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\pnlvlbody\ilvl0\ls20\pnrnot0\pndec\pnb0\pni0\pnstart1\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls20\adjustright \f16\lang2057 {\f0\fs20 Pr\'e9nom (s) /}{\i\f62\fs20\lang1033 First name (s) / \'c8\'ec\'ff(\'e8\'ec\'e5\'ed\'e0) }{\i\f62\fs20\lang1049 \'e8 \'ee\'f2\'f7\'e5\'f1\'f2\'e2\'ee}{\i\f0\fs20\lang1033 \tab }{\f0\fs20\lang1033 \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\f0\fs20\lang1033 \par }\pard \s15\ri-45\nowidctlpar\tx-720\tx709\tx1418\tx4395\tx4962\tx7797\tx8647\hyphpar0\adjustright {\f0\fs20\lang1033 \tab Sexe:\tab masculin / f\'e9minin\tab \tab }{\i\f62\fs20\lang1033 Sex: male / female\tab \'cf\'ee\'eb: \'ec\'f3\'e6\'f1\'ea\'ee \'e9/\'e6\'e5\'ed\'f1\'ea\'e8\'e9}{\i\f0\fs20 }{\f0\fs20\lang1033 \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang2057 \hich\af0\dbch\af0\loch\f0 3.\tab}}\pard \s15\qr\fi-284\li284\nowidctlpar\tx720\tqr\tx1843\tx2410\tx2835\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls13\pnrnot0\pndec\pnb0\pni0\pnstart3\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls13\adjustright {\f0\fs20 Nationalit\'e9 / Nationality /}{\i\f62\fs20\lang1049 \'c3\'f0\'e0\'e6\'e4\'e0\'ed\'f1\'f2\'e2\'ee}{\f0\fs20 \tab \par }\pard \s15\nowidctlpar\tx720\tqr\tx1843\tx2410\tldot\tx10490{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\hyphpar0\adjustright {\f0\fs20 \par {\pntext\pard\plain\s15 \fs20\lang2057 \hich\af0\dbch\af0\loch\f0 4.\tab}}\pard \s15\fi-284\li284\nowidctlpar\jclisttab\tx-1418\tx720\tqr\tx1843\tx2835\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls13\pnrnot0\pndec\pnb0\pni0\pnstart3\pnindent360\pnhang {\pntxta .}}\hyphpar0\ls13\adjustright {\f0\fs20 Profession / Occupation / }{\i\f62\fs20 \'d0\'ee\'e4 \'e7\'e0\'ed\'ff\'f2\'e8\'e9}{\f0\fs20 \tab \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 5.\tab}}\pard \s15\fi-284\li284\nowidctlpar\tx-720\tx709\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls46\pnrnot0\pndec\pnb0\pni0\pnstart5\pnindent360\pnhang{\pntxta .}}\hyphpar0\ls46\adjustright {\f0\fs20\lang1033 Date et lieu de naissance / }{\i\f0\fs20\lang1033 Date and place of birth }{\i\f0 / }{\i\f62\fs20 \'c4\'e0\'f2\'e0 \'e8 \'ec\'e5\'f1\'f2\'ee \'f0\'ee\'e6\'e4\'e5\'ed\'e8\'ff}{\i\f0\fs20\lang1033 \tab }{\f0\fs20\lang1033 \par }\pard \s15\nowidctlpar\tx-720{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\hyphpar0\adjustright {\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 6.\tab}}\pard \s15\fi-284\li284\nowidctlpar\tx720\tqr\tx1560\tx2835\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls46\pnrnot0\pndec\pnb0\pni0\pnstart5\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls46\adjustright {\f0\fs20\lang1033 Domicile / }{\i\f0\fs20\lang1033 Permanent address}{\i\f0 / }{\i\f62\fs20 \'cf\'ee\'f1\'f2\'ee\'ff\'ed\'ed\'fb\'e9 \'e0\'e4\'f0\'e5\'f1}{\f0\fs20\lang1033 \tab \par }\pard \s15\nowidctlpar\tx85\tx142\tx720\tqr\tx1418\tqr\tldot\tx10493{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\hyphpar0\adjustright {\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 7.\tab}}\pard \s15\fi-284\li284\nowidctlpar\tx-993\tx720\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls46\pnrnot0\pndec\pnb0\pni0\pnstart5\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls46\adjustright {\f0\fs20\lang1033 Tel. N}{\f0\fs20\lang1033 {\field{\*\fldinst SYMBOL 176 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\f0\fs20\lang1033 / }{\i\f62\fs20\lang1033 \'cd\'ee\'ec\'e5\'f0 \'f2\'e5\'eb\'e5\'f4\'ee\'ed\'e0}{ \f0\fs20\lang1033 \tab \par }\pard \s15\nowidctlpar\tx-720{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\hyphpar0\adjustright {\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 8.\tab}}\pard \s15\fi-284\li284\nowidctlpar\tx720\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls46\pnrnot0\pndec\pnb0\pni0\pnstart5\pnindent360\pnhang{\pntxta .}}\hyphpar0\ls46\adjustright { \f0\fs20\lang1033 Adresse actuelle (si diff\'e9rente de 6.) \tab \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\i\f62\fs20\lang1033 \tab Present address (if different from 6.) / \'c0\'e4\'f0\'e5\'f1 \'ef\'f0\'ee\'e6\'e8\'e2\'e0\'ed\'e8\'ff \'e2 \'ed\'e0\'f1\'f2\'ee\'ff\'f9\'e5\'e5 \'e2\'f0\'e5\'ec\'ff (\'e5\'f1 \'eb\'e8 \'ee\'f2\'eb\'e8\'f7\'e0\'e5\'f2\'f1\'ff \'ee\'f2 \'ef. 6) \par }{\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 9.\tab}}\pard \s15\fi-284\li284\nowidctlpar\tx-1418\tx709\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls18\pnrnot0\pndec\pnb0\pni0\pnstart9\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls18\adjustright {\f0\fs20\lang1033 Nom et pr\'e9nom du / de la repr\'e9sentant(e)}{\cs29\f0\fs20\lang1033 \chftn {\footnote \pard\plain \s28\nowidctlpar\tlul\tx851\adjustright \f16\lang2057 {\tab \par }\pard\plain \s15\nowidctlpar\tx-720\tx11624\hyphpar0\adjustright \f16\lang2057 {\cs29\sub \chftn }{\f0\fs16\lang1033\sub }{\f0\fs16\lang1033 Si le / la requerant(e) est represente(e), joindre une procuration signee par le / la requerant(e) en faveur du / de la representant(e). \par }\pard \s15\nowidctlpar\tx-720\tx142\hyphpar0\adjustright {\lang1033 \tab }{\i\f0\fs16\lang1033 A form of authority signed by the applicant should be submitted if a representative is appointed. \par }{\i\f62\fs16 \'c5\'f1\'eb\'e8 \'e7\'e0\'ff\'e2\'e8\'f2\'e5\'eb\'fc \'e4\'e5\'e9\'f1\'f2\'e2\'f3\'e5\'f2 \'f7\'e5\'f0\'e5\'e7 \'ef\'f0\'e5\'e4\'f1\'f2\'e0\'e2\'e8\'f2\'e5\'eb\'ff, \'f1\'eb\'e5\'e4\'f3\'e5\'f2 \'ef\'f0\'e8\'eb\'ee\'e6\'e8\'f2\'fc \'e4\'ee \'e2\'e5\'f0\'e5\'ed\'ed\'ee\'f1\'f2\'fc \'ed\'e0 \'e8\'ec\'ff \'ef\'f0\'e5\'e4\'f1\'f2\'e0\'e2\'e8\'f2\'e5\'eb\'ff, \'ef\'ee\'e4\'ef\'e8\'f1\'e0\'ed\'ed\'f3\'fe \'e7\'e0\'ff\'e2\'e8\'f2\'e5\'eb\'e5\'ec.}}}{\f0\fs20\lang1033 \tab \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\i\f62\fs20\lang1033 \tab Name of representative* / \'c8\'ec\'ff \'e8 \'f4\'e0\'ec\'e8\'eb\'e8\'ff \'ef\'f0\'e5\'e4\'f1\'f2\'e0\'e2\'e8\'f2\'e5\'eb\'ff* \par }{\f0\fs20\lang1033 \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 10.\tab}}\pard \s15\fi-142\li57\nowidctlpar\jclisttab\tx-1418\tqr\tx-1134\tx720\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls31\pnrnot0\pnb0\pni0\pnstart13\pnindent360\pnhang{\pntxtb 10.}} \hyphpar0\ls31\adjustright {\f0\fs20\lang1033 Profession du / de la repr\'e9sentant}{\i\f0\fs20\lang1033 (e) \tab \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\i\f62\fs20\lang1033 \tab Occupation of representative / \'d0\'ee\'e4 \'e7\'e0\'ed\'ff\'f2\'e8\'e9 \'ef\'f0\'e5\'e4\'f1\'f2\'e0\'e2\'e8\'f2\'e5\'eb\'ff}{\f0\fs20\lang1033 \par \par {\pntext\pard\plain\s15 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 11.\tab}}\pard \s15\fi-284\li199\nowidctlpar\tx720\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls33\pnrnot0\pndec\pnb0\pni0\pnstart11\pnindent360\pnhang{\pntxta .}}\hyphpar0\ls33\adjustright { \f0\fs20\lang1033 Adresse du / de la repr\'e9sentant(e) \tab }{\i\f0\fs20\lang1033 \par }\pard \s15\nowidctlpar\tx-720{\*\pn \pnlvlcont\ilvl0\ls0\pnrnot0\pndec }\hyphpar0\adjustright {\i\f0\fs20\lang1033 \tab Address of representative}{\i\f0 / }{\i\f62\fs20 \'c0\'e4\'f0\'e5\'f1 \'ef\'f0\'e5\'e4\'f1\'f2\'e0\'e2\'e8\'f2\'e5\'eb\'ff}{ \f0\fs20\lang1033 \par \par {\pntext\pard\plain\s48 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 12.\tab}}\pard\plain \s48\fi-284\li199\nowidctlpar\tx-720\tx709\tldot\tx5387\tx5670\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls33\pnrnot0\pndec\pnb0\pni0\pnstart11\pnindent360\pnhang {\pntxta .}}\hyphpar0\ls33\adjustright \f16\fs20 {Tel. N}{{\field{\*\fldinst SYMBOL 176 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{/ }{\i\f62 \'cd\'ee\'ec\'e5\'f0 \'f2\'e5\'eb\'e5\'f4\'ee\'ed\'e0}{\tab \tab Fax N}{{\field{\*\fldinst SYMBOL 176 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{ / }{\i\f62 \'cd\'ee\'ec\'e5\'f0 \'f2\'e5\'eb\'e5\'f4\'e0\'ea\'f1\'e0}{\tab \par }\pard \s48\nowidctlpar\tx-720\tx709\tqr\tx1418\tldot\tx5103\tx5529\tldot\tx10490\hyphpar0\adjustright { \par \par \par {\pntext\pard\plain\s48 \b\f16\fs20\lang1033 \hich\af16\dbch\af0\loch\f16 B.\tab}}\pard \s48\fi-357\li300\nowidctlpar\jclisttab\tx-1418\tx-720\tx709\tqr\tx1418\tldot\tx5103\tx5529\tldot\tx10490{\*\pn \pnlvlbody\ilvl0\ls29\pnrnot0 \pnucltr\pnstart1\pnindent360\pnhang{\pntxta .}}\hyphpar0\ls29\adjustright {\b LA HAUTE PARTIE CONTRACTANTE \par }\pard\plain \s15\nowidctlpar\tx-720\hyphpar0\adjustright \f16\lang2057 {\b\i\f0\fs20\lang1033 \tab THE HIGH CONTRACTING PARTY \par }{\b\i\f64\fs20\lang1033 \tab \'c2\u1067\'3f}{\b\i\f62\fs20\lang1033 \'d1\'ce\'ca\'c0\'df \'c4\'ce\'c3\'ce\u914\'3f\'c0\'d0\'c8\'c2\'c0\'de\'d9\'c0\'df\'d1\'df \'d1\'d2\'ce\'d0\'ce\'cd\'c0 \par }{\f0\fs20\lang1033 \par \par \tab }{\f0\fs18\lang1033 (Indiquer ci-apr\'e8s le nom de l\rquote Etat / des Etats contre le(s) quel(s) la requ\'eate est dirig\'e9e) \par }{\i\f0\fs18\lang1033 \tab (Fill in the name of the State(s) against which the application is directed) \par }{\i\f62\fs18\lang1033 \tab (\'d3\'ea\'e0\'e6\'e8\'f2\'e5 \'ed\'e0\'e7\'e2\'e0\'ed\'e8\'e5 \'e3\'ee\'f1\'f3\'e4\'e0\'f0\'f1\'f2\'e2\'e0, \'ef\'f0\'ee\'f2\'e8\'e2 \'ea\'ee\'f2\'ee\'f0\'ee\'e3\'ee \'ed\'e0\'ef\'f0\'e0\'e2\'eb\'e5\'ed\'e0 \'e6\'e0\'eb\'ee \'e1\'e0) \par {\pntext\pard\plain\s48 \fs20\lang1033 \hich\af0\dbch\af0\loch\f0 13.\tab}}\pard\plain \s48\fi-284\li199\nowidctlpar\tx-1418\tx720\tqr\tldot\tx10206{\*\pn \pnlvlbody\ilvl0\ls24\pnrnot0\pndec\pnb0\pni0\pnstart13\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls24\adjustright \f16\fs20 {\tab \par {\pntext\pard\plain\s48 \b\lang1033 \hich\af0\dbch\af0\loch\f0 II.\tab}}\pard \s48\fi-720\li720\nowidctlpar\tx-1418\jclisttab\tx720\tqr\tldot\tx10493{\*\pn \pnlvlbody\ilvl0\ls49\pnrnot0\pnucrm\pnb1\pni0\pnfs24\pnstart2\pnindent720\pnhang{\pntxta .}} \hyphpar0\ls49\adjustright {\page }{\b\fs24 EXPOS\'c9 DES FAITS \par }\pard\plain \s15\nowidctlpar\tx-720\tx709\hyphpar0\adjustright \f16\lang2057 {\b\f0\lang1033 \tab }{\b\i\f0 STATEMENT OF THE FACTS \par }{\b\i\f0\fs18 \tab }{\b\i\f62 \'c8\'c7\'cb\'ce\'c6\'c5\'cd\'c8\'c5 \'d4\'c0\'ca\'d2\'ce\'c2}{\b\i\f0\fs18 \par }\pard \s15\nowidctlpar\tx-720\hyphpar0\adjustright {\f0\fs18\lang1033 \par }{\f0\fs16\lang1033 \tab }{\f0\fs18\lang1033 (Voir chapitre II de la note explicative) \par }{\i\f0\fs18\lang1033 \tab (See Part II of the Explanatory Note}{\i\f0\fs16\lang1033 ) \par \tab }{\i\f62\fs18\lang1033 (\'d1\'ec. \'d0\'e0\'e7\'e4\'e5\'eb \'cf \'c8\'ed\'f1\'f2\'f0\'f3\'ea\'f6\'e8\'e8) \par }{\f0\fs18\lang1033 \par }{\f0\fs16\lang1033 \par \par {\pntext\pard\plain\s15 \cs29\fs20\lang2057\super \hich\af0\dbch\af0\loch\f0 14.\tab}}\pard \s15\fi-284\li199\nowidctlpar\tx-1418\tx-720\jclisttab\tx709{\*\pn \pnlvlbody\ilvl0\ls36\pnrnot0\pndec\pnb0\pni0\pnstart14\pnindent360\pnhang{\pntxta .}} \hyphpar0\ls36\adjustright {\cs29\i\f0\fs20\super {\field{\*\fldinst SYMBOL 32 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}{\footnote \pard\plain \s15\qr\ri-45\nowidctlpar\adjustright \f16\lang2057 {\cs29\f0\super {\field{\*\fldinst SYMBOL 32 \\f "Symbol" \\s 12}{\fldrslt\f3\fs24}}}{\f0 }{\f0\fs16 Si necessaire, continuer sur une feuille separee \par }\pard \s15\qr\li-567\ri-45\nowidctlpar\adjustright {\i\f0\fs16 Continue on a separate sheet if necessary \par }{\i\f62\fs16 \'c5\'f1\'eb\'e8 \'ed\'e5\'ee\'e1\'f5\'ee\'e4\'e8\'ec\'ee, \'ef\'f0\'ee\'e4\'ee\'eb\'e6\'e8\'f2\'e5 \'e