4.02 Attachment 1 - Self-Certification of the Anti-Mafia Communication.docx
DOCX document 35 KB Posted
- Attached to
- Housing Home Appliances
- Solicitation number
- N6817126QN038
About this file
This is a self-certification form for anti-mafia compliance required under Italian Legislative Decree 06/09/2011 n.159, Article 85. The document serves as a template for contractors to declare their eligibility and that of their family members to participate in procurement procedures by confirming the absence of prohibitions, forfeitures, or suspensions related to organized crime involvement.
The form requires the declarant to provide personal identification information including name, date and place of birth, fiscal code or VAT number, and residential address. Two versions are included: one certifying that the declarant alone has no disqualifying causes under Article 57, and a second version extending the certification to cohabiting family members aged 18 or older under Article 67, requiring their names, dates of birth, places of birth, and fiscal codes. The declarant must sign the form and provide a copy of their identity document. The form explicitly states it does not require signature authentication and replaces standard certifications normally required by public administration entities. The document references Italian data protection legislation (Legislative Decree No. 196/2003) and includes criminal liability warnings pursuant to Presidential Decree 445 of December 28, 2000, for false declarations or fraudulent documentation. This certification requirement appears to be a mandatory compliance element for the Housing Home Appliances solicitation (N6817126QN038) issued by the Department of the Navy Naval Supply Systems Command.
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Other files
| File | Type | Posted |
|---|---|---|
| Solicitation Amendment N6817126QN0380001 SF 30.pdf | ||
| 4.02 N6817126QN038.pdf |
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Text version
SELF-CERTIFICATION OF THE ANTI-MAFIA COMMUNICATION
(Art. 85 of Legislative Decree 06/09/2011 n.159)
The undersigned (Last name, Name) ______________________________________________________________
| Date and place of Birth | FISCAL CODE or VAT Number | Place of residence | Prov. | |
| Street_____________________________________________________________________ | n•_____________ |
Fully aware of the criminal liability faced, pursuant to and by effect of articles 75 and 76 of the Presidential Decree 28 December 2000, n• 445, in case of false declarations or creation, exhibition or use of false documents, or documents containing data no longer corresponding to the truth, declares and attests under his/her own responsibility:
That the causes of prohibition, forfeiture or suspension pursuant to art. 57 of Legislative Decree 06/09/2011 n• 159 are not present.
The undersigned also declares to be fully informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the data collected will be processed, even with IT tools, exclusively within the purpose of the procedure for which this declaration is made.
Date
Signature
Provide copy of the Identity document of the subscriber.
This declaration does not require the authentication of the signature and replaces, for all the intents and purposes, the normal certifications required by a Public Administration, as well as for managers of public services and the private sector who allow it.
Legislative Decree 06/09/2011 n. 159, art. 85 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
Attachment 1
SELF-CERTIFICATION OF THE ANTI-MAFIA INFORMATION
(Art. 85 of Legislative Decree 06/09/2011 n.159)
The undersigned (Last name, Name) ______________________________________________________________
| Date and place of Birth | FISCAL CODE or VAT Number | Place of residence | Prov. | |
| Street_____________________________________________________________________ | n•_____________ |
Fully aware of the criminal liability faced, pursuant to and by effect of articles 75 and 76 of the Presidential Decree 445 of 28 December 2000, in the event of false declarations or the formation, exhibition or use of false documents, or documents containing data that no longer correspond to the truth, declares and attests under his/her own responsibility:
That are no causes of prohibition, forfeiture or suspension pursuant to art. 67 of Legislative Decree 06/09/2011 No. 159, for the undersigned and/or cohabiting family members aged 18 or more (whose data are made available below).
| FIRST NAME |
| LAST NAME |
| Date of Birth |
| Place of Birth |
| Fiscal Code |
The undersigned also declares to be fully informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the data collected will be processed, even with IT tools, exclusively within the purpose of the procedure for which this declaration is made.
Date
Signature
Provide copy of the Identity document of the subscriber.
This declaration does not require the authentication of the signature and replaces, for all the intents and purposes, the normal certifications required by a Public Administration, as well as for managers of public services and the private sector who allow it.
Legislative Decree 06/09/2011 n. 159, art. 85 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
Attachment 2
File details come from the government source that posted it. Updated .