DRAFTAttachment 9 Antimafia Self Declaration Form.pdf

This document is an Italian Anti-Mafia Information Self-Certification form (Autocertificazione della Informazione Antimafia), a legal document used for declaring the absence of mafia-related impediments. The form is designed for individuals to provide personal details and certify that they and their family members of legal age are not subject to legal restrictions, prohibitions, or suspensions as defined by Italian legislative decree.

The form requires the individual to complete personal information including name, birthplace, date of birth, fiscal code, and residence address. There is a table for listing family members with their respective details. The document emphasizes that the declarant is responsible for the accuracy of the information provided and that false statements can result in legal penalties. A copy of the individual's identification document must be attached, and the form can be used for administrative procedures with public and private service providers.