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Doc. code 025 Application entran ce examination 1st Level Degree TO THE MAGNIFICIENT RECTOR UNIVERSITY OF PERUGIA The undersigned _________________________________________________________________________ surname name born in__________________________________________ country_________________________________ date of birth____________ residence _____________________________(_______) postal code__________ address______________________________________________ n.___________ domiciled for the at present for the entrance examination in________________________________________ postal code__________ address______________________________________________ n.______________ telephone numbers________________________________________________________________________ tax code_____________________________________________ aware of the previewed penalties in case of false declarations and of the loss of the eventually obtained benefits (art. 75 and 76 D.P.R. n. 445 of 28/12/2000) DECLARES -to be in possession of the school-leaving certificate______________________________________________ ______/100 ( _______________ ) obtained in the academic year__________________ mark: _______/60 ( _______________ ) at the institute____________________________________________________________________________ (name and address of the school) REQUESTS for the Academic Year 200…./… to be allowed to take part to the selective entrance examination for the degree course: _____ ”JOB CREATION ORIENTED BIOTECHNOLOGY” International First Level Degree ____________ The undersigned declares to have looked at the date, seat and procedure of the entrance examination, and also at the exclusion reasons published in the notice of the course. Furthermore he/she declares to be aware that no communication will be given on this matter. He/she also declares to be aware that, in conformity with art. 13 of D.L.vo 30 june 2003, n. 196 “Codice in materia di protezione dei dati personali”, his/her personal data will be used by University of Perugia only for institutional purposes, in the observance of the provisions in force. Perugia……………… Signature(1)…………:……………………………… Stamp and signature of the accepting officer______________________________________ (1) the signing of this declaration from the undersigned in presence of the accepting officer does not require the authentication (art. 38 of D.P.R. 28/12/2000 n. 445), but it is followed by the signature and stamp of the accepting officer. The signing can be done in absence of the accepting officer under presentation of a copy of a valid document of identification. Attachments: a) Receipt of the bulletin post office account n° 8052 in the name of: Banca dell’Umbria-Gruppo Unicredit, of Euro 50,00, as contribution for general expenses for the admission to the course (available at the main Secretariat of Medicina) and clear copy of an identification document (passport is better).
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