength=&quot;50&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;b4c999ba&quot; data_label=&quot;Nationaliteit&quot; data_map_field=&quot;nationality&quot; data_help=&quot;Nationaliteit&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><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Andere nuttige informatie:</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;af9f60fa&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Andere nuttige informatie&quot; data_map_field=&quot;comment&quot; data_help=&quot;Andere nuttige informatie&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: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Familiale situatie: </span></td>
			<td>{% textinput_tag name=&quot;3c3b631d&quot; data_label=&quot;Familiale situatie&quot; data_map_field=&quot;family_situation&quot; data_help=&quot;Samenwonend, ...&quot; maxlength=&quot;70&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

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