“Dona un albero a Roma” (donate a tree to Rome)

To
Roma Capitale
Dipartimento Tutela Ambientale – Protezione Civile
U.O. Gestione Verde Pubblico
Piazza di Porta Metronia, 2
00183 Roma
[email protected]
REGISTRATION FORM
“Dona un albero a Roma” (donate a tree to
Rome)
I undersigned __________________________________________________________________________________
born in (city and state) _________________________________________________________________________
on (date of birth) ______________________________________________________________________________
resident in (city and state) _________________________________________________________________________
address ____________________________________________________________________________________
Postcode ___________________ Tel ____________________________Mobile ______________________________
Fax _________________/ Email _____________________________________ @ ____________________________
DECLARE
that I i ntend to take part in the “DONA UN ALBERO A ROMA ” (donate a tree to Rome)
initiative, for which purpose I , the undersig ned,



donate a total of _____________ tree/trees
transfer the sum of € 250.00 per tree for a sum total of € _____________.00 as donation to Roma Capitale
for purchase and maintenance of the tree/s donated.
specify the area/areas (Municipio/Municipi, or administrative borough/s) in which the tree/s is/are to be
located:
nr. ____type1 _________ □ MUNICIPIO I
nr. ____type __________ □ MUNICIPIO II
nr. ____type __________ □ MUNICIPIO III
nr. ____type __________ □ MUNICIPIO IV
nr. ____type __________ □ MUNICIPIO V
nr. ____type __________ □ MUNICIPIO VI
nr. ____type __________ □ MUNICIPIO VII
nr. ____type __________ □ MUNICIPIO VIII
nr. ____type _________
nr. ____type _________
nr. ____type _________
nr. ____type _________
nr. ____type _________
nr. ____type ________
nr. ____type _________
□ MUNICIPIO IX
□ MUNICIPIO X2
□ MUNICIPIO XI
□ MUNICIPIO XII
□ MUNICIPIO XIII
□ MUNICIPIO XIV
□ MUNICIPIO XV
 It is requested that the following dedicatory message accompany the donation (max. 140 characters)
(include message if desired): ____________________________________________________________
 _________________________________________________________________________________________
___________________________
____________________________________________________________________________________
I undersigned declar e that I am aw are that :


in regard to the tree species selected, to ensure compatibility with the plant life assets present in the area
selected, I must reach an agreement with the technical staff of the parks and gardens service, Servizio
Giardini del Dipartimento Tutela Ambientale;
planting shall take place at the agronomically appropriate time and season (autumn/fall-winter) for planting.
Please find attached :
□ a pdf format copy of a valid ID document;
□ a copy of the receipt for payment3 by bank transfer totalling € 250.00 per tree, consisting in a donation made to
Roma Capitale with specification of the reason for payment: “Adesione al progetto Dona un Albero a Roma”
(participation in the “Give Rome a Tree” project).
For the bank transfer to Roma Capitale, Tesoreria Comunale, capofila (reference bank) Unicredit S.p.A , Via
Monte Tarpeo, 41, the procedure can be undertaken at any bank or post office (Banco Posta). The beneficiary’s
bank data are as follows:
National
code
IBAN
CIN
IT
69
P
Codice IBAN (IBAN code)
ABI
CAB
02008
05117
C/C (current
account)
000400017084
BIC code (for transfers from abroad)
SWIFT CODE UNCRITMM
I undersigned issue AUTHORISATION that my name may be included in the Registro Donatori “Un Albero a Roma”
(the “donate a tree to Rome” donors’ register) accessible on the Roma Capitale web portal:
1
To select the tree/s, users may access the photo gallery and find the corresponding code
This Municipio (admnistrative borough) has yet to decide whether it shall join the project, by means of a deliberation,
Deliberazione Municipale, to this effect.
3
The contribution may instead be made by payment to the municipal treasury office, Tesoreria Comunale – via Monte Tarpeo,
41
2
YES
NO
I undersigned furthermore declare that:
-
-
in accordance with art. 47 seq. of the section, Titolo V, of the D.P.R. (presidential decree) of 28 December
2000 no. 445, I am aware of the criminal law consequences of misrepresentation and of drafting or use of
false deeds as per art. 76 of the said decree;
I am aware, for the purposes of art. 13 of D. Lgs. (legislative decree) no. 196/2003, that the personal data
collected shall be processed (also by electronic means) solely for the purposes of the procedures pertaining
to the declaration herein; that the body responsible for the processing of the data is the parks and gardens
operational unit, U.O. Gestione Verde Pubblico, in the person of the director thereof; and am aware of the
provisions of art. 7 of D. Lgs. (legislative decree) no. 196/2003 pertaining to the rights relative to
competence for, and access to, personal data and other rights.
The application is undersigned by the applicant, has been scanned as a pdf file and has been sent, only by e-mail,
with the attachments consisting in a copy of the receipt attesting to the bank transfer effected and a copy of the ID
card, to the address [email protected] .
Place ______________________, date ____/____/____
Applicant
_________________________________________

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