Annex 1

Spett.le AGIRE S.c.r.l.

Piazza Sordello 43

46100 Mantova MN - Italy

SUBJECT: Call for proposal for communications services in the field of projects DIADEME LIFE15 CCM/IT/000110.

Applicant details form

Name of the organisation
Contact details for the purpose of this action
Registration number (or equivalent es Chamber of Commerce for Italian Companies)
Date of registration
Legal address of registration
Country of registration
Website and E-mail address of the organisation
Telephone number: Country code + city code + number
Fax number: Country code + city code + number
Legal status / □ Yes □ No

Declaration

I undersigned ______

Born in ______on ______

Tax code/VAT______

legal address______

In my capacity as legal representative of the company ______as before indicated in the Applicant details form. Tax code/VAT Number ______

As part of the submission of the offer for communications services in the context of projects, following the letter of invitation by AGIRE Scrl.

Being aware of the provisions of articles 75 and 76 of Italian Presidential Decree December 28, 2000 No. 445 about the impact and criminal liability that may be encountered in case of false declarations, pursuant to and by effect of art. 47 of Presidential Decree 445/2000, under my own responsibility

I CERTIFY THAT

As far as this procedure is concerned, our organisation:

a) is not subject to a conflict of interest;

b) is not in one of the situations of exclusion, referred to the public tenders;

c) the company I represent is committed to take into account, in case of award, of the obligations relating to the provisions in force concerning safety, working conditions and social security and welfare of workers

d) the company agrees, if awarded the contract, to assume the obligations of traceability of financial flows;

e) the company has taken full knowledge of all clauses contained in the invitation letter and its annexes and accept the aforementioned clauses in a full and unconditional way;

f) I am informed that, pursuant to the Legislative Decree 196/2003, that the personal data collected will be used exclusively in the context of proceedings for which the statement is made

AND I CERTIFY THAT NONE OF THE FOLLOWING CASES APPLY

TO OUR ORGANISATION:

j) it is not in compliance with its obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the country in which it is established or with those of the country of the contracting authority or those of the country where the contract is to be performed;

As an authorised representative I certify that the information given in our offer is correct.

Date ______Signature ______

PS: Attach at the declaration the identity card or passport of the person who sign this declaration.