Annex 2: Self-certification

The undersigned, ______

born on ______in ______

in its quality as ______

authorized to act on behalf of the contractor company/ firm ______

with the registered head office located in (town, postal code, street) ______

STATES

1) That the company’s/firm’s identity data, for which the offer for KEP AUSTRIA evaluation is being submitted to the Central European Initiative, are the following:

a) Corporate name______

b) Registered head office ______

c) Fiscal code ______

d) VAT number______

e) Phone number______

f) FAX______

g) E-mail address ______

2) That the company/firm is registered in the Trade Register of ______in the country of ______from______till______under the number______for the following activities______

3) That the company/firm has paid all its taxes and other statutory social contributions required by law

4) That the personal data and the address of the company’s holder (for sole proprietorships), associates (for general partnerships) general partners (for limited partnerships), directors entitled to represent the company (for other types of companies), special director and of the technical director (if present) are the following:

Name and surname:

Date and place of birth:

Address:

Position and its ending date:

5)

□ That no final judgement was pronounced against the company / firm and that no irrevocable criminal decree of conviction or a sentence for the determination of penalty for serious criminal offence against the State or Communities that affect the professional morality had been issued for the company / firm;

or

□ That the following final judgement /sentences were pronounced against the company / firm or an irrevocable criminal decree of conviction or the sentence for the determination of penalty was issued towards the company / firm (please indicate the type of offence and the article of reference, year, applied penalty, any plea bargaining, discharge or other issues)

______

□ That no final judgement was pronounced and that no irrevocable criminal decree of conviction or a sentence for the determination of penalty, for serious criminal offence against the State or Communities that affect the professional morality had been issued towards individuals no longer holding the position of the company holder, associate, general partner, director with the right of representing the company, technical director, in the last three years considering the present date;

or

□ That the following final judgement/sentence was pronounced or an irrevocable criminal decree of conviction or the sentence for the determination of penalty was issued towards individuals no longer holding their position in the last three years considering the present date (please indicate the type of offence and the article of reference, year, applied penalty, any plea bargaining, discharge or other issues)

______

6) That the company/firm

a) Is not facing bankruptcy, compulsory liquidation, arrangement with creditors, and that there are no ongoing proceedings that could lead to one of these situations;

b) Did not commit any serious duly identified offences according to the safety regulations and to any other obligation deriving from business relationships;

c) Did not commit any serious negligence or bad faith offence or serious mistakes in carrying out its own activities;

d) Did not commit any violations, identified according to the obligations concerning taxes and duties, deriving from the legislation of the country in which the company is located

e) did not made false statements in relation to the requirements and conditions necessary for the participation in the procedure for submission of offers for KEP AUSTRIA Evaluation;

f) Did not commit serious duly identified offences according to the legislation regulating national insurance and assistance contributions, as foreseen by the legislation of the state in which the company/firm is located;

g) Employs a total of______workers;

h) Did not receive disqualifying sanctions or any other sanction that would imply a ban on signing up contracts with public administration institutions;

7) That the global turnover produced in the last three financial years, approved before the date of the application for registration amounts to a total of €______

Finally, the undersigned states to inform promptly the Central European Initiative about any variation of the present statement.

Place and date______

Signatory

Central European Initiative, Via Genova 9, Trieste. Tel. +39 040 7786 777/721