PLEASE FILL IN ALL FIELDS OF THIS DECLARATION

Replacement Declaration Form 
(Article 46 of DPR 445/2000)
and
Declaration form instead of the affidavit
(Article 47 of DPR 445/2000)

I, the undersigned _________________________________________________________________ 
Place of birth ____________________________ state/province ____________________________
Date of birth (DD/MM/YYYY) ___________________ 
Full residential address _____________________________________________________________ _____________________________________________

DECLARE

pursuant to Articles 46, 47 and 38 of DPR 445/2000, 

that I have obtained the following degree: 
(specify if it is laurea V.O. before 1999, or laurea specialistica DM 509/99, or laurea magistrale DM 270/04)
Qualification: _________________________________________________________________ Obtained at: __________________________________________________________________ Graduation date ___________________________ final mark: __________________________
Title of the thesis ______________________________________________________________
or

that I will graduate within 31/10/2024
(specify if it is laurea specialistica DM 509/99, or laurea magistrale DM 270/04)
Qualification: _________________________________________________________________
University: ___________________________________________________________________
Provisional title of the thesis _____________________________________________________
and, on or before the beginning of the course, I will submit the self-declaration at the Ph.D office (dottorato@unifi.it). I understand that failure to do so will result in the rejection of my application.

I have passed the following exams
N.B. the list of exams is compulsory even for those who have not yet obtained their master’s degree 

Course Title	Mark/Out of	Date	

			

______________ add lines as necessary ______________

I have obtained the following bachelor’s degree
qualification: _________________________________________________________________ obtained at: ___________________________________________________________________ graduation date ___________________________ final mark: ___________________________
title of the thesis________________________________________________________________

I have passed the following exams
N.B. the list of exams is compulsory

Course Title	Mark/Out of	Date	

			

______________ add lines as necessary ______________

Pursuant to Articles 47, 38 and 19 of DPR 445/2000, declare that the photocopies relating to the qualifications attached to the application (publications, certifications, degree, etc.), conform to the originals.
I also declare that I am fully aware of the penal liability in case of false statements, false qualifications and/or use of false documents referred to in Art. 76 of DPR 445/2000, as well as the forfeiture of any benefits resulting from giving false statements according to Art. 75 of DPR 445/2000.
I hereby attach the photocopy of a valid identity document. Failure to do so will result in the application being considered null and void.

Date ______________________

								           The Declarant
								________________________
									(readable signature)