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									                              UNIVERSITÀ DEGLI STUDI DELL'INSUBRIA
                                               via Ravasi 2, 21100 Varese



ANNEX A - FAC SIMILE
APPLICATION TO THE OPEN COMPETITION FOR THE AWARDING OF A RESEARCH SCHOLARSHIP



                                                                    Al Magnifico Rettore
                                                                    Università degli Studi dell’Insubria
                                                                    Via Ravasi, 2
                                                                    21100 VARESE


   I, UNDERSIGNED, ASK TO APPLY TO THE OPEN COMPETITION FOR THE AWARDING OF A RE-
   SEARCH SCHOLARSHIP; PROJECT TITLE (please, indicate the project title and the SSD code):
   …………………………………………………………………………………………………………………………………
   ………………………………………………………………….

   According to Items 46 e 47 of the Presidential Decree 445/2000 and being aware that false statements are pun-
   ished according to the Criminal Code and special laws, I declare that:

        NAME AND SURNAME
        PLACE AND DATE OF BIRTH
        TAX CODE
        PERMANENT ADDRESS

        CITIZENSHIP ……………………………………………………….……………;


        I, furthermore, declare that:

   A) I attained the following degree title:

   1.             DEGREE IN

                  DATE OF ATTAINMENT

                  AT THE UNIVERSITY                                                           MARK



   2.           □ PhD

                DATE OF ATTAINMENT

                AT THE UNIVERSITY                                                             MARK

                                                          or


                  □ MY PROFESSIONAL SCIENTIFIC CURRICULUM IS APPROPRIATE FOR THE RESEARCH
                  ACTIVITY.




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                            UNIVERSITÀ DEGLI STUDI DELL'INSUBRIA
                                                  via Ravasi 2, 21100 Varese



  FOR CANDIDATES WHO ATTAINED THE DEGREE TITLE OUTSIDE ITALY THAT HAS NOT BEEN PREVIOUSLY
  DECLARED EQUIVALENT TO AN ITALIAN TITLE:

  □ I ask to consider my degree title equivalent to an Italian title only for the admission to this competition.

  For this purpose I enclose the degree title (in original or as a substitutive certification) with the following attachments:
     1. Official translation in Italian language
     2. legalization and “declaration of value” of the degree




B) I am aware of the possible incompatibilities and the prohibition to combine different incomes

Annexes list;

    1) Certification of the Degree title with examinations and grades and the final mark;
    2) □ PhD certification
       or
       □ documented professional scientific curriculum related to the field of the research;
    3) □ for titles attained outside Italy: declaration of equivalence (if available), complete traqnslation of the ti-
       tle/s, declaration of value and legalization issued by the competent Italian Embassy or Consulate;
    4) □ documents and titles eventually useful for the evaluation, such as specialization diplomas statements
       of attendance to specialization courses;
    5) □ printed publications with date and place of publication or acceptance letter by the editor;
    6) Photocopy of a valid ID

The titles n. 1) 2) 4) and 5) can be accepted in non original copies or as auto-certification to be drawn
on the annex B.



I, undersigned, give my consent to the processing of personal data, within observance of law n. 675/1996, for
the accomplishments related to this procedure.

Place and date                                                                              Signature
                                                                                    (The signature is mandatory)




               POSTAL ADDRESS FOR COMUNICATIONS RELATED TO THIS COMPETITION:

   ADDRESS:
   TELEPHONE:
   E-MAIL ADDRESS:




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                         UNIVERSITÀ DEGLI STUDI DELL'INSUBRIA
                                            via Ravasi 2, 21100 Varese




ANNEX B - FAC SIMILE
SUBSTITUTE STATEMENT OF CERTIFICATION (ITEM 46 OF PRESIDENTIAL DECREE 445/2000)
SUBSTITUTE STATEMENT OF ATTESTED AFFIDAVIT (ITEM 47 OF PRESIDENTIAL DECREE 445/2000)




 I, Undersigned
 Name ______________________________________________________________________
 Surname_________________________________________________________________________
 Place of birth ________________________________________________________________________
 Date of Birth____________________________________________________________________________

 On my own responsibility, being aware that false statements, as by item 76 of Presidential Decree 445/2000,
 are punished according to the Criminal Code and special laws, I declare that:



    a) all the enclosed titles, certifications and publications are true copies;
    b) I obtained the following titles:
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 __________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ________________________________________________________________________________________
 ____________________________________________________________________________

 I, undersigned, give my consent to the processing of personal data, within observance of law n. 675/1996, for
 the accomplishments related to this procedure.

 Place and date                                                                  Signature
                                                                         (The signature is mandatory)




 N.B. Please, enclose a photocopy of a valid ID.




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