SELF-CERTIFICATION OF UNIVERSITY DEGREE 1

To the Rector
Alma Mater Studiorum – University of Bologna

I, the undersigned ......………………………………………………………………………………………………………

availing myself of the provisions under Art.3 and Art.46 of the Italian D.P.R. No.445/2000 and fully aware that
under Art.76 those who are untruthful, commit forgery, or make use of false papers are punished according to the
criminal law and the special legislation, besides losing all rights to the benefits described under Art. 75

TAKE FULL RESPONSIBILITY FOR CERTIFYING THAT:

- my NAME is ………………………….…………, my SURNAME is..........…….…………………………………….

- I was BORN in………………….………………………………………………on…………………………...............
- I am DOMICILED in: Country………………………….……. Street.....………………………………… No. ……...
Post Code…….....................………Town...................……………….Province/Region.......................................................
Tel. …………………...................E– mail address..............………………………..............................................................
- I successfully completed the degree course in ...............................................………………………………………...
…………………………………………………………………………………………………….year …………………...
Faculty/Institute ……………………………………………………………..……………………………………………...
University of ………….………………….…………………………………………………………………………………
and passed the final examination on (day/month/year)…………………………………………………………..………...
obtaining the mark of .....................................................................and was awarded the academic title of
………………………………….....................in……………………………………………………………………………
Please specify the relevant diplomatic or consular authority in the country where the degree was awarded if it is a non-
Italian degree……………………………………………………………………………………………………………….
In order to be awarded the above mentioned title, I passed the following exams and obtained the marks and credits
specified on the dates here reported:
Subject Mark Credits Date
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This statement can only be released by EU citizens, but citizens from non-EU countries residing in Italy with a regular
foreigner’s permit of stay can make such a statement if their degree was awarded in Italy.
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I also certify that I discussed the dissertation entitled: …..

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Supervisor:………………………………….……………………………..………………………………………………
Subject: ……………………………………………………………………………………………………………….

I STATE
I am aware, it being understood that the criminal liability continues to exist, that in case of untruthful statements
automatically I forfeit the right to enrolment, my academic career will be ruined, and there will be no refund of the entry
fee.

Forlì, ___________________
…………………………..……………………
(SIGNATURE)

According to the Italian Law D. Lgs. N. 196/2003, art. 13, (Personal data protection code), applicants are informed that
the Data controller is Alma Mater Studiorum – Università di Bologna, Via Zamboni 33, 40126, Bologna.
The personal data produced by the applicants will only be processed for the institutional purposes of the University of
Bologna.
Any refusal on applicants’ part to supply requested information may result in the University of Bologna being unable to
carry out the necessary fulfilments and administrative procedures regarding student career management.
In relation to the aforementioned data processing, applicants may exercise the rights stipulated in article 7 of the Italia
Law D. Lgs. N. 196/2003.