Substituting certification and deed of fame Articles 46 and 47 DPR445/2000 (not alternative attestation of the state of risk

) - Statements by the owner / tenant: I, the undersigned _________________________ __________proprietario vehicle insured with policy / budget numero______________ , declare as follows: 1. 2. 3. 4. 5. 6. 7. 8. that the vehicle has not moved the date of ___ / ___ / ___ ___/___/___; to be in community of property with Mr. / Ms _________________________; of belonging as a member society of people want to __________________________________; made payable contraenza of the bill / estim ate to Mr. / Ms ____________________________; have purchased on ___ / ___ / ___ moped with the chassis _________________________________; have sold on ___ / ___ / ___ moped with the chassis of the vehicle ___________________________________ ; currently indicated in the policy will be sold / demolished, they are entitled to class on n °____ while not in possession of risk because not issued by 'bus iness __________________ which have been prohibited from recruiting new business , 9 . not to have caused casualties from the date of effect of contract on _____ ________________________ 10. be a component of stable coexistence (same residenc e) of Mr. / Madam _____________________ owner of the vehicle insured targato____ ____________attualmente con_______________________ in view of Articles. 1892, 1893 and 1894 d.c. and aware of the legal consequence s arising from the release of false statements and the production or use of fals e documents under 'art.76 of the DPR 445/2000, well aware that the falsification or alteration of a bill or documentation required for the conclusion a contract , and falsification of claims and worsening of the consequences of an accident i s a criminal offense covered by 'Art. 642, Ä .p. and punished with imprisonment fr om 6 months to 4 years. Date _______________________ Owner's Signature ______________________ I attach a copy of identity document-sided Linear S.p.a. Insurance Company See and Managing Director: 40127 Bologna - Via d el Pillar, 52 - tel. (051) 6378004/telefax (051) 6,378,419 - Share capital â ¬ 19, 300,000 REA No 362005 - Tax Code, VAT and No 'Register of Companies of Bologna 0 4260280377 Company authorized to provide insurance with Provv. ISVAP 18 June 199 6 (OJ 28 June 1996, No 150) single-member company subject to the direction and c oordination of Unipol SpA Financial Group

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