ENCLOSURE B

The undersigned (surname and name) ................................................................................ born in ...................................(prov.…..) on………………..Tax Code…………..……..……. 
resident in ................................................ (prov........) Student ID number ………………….

DECLARES, pursuant to Presidential Decree no. 445/2000:

•	to have the following QUALIFICATIONS

Qualification 1
Name of the qualification achieved _________________________________________
Name and type of the issuing educational or training institution ___________________
____________________________________________________________________
Date of achievement ___________________________________________________
Main subjects / professional skills which are the subject of study __________________
_____________________________________________________________________
Grade (if expressed) ___________________________________________________

Qualification 2
Name of the qualification achieved _________________________________________
Name and type of the issuing educational or training institution ___________________
____________________________________________________________________
Date of achievement ___________________________________________________
Main subjects / professional skills which are the subject of study __________________
____________________________________________________________________
Grade (if expressed) ________________________________________________

Qualification 3
Name of the qualification achieved ________________________________________
Name and type of the issuing educational or training institution __________________
____________________________________________________________________
Date of achievement ___________________________________________________
Main subjects / professional skills which are the subject of study _________________
____________________________________________________________________
Grade (if expressed) __________________________________________________

Qualification 4
Name of the qualification achieved _________________________________________
Name and type of the issuing educational or training institution ___________________
____________________________________________________________________
Date of achievement ____________________________________________________
Main subjects / professional skills which are the subject of study __________________
_____________________________________________________________________
Grade (if expressed) ___________________________________________________

(please declare all the qualifications achieved, by adding up other sets of “Qualifications”, if required, or by cancelling those not filled-in)
•	to have made the following PUBLICATIONS

Publication 1
Title of publication ___________________________________________________
Authors _____________________________________________________________
Publisher ____________________________________________________________
Date of publication: ____________________________________________________
Abstract _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Code (ISBN/ISMN/ISSN/DOI)_____________________________________________

Publication 2
Title of publication ___________________________________________________
Authors ____________________________________________________________
Publisher ____________________________________________________________
Date of publication: ____________________________________________________
Abstract _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Code (ISBN/ISMN/ISSN/DOI)_____________________________________________

Publication 3
Title of publication ___________________________________________________
Authors _____________________________________________________________
Publisher ____________________________________________________________
Date of publication: ____________________________________________________
Abstract _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Code (ISBN/ISMN/ISSN/DOI)_____________________________________________

Publication 4
Title of publication ___________________________________________________
Authors _____________________________________________________________
Publisher ___________________________________________________________
Date of publication: ____________________________________________________
Abstract _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
Code (ISBN/ISMN/ISSN/DOI)_____________________________________________

(please include all publications, by adding up other sets of “Publications”, if required, or by cancelling those not filled-in)

PLEASE NOTE:
The declarant is criminally liable in case of false declarations (art. 76 of Presidential Decree of December 28, 2000, no. 445). The declarant forfeits the benefits achieved, if any, in case of untrue declarations (art. 75 of Presidential Decree of December, 2000, no. 445).