Da Coge, maggio 2012
REFERENCE: REQUEST FOR AUTHORIZATION TO USE PRIVATE VEHICLE FOR OFFICIAL TRIPS OR BUSINESS TRAVEL FOR FONDAZIONE BRUNO KESSLER
I, the Undersigned ______FBK employee/in-house consultant with the ______Research Unit/Service wish to use my private vehicle for official trips and/or business travel and
declare
- that I am authorized to drive with valid ____ category driver’s license No. ______;
- that, for official trips and/or business travel I will use the following vehicles:
Model ______plate No. ______
□ private vehicle
□ vehicle owned by[1] ______, with whom I, the Undersigned, am:
□ in community of property □ out of community of property
or, alternatively
Model______plate No.______
□ private vehicle
□ vehicle owned by ______, with whom I, the Undersigned, am:
□ in community of property □ out of community of property
I also declare
- that the above vehicle/s is/are in good working order;
- that the above vehicle/s is/are covered by a third-party liability insurance policy stipulated in compliance with current applicable regulations;
- that I relieve Fondazione Bruno Kessler from any liability deriving from the use of my own vehicle and from any damage caused to third parties;
- that I am aware that comprehensive (kasko) insurance coverage on the vehicle used is activated by the Foundation only if the official trip or business travel has been authorized according to the procedures in force at FBK which provide for kilometric reimbursement;
- that I will promptly inform Fondazione Bruno Kessler of any changes in the information provided that may occur;
- that I authorize, pursuant to and for the purposes of Legislative Decree 196/2003, the processing of personal information provided with exclusive reference to the procedure in question.
Trento, ______
Signature
______
In acknowledgement, I hereby authorize
The Head of Unit/Service
Date ______
Signature ______
2 di 2
[1] Please indicate the natural or legal person who owns the vehicle