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Attn STUDENT SERVICE AREA UNIVERSITY of ROME “FORO ITALICO”

HEADOFFICE Self-certification/Dichiarazione sostitutiva

(only for EU Students)

I , the undersigned ……… Born at………. (……)

On …/…/… residing in ……… (…..) address

……….., student registration number... , Course in European Master in Health & Physical Activity (LM-67-I), academic year 2021/22 According to the provisions of DPR nr 445 of 28 December 2000 art. 46

Declares

Family composition (as per family status declaration)

Surname and name Birth date Degree of kinship

Family income

(sum of all individual gross incomes earned in the year 2019)

Income from work € ………

Income from assets € ………

Bank statement on 31st December 2020 € ………

Average amount 2020 in bank account € ………

Other incomes € ………

Total gross annual income € ………..

I certify that the information provided in this form is true and correct.

Date, ……….

Student’s signature

………..

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