SELF CERTIFICATION of AntiMafia communication and information EN version.docx
DOCX document 27 KB Posted
- Attached to
- PROCUREMENT AND DISPOSAL OF FIRE EXTINGUISHERS
- Solicitation number
- N6817126QN083
About this file
This file is a Self-Certification of Anti-Mafia Information form required under Italian Legislative Decree 06/09/2011 n.159, Article 85. The document serves as a certification template for individuals to declare under criminal liability that they and their cohabiting family members aged 18 or older have no causes of prohibition, forfeiture, or suspension as defined under Article 67 of the same legislative decree. The declarant must provide personal identifying information including name, date and place of birth, fiscal code or VAT number, and residential address, along with detailed information for all applicable family members. The form requires the declarant's signature, a copy of their identity document, and certification that personal data will be processed exclusively for the purpose of the procurement procedure in compliance with Italian data protection regulations (Legislative Decree No. 196/2003).
This certification template is ancillary to the primary federal contract opportunity for procurement and disposal of fire extinguishers at Naval Support Activity Naples. While the anti-mafia certification may be required due to the contract's location in Italy, it does not directly address the fire extinguisher procurement requirements, pricing terms, or other substantive contract details. The form itself contains no procurement specifications, timeline information, or award criteria relevant to the underlying solicitation N6817126QN083.
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Other files
| File | Type | Posted |
|---|---|---|
| 4.02d Solicitation Amendment N6817126QN0830002 SF 30.pdf | ||
| 4.02a Solicitation Amendment N6817126QN0830001 SF 30.pdf | ||
| SELF CERTIFICATION of AntiMafia communication and information EN version.docx | DOCX document | |
| Solicitation - N6817126QN083.pdf | ||
| ELINS MATRIX- Final.xlsx | XLSX spreadsheet |
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Text version
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 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
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File details come from the government source that posted it. Updated .