ANNEX B - FAC SIMILE OF THE DECLARATION FOR PARTICIPATION IN THE
TENDER NOTICE
ANNEX B), RELATING TO THE REQUIREMENTS STATED IN ARTICLE 38, PARAGRAPH 1 ,
SECTIONS B), C) and M-TER) OF D.LGS. 163/2006
INSTRUCTIONS FOR COMPLETION
In order to avoid presenting incorrect or incomplete declarations that may lead to
the exclusion of the company from the tender procedure, participants are invited to
make use of the facsimile prepared by the Administration to help participants with
presentation of the statement (pursuant to and in accordance with articles 38, 46 and 47
of the D.P.R. of 28 December 2000, no. 445) in relation to the requirements of article
38, paragraph 1, sections b), c) and m-ter) of D.lgs 163/2006
The documents that follow are not modifiable, except for specifically prepared fields.
It is possible to move around within the documents using the mouse pointer, with the arrow
keys or with the “tab” key.
Furthermore, in some cases during completion the participant will find fields containing a
special list of data, from which it possible to choose the relevant options. By selecting the
chosen data directly with the mouse pointer this will automatically be entered in the
facsimile.
NB: A PHOTOCOPY OF AN IDENTITY DOCUMENT MUST BE ENCLOSED
WITH THE DECLARATION.
IT IS ALSO SPECIFIED THAT IT IS NOT NECESSARY TO ENCLOSE FURTHER
DOCUMENTATION.
ANNEX B), RELATING TO THE REQUIREMENTS STATED IN ARTICLE 38, PARAGRAPH 1 ,
SECTIONS B), C) and M-TER) OF D.LGS. 163/2006
Declaration form to be completed by:
- the owner or technical directors, in the case of a one man business;
- each of the partners and the technical directors in the case of a general partnership;
- the acting partners and technical directors in the case of a "società in accomandita
semplice" ("special partnership");
- the directors with powers to represent the company and technical directors, or the
individual sole shareholder, or the majority shareholder in the case of companies with less
than four shareholders in all other cases;
- persons leaving office in the year preceding the date of publication of the tender notice
(only for the declaration stated in point 3), including directors and technical directors who
have worked at any company taken over by or merged with the company in the last year
or those that have ceased to hold the relevant office in the aforesaid period,
should the legal representative not be directly
situation.
aware of their personal
To the Administration
Object: “PRE-COMMERCIAL PROCUREMENT FOR THE ASSIGNMENT OF RESEARCH
AND DEVELOPMENT SERVICES IN THE CONTEXT OF THE PROJECT CALLED
NYMPHA – MD REGARDING THE “SEARCH FOR MOBILE TECHNOLOGICAL
SOLUTIONS TO SUPPORT HEALTH WORKERS AND PATIENTS WITH THE CARE
AND MANAGEMENT OF BIPOLAR DISORDER”.
The undersigned ______________________________________________
born in _______________________ on _________________
resident in _____________________________________
in __________________________________________________
in the role of _______________________________
for the company______________________________________________________________
with its offices in _________________________________
(street) __________________________________________________
Taxpayer’s code _______________________ VAT number _______________________
In accordance with D.P.R. 445/2000, aware of the criminal penalties provided for by article 76
of the aforesaid decree, with reference to the aforementioned company
DECLARES
1) that there are no pending proceedings against him for the application of one of the
preventive measures under the terms of article 3 of the Law of 27 December 1956, no. 1423
or one of the disqualifying causes provided for under article 10 of the Law of 31 May 1965,
no. 575;
2) that there is no reason for his exclusion under the terms of article 38, par. 1 m-ter);
(if applicable, only to be completed in the event of convictions)
3) that he has received the following final convictions, irrevocable criminal convictions or
sentences in application of a penalty pursuant to the provisions of article 444 of the
criminal code, including those expunged (it is compulsory to declare ALL convictions,
specifying the details of the judgement and the type of offence recorded, except
when the crime has been decriminalised or where there has been supervening
rehabilitation or when the offence has been declared extinguished after the conviction or
in the event of revocation of the conviction itself):
TO BE COMPLETED IN THE EVENT OF CONVICTIONS
Name
Details of judgement
Type of offence
PLACE AND DATE _______________________
_____________________________
(SIGNATURE IN FULL)
ENCLOSED: photocopy of the identity document of the legal representative.

Informative note according to article 13 of the D.Lgs. of 30 June 2003, no. 196
“Code on the protection of personal data”
The Legislative Decree of 30 June 2003, no. 196 guarantees that the handling of data will take place
respecting fundamental rights and freedom, and the dignity of the party concerned, with particular
reference to confidentiality, personal identity and the right to data protection.
The contracting authority intends to handle data lawfully and correctly, with full safeguarding of your
rights and confidentiality according to article 9 of the Law of 31 December 1996, no. 675.
According to article 13 of legislative decree 196/2003, participants in the tender procedure are
informed that:
1.
the data provided by participants in the tender procedure will be handled exclusively with
reference to the procedure for which the documentation was presented;
2.
data will be handled using paper and/or computerised media;
3.
the provision of data is compulsory in order to carry out procedures relating to participants in
the tender procedure;
4.
the data controller shall be the contracting authority;
5.
the person responsible for the handling of the data shall be the Manager of the Tenders
Department;
6.
at any time, the participant may exercise his rights in relation to the data controller, according
to article 7 of legislative decree 196/2003.
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