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<html>
<head>
  <meta content="text/html; charset=ISO-8859-1"
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 <title>Mutuelles Pr&eacute;sence</title>
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<div id="centre-popup">

    <h1>R&eacute;cup&eacute;ration de votre mot de passe </h1>
    
    <font color='red'><b></b></font>
    		        <form name="num_contrat" action="open_oubli_password.php" method="post"><input type="hidden" name="PHPSESSID" value="e6d13c1a8c12a0d62fbb25b81078fba1" />
        	<b>Veuillez saisir le num&eacute;ro de votre contrat</b><br>
            <input type="text" class="habillage-champs" name="num_contrat" value=""><br>
            <br>
        	<b>Veuillez saisir l'adresse email associ&eacute;e de votre contrat</b><br>
            <input class="habillage-champs" type="text" name="mon_email" value=""><br>
            <br>
            <b>Recopiez le code de s&eacute;curit&eacute; ci-dessous</b><br>
            <img class="alignement" src="../lib/img.Captcha.php"> 
            <br><input class="habillage-champs" type="text" name="accesskey" value="" style="width:150px;"><br>
            <br>
            <br>
            <input type="image" style="border: 0px solid ;" alt="envoyer" src="../pictos_site/btn_valider.gif?PHPSESSID=e6d13c1a8c12a0d62fbb25b81078fba1">
        </form>
                <br>
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