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

I, the undersigned name and surname, born in place (Country) on date, resident in city (Country),
Permanent address xxx postcode xxx
Being the beneficiary of the research grant (“assegno di ricerca”) “title” at the Department/Centre of xxx, fully aware of the criminal liability in the event of false statements pursuant to articles 75 and 76 of Presidential Decree 445/2000, 
HEREBY DECLARE THAT
•	I am not under a permanent employment contract with any University, other private and public institution, other private and public research center, the National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), the Italian Space Agency (ASI);
•	I have no relationship up to the fourth degree of kinship with any of the professors in the Department managing the grant, or with the University Rector, the Managing Director or a member of the Board of Directors;
•	I have read the Regulation on research grants and I undertake to follow its rules; 
•	Option 1 I have carried out activities as a research fellow (“assegnista di ricerca”) at the University of xxx for the period xxx and with the present research grant I will exceed/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);
•	Option 2 I have not carried out activities as a research fellow (“assegnista di ricerca”);
•	I have the following social security cover: 
•	Option 1 GESTIONE SEPARATA INPS (www.inps.it);
•	Option 2 GESTIONE SEPARATA INPS (www.inps.it) plus an additional social security cover xxx (please indicate which social security fund); 
•	for the monthly grant payments, my IBAN code is xxx;

As for the annual Italian Wage & Tax Statement compilation ("Certificazione Unica") by the University of Pisa, I provide my partner data here below:
Name and Surname xxx
Date and place of birth xxx
Tax Code (if any) xxx

Date xxx
Signature __________________________