Acceptance and Assumption of Liability Form

To the CAI of the Department 
To International Cooperation Unit (pdf attached to cooperations@unipi.it)

I, the undersigned ________________________________________________________________
Born in ___________________________ on ______________ University ID number___________
Enrolled in the BA/MS Degree Programme in__________________________________________
selected in the “Call for financial grants for mobility at partner universities for the issue of double degrees - year 2026” with a grant financial gross amount of 5.000,00 euro,

Declare

•	to accept the said grant
•	to have no other mobility grants of the University of Pisa for the same purpose
tick the applicable box
   □ to have not benefited from similar financial support/ Erasmus grant in the two previous academic years  
   □ to have benefited from similar financial support/Erasmus grant in the two previous academic years  
Undertake

•	to promptly write to notify the intention to waive

•	to submit to the relevant CAI the complete table “Learning Agreement-After the Mobility”, after the mobility, within and no later than 60 days form return, under penalty of contribution refund
•	to fully refund the contribution in the event of failure to obtain the double or joint qualification

Date and signature 

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