Self-certification for Antimafia communication.pdf

This is a self-certification form for antimafia compliance required as Attachment 3 to RFQ W912PF26QA014. The form is an Italian declarative statement (Dichiarazione sostitutiva di certificazione) issued under D.P.R. n. 445 del 28.12.2000, serving as a substitute for formal certification documentation.

The form requires the signatory to provide personal identification information including name, tax identification number (C.F.), birthplace, and residence address, as well as the company name, tax identification number, and registered office location. The declarant, acting in an official capacity for the enterprise, must certify under penalty of perjury that neither they nor the company are subject to the prohibition, disqualification, or suspension causes outlined in Article 67 of Legislative Decree No. 159 dated 06/09/2011 (antimafia legislation). The signatory must also acknowledge awareness that personal data collected will be processed exclusively in connection with this procurement procedure in accordance with D.Lgs. n. 196/2003 regarding personal data protection. The form requires a legible signature and date from the declarant.