SELF-CERTIFICATION of AntiMafia communication.docx
DOCX document 31 KB Posted
- Attached to
- Administrative Offices Furniture
- Solicitation number
- N6817126QN072
About this file
This document is a self-certification form for anti-mafia compliance required under Italian Legislative Decree 06/09/2011 n.159. The form contains two separate certification templates that contractors or bidders must complete and submit as part of the solicitation process for the Naval Supply Systems Command's Administrative Offices Furniture procurement (Solicitation N6817126QN072).
The first certification attests that the undersigned individual has no prohibitions, forfeitures, or suspensions under Article 57 of the referenced Legislative Decree. The second certification, included as Attachment 1, extends this declaration to include the undersigned and all cohabiting family members aged 18 or older, requiring personal information (name, date of birth, place of birth, and fiscal code) for each covered individual. Both forms require the signatory to acknowledge criminal liability for false declarations and must be accompanied by a copy of the subscriber's identity document. The declarations do not require signature authentication and serve as replaceable certifications for public administration and private sector entities that accept them. The forms include standard data protection notices referencing Italian privacy legislation (Legislative Decree No. 196/2003) regarding the processing of collected personal information solely for the procurement procedure purposes.
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| 4.03 QA.pdf | ||
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| 4.02 RFQ - N6817126QN0720001.pdf | ||
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| Room 278 measurements.pdf | ||
| 4.02 RFQ - N6817126QN072.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 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
Attachment 2
File details come from the government source that posted it. Updated .