_Attachment 5 SELF CERTIFICATION of AntiMafia communication information EN version.pdf
PDF 125 KB Posted
- Attached to
- Credo Facilitators Federal contract opportunity
- Solicitation number
- N6817125Q0007
About this file
This document is a self-certification form for anti-mafia communications required under Article 85 of Italian Legislative Decree 06/09/2011 n.159. The form requires individuals to declare that there are no causes of prohibition, forfeiture, or suspension pursuant to Article 57/67 of the Legislative Decree.
The form requires basic identification information including the signatory's name, date and place of birth, fiscal code or VAT number, and place of residence. There are two versions of the form (Attachments 1 and 2), with Attachment 2 including an additional table for listing cohabiting family members aged 18 or older. The declaration includes acknowledgment of criminal liability for false statements under Presidential Decree 445/2000 and consent to data processing under Legislative Decree 196/2003. The form must be submitted with a copy of the signatory's identity document but does not require authentication of the signature, as it serves as a replacement for normal public administration certifications.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2.01 AMENDMENT 02 RFQ N6817125Q0007.pdf | ||
| 2.01 AMENDMENT 01 RFQ N6817125Q0007.pdf | ||
| _Attachment 4 CONTRACT ADMINISTRATION PLAN updated.pdf | ||
| _Attachment 2 Past Performance Questionnaire.pdf | ||
| _Attachment 1 Past Performance Information.pdf | ||
| _Attachment 4 CONTRACT ADMINISTRATION PLAN.pdf | ||
| 2.0 REQUEST OF QUOTE N6817125Q0007.pdf | ||
| _Attachment 3 QASP.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
Attachment 2
File details come from the government source that posted it. Updated .