Attachment 2_SelfCertification_AntimafiaCommunication.pdf

This document is a Self-certification for Antimafia Communication form required as Attachment 3 to RFQ W912PF26QA024, based on Italian legislative requirements (D.P.R. n. 445 del 28.12.2000).

The form is a declarative certification statement in which an individual authorized representative of a company declares under penalty of perjury that neither they nor the company are subject to the causes of prohibition, disqualification, or suspension outlined in Article 67 of Legislative Decree No. 159 of September 6, 2011 (antimafia measures). The signatory must provide personal information including full name, tax identification number (C.F.), birth information, and residence address, along with the company's legal name, tax identification number, and registered office location. The declarant acknowledges criminal penalties for false statements and consequent loss of any benefits obtained, and confirms awareness of personal data protection regulations under Legislative Decree No. 196/2003, which restricts the use of personal data to the specific procurement proceeding. The form requires the date of execution and the legible signature of the authorized declarant.