B08-SOL_W912PF26QA031_Attachment6_SelfCertificationforAntimafiaCommunication.pdf

This is an Italian anti-mafia self-certification declaration form required as part of federal contract opportunity W912PF26QA031.

The document is a substitute certification statement (Dichiarazione sostitutiva di certificazione) based on D.P.R. n. 445 dated December 28, 2000. It requires the undersigned individual, acting in an official capacity for a company, to declare under penalty of perjury that no grounds exist for prohibition, disqualification, or suspension under Article 67 of Legislative Decree n. 159 dated September 6, 2011. The declarant must provide personal information including name, tax identification number (C.F.), birth information, residence address, position held, company name and tax identification number, and company headquarters address. The declaration acknowledges awareness of criminal penalties for false statements and resulting loss of any benefits obtained, as referenced in Articles 75 and 76 of D.P.R. 445/2000. The form also includes a data privacy notification conforming to Legislative Decree n. 196/2003 regarding personal data protection, specifying that collected personal data will be processed exclusively for the contracting procedure and may be handled through electronic means. The declaration requires the signatory's legible signature and date.