ANNEX E

Declaration by the Applicant

I hereby declare that the information given in this application is true and correct to the best of my
knowledge and belief. In case any information given in this application proves to be false or
incorrect, I shall be responsible for the consequences.

I understand that completing the application process does not guarantee awarding the grant I
request from ARDA under this PSD GS.

Personal Details:

Full Name:
(First Name) (Middle Name) (Last Name)

Position: _________________________

Date: ___________________________

Signature Date
(dd/mm/yyyy)

REF/KPSD=GS-2016