Self-Certification Form Template printable pdf download

Self-Certification Form Template

SELF-CERTIFICATION FORM TEMPLATE

SELF-CERTIFICATION

(Art. 46 D.P.R. n. 445, 28 December 2000)

I, the undersigned,_________________________________________________________________

born in ___________________________________________ (prov. _____ ) on ________________

resident in __________________________________ (prov. _____ ) road/square _______________

_____________________________________________________________________ n. ________

Under his personal responsibility and fully aware of legal consequences of making false declaration

according to art. 76 D.P.R. 445/2000 and to the provisions of the Penal Code and the special

legislation in this matter.

DECLARE

________________________________________________________________________________

I, the undersigned, am aware that according to art.10 of Law 675/96 the personal data hereby

declared will be used, also through IT tools, exclusively in the limit of the procedure for which this

self-certification is made.

The declarant

___________________________

_________________________

(Place and date)

(Signature)

The signature doesn’t have to be authenticated.

Self-Certification Form Template