ANNEX

PhD Program in

Self-certification and declaration

made according to and by effect of the DPR 28th December 2000 n. 445

(to be attached to the application)

The undersigned ,

born on (date) , in (Town) ,

(Province) , (Country) ,

resident in (Town) , (Province) ,

(Country) , at (Address) ,

postcode , Phone: ; e-

mail: ; With

reference to the application for admission to the PhD program in:

DR n. , according Articles. 75 and 76 of Presidential Decree No December 28, 2000. 445, in

the case of false declarations, false documents or use of forged documents, shall incur the penalties called by

the decree, and will expire immediately from the ranking of the competition in the epigraph,

DECLARES

to be in possession of the following other educational qualifications and/or professional

qualifications: (indicate all the necessary data for a possible verification):

1) ,

2) ,

3) ,

4) ,

5) ,
6) ,

7) ,

8) ,

that the copies of the documents listed below, attached to this declaration, are equal to the original:

Date, Signature (full and readable),