\documentclass[a4paper]{article} 
\usepackage[utf8]{inputenc}
\usepackage[T1]{fontenc}
\usepackage{fourier}
\usepackage{alterqcm}
\usepackage{fullpage}
\thispagestyle{empty}

\begin{document}
{\Large
NOM : 

PRÉNOM :

\bfseries
\vspace{1cm}
\AQannexe[propstyle=\bfseries\arabic]{1}{10}{4}%
 \hspace{2cm}
\AQannexe[propstyle=\bfseries\alph]{11}{20}{3}}
\end{document}
 
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% format   : pdflatex
% engine   : pdfetex
% author   : Alain Matthes
