You are on page 1of 1

Name ………………………………………….

…………………………………………………
Professional title

…………………………………………………
Institution

…………………………………………………
Private address

Statement

I declare that the paper to be published in the Scientific SERiA Annals titled
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
is original and has not been published as whole or in pieces.

…………………………………….
Signature

You might also like