Antimafia Self Declaration Form_Revision1.docx

SELF-DECLARATION OF ANTI-MAFIA INFORMATION

(To be completed by the individuals referred to in Art. 85 of Legislative Decree No. 159 of 06/09/2011) The undersigned___________________________________________________________________________________________________ born on__________________________________________________________________________________________________________ Tax Code ________________________________________________________________________________________________________ and resident in (City/Town) ____________________________________________________________________ Prov. ________________ at (Street/Address) _______________________________________________ No. ______________________________________________ fully aware of the criminal liability they are subject to, pursuant to and for the purposes of Articles 75 and 76 of Presidential Decree No. 445 of December 28, 2000, in the case of false declarations or the creation, exhibition, or use of false documents, or of documents containing data that is no longer true, declares and certifies under their own responsibility: that with regard to themselves and their cohabiting adult family members (whose details are made available below), there are no grounds for prohibition, forfeiture, or suspension as referred to in Art. 67 of Legislative Decree No. 159 of 06/09/2011.

First Name

The undersigned also declares to be informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the collected data will be processed, including by electronic means, exclusively for the purposes of the procedure for which this declaration is made.

Date ___________

Subjects Subject to Anti-Mafia Verification

1. For sole proprietorships, the anti-mafia documentation must refer to the owner and the technical director, where applicable.

2. For associations, companies, societies, (consortiums, temporary groupings of companies, and network contracts), the anti-mafia documentation must refer to the technical director, where applicable, as well as the following:

a) for associations, to the person who has legal representation;

b) for limited companies, including consortile ones under Article 2615-ter of the Italian Civil Code, for cooperative companies, for cooperative consortiums, for consortiums under Book V, Title X, Chapter II, Section II of the Italian Civil Code: to the legal representative and any other members of the administrative body, as well as to each of the consortium members who, in the consortiums and consortium companies, holds, even indirectly, a participation of at least 5 percent;

c) for limited companies, also to the majority shareholder in the case of a company with four or fewer shareholders, or to the sole shareholder in the case of a single-member company;

d) for consortiums under Article 2602 of the Italian Civil Code and for European Economic Interest Groupings, to the person who represents them and to the entrepreneurs or member companies;

e) for limited partnership companies (società semplice) and general partnerships (società in nome collettivo), to all partners;

f) for limited partnerships (società in accomandita semplice), to the general partners (soci accomandatari);

g) for foreign companies with a permanent secondary site/branch in Italy (under Article 2508 of the Italian Civil Code), to those who permanently represent them in the territory of the State;

h) for temporary groupings of companies, to the companies constituting the grouping, even if located abroad, according to the methods indicated in the preceding letters;

h-bis) ((for network contracts, to the companies participating in the contract, according to the methods indicated in the preceding letters, and, where present, to the common body));

i) for partnerships, to the individual partners (natural people) of the partnerships or capital companies that are themselves partners.

2-bis. In addition to the provisions of the preceding paragraph 2, for associations and companies of any type, even those without a legal personality, the anti-mafia documentation also refers to the members of the board of statutory auditors or, in the cases contemplated by Article 2477 of the Italian Civil Code, to the sole auditor, as well as to the individuals who carry out the supervisory tasks referred to in Article 6, paragraph 1, letter b) of Legislative Decree No. 231 of June 8, 2001.

2-ter. For companies established abroad that do not have a secondary headquarters with permanent representation in the territory of the State, the anti-mafia documentation must refer to those who exercise powers of administration, representation, or management of the company.

2-quater. For capital companies in the public gaming sector (referred to in paragraph 2, letters b and c), in addition to what is provided for in those letters, the anti-mafia documentation must also refer to any individual shareholders (natural people) who hold, even indirectly, a share of the capital or assets greater than 2 percent. This also includes general managers and people responsible for the branch or permanent establishments in Italy of non-resident entities. In case that the individual shareholders hold the participation above the aforementioned threshold through other limited companies, the documentation must also refer to the legal representative and any members of the board of directorsof the shareholder company, to the natural people who, directly or indirectly, control that company, as well as to the general managers and the people responsible for the branch or permanent establishments in Italy of non-resident entities. The documentation referred to in the preceding sentence must also refer to a non-separated spouse.

3. The anti-mafia information must also refer to the cohabiting adult family members of the subjects referred to in paragraphs 1, 2, 2-bis, 2-ter, and 2-quater.