SELF-DECLARATION IN LIEU OF AFFIDAVIT
(Under Presidential Decree no. 445 of 28 December 2000, art. 47 of)

I, the undersigned (name and surname_____________________________________________
Born in ____________________________________________ (Country) __________________________
On d___/m_______/y_______________
Resident in _____________________________________ (Country) ___________________________________
Permanent address_______________________________________________postcode_______________
Being the beneficiary of the research grant "_____________________________________________________________________________________
_______________________________________________________________________________________"
In the Department/Center of ______________________________________________________________, fully aware of the penal responsibilities in the event of false declaration as provided for in Presidential Decree 445/2000, art. 75 and 76  
HEREBY DECLARE
•	That I am not under a permanent employment contract with: Universities, other private and  public institutions, other private and public research centers, National Agency for new technology, energy and economic development (ENEA), the Italian Space Agency (ASI).
•	That I have no relationship up to the fourth degree, with any of the professors in the Department where the grant is activated, or with this  University Rector,  General Manager or an Administration Board member.
•	That I have read the Regulation on research grants which rules I undertake to follow

•	That I have/have not* carried out activities as a research fellow at the University of _____________________________________________ for the period ________________________ and that with the present research grant I will exceeded/will  not exceed the limits established by the Law no. 11 of 27 February 2015; art. 6,subparagraph 2-bis (as for these limits, the periods relating to research grants awarded under Law 449/1997 must not be declared);

•	That I have the following social security cover:
•	GESTIONE SEPARATA INPS (www.inps.it).;
•	GESTIONE SEPARATA INPS (www.inps.it) plus an additional social security cover (please indicate which social security fund) ____________________________________________________;

•	That for the monthly grant payments, my IBAN code is _______________________________________________________________;

To allow this administration the annual editing of the "Certificazione Unica (CU)", I here furthermore provide my spouse following data:

Name and Surname ____________________________________________________________________
Date and place of birth ____________________________________________________________________
Tax Code (if any) ____________________________________________________________________

 Date ________________
 Signature

 __________________________