Attachment 0002_Anti Mafia Self Certification.pdf

This is an Italian Anti-Mafia Self Certification form, a declaration document used in Italian public procurement processes. The form is a substitute certification (Dichiarazione sostitutiva di certificazione) issued under D.P.R. n. 445 of December 28, 2000, and serves as a legal declaration rather than a formal certificate.

The form requires the declarant to provide personal identification information including full name, tax identification number (C.F.), birthplace, and residential address, as well as the company name, tax identification number, and business address. The declarant must state their position within the company. The declaration attests that neither the individual nor the company is subject to the prohibitions, disqualifications, or suspensions outlined in Article 67 of Legislative Decree n. 159 of September 6, 2011, which relates to anti-mafia regulations. The declarant acknowledges potential criminal penalties for false statements and loss of any benefits obtained through fraudulent declaration, as referenced in Articles 75 and 76 of D.P.R. 445/2000. The form also includes a data protection notice under Legislative Decree n. 196/2003, informing the declarant that personal data collected will be processed exclusively within the context of the specific proceeding for which the declaration is submitted. The document requires the declarant's signature and date.