Declaration of external activities

To the Rector of the University of Urbino Carlo Bo

The undersigned

Surname …………………………………………..…………. Name …………………………….…………………

Italian Fiscal Code (if already assigned by the competent authority) …………………………………………….

Date of birth …………………………...………. Place of birth ………………………………………. (Country of birth: ………………..………)

Enrolled for the academic year ……………………… to the ………………. year of the Ph.D. programme in
.…..………………………………………………………………………………..…………ciclo………………………

being aware of the penal sanctions forseen for untruthful affirmations and the creation and use of false documentation, reffered to in art. 76 of the DPR 445/2000, and the consequent loss of the benefits grantes based on the acceptance of this request

DECLARES

□ to carry out the following paid working activity : 

Institution/Company : ………………………………………………Headquater : …………………………………

Type of activity carried out : …………………………………………………………………………………………

Type of work (occasional or continuous collaboration, fixed-term or permaneent employee…):  ……………………………………………………………………………………………………………

From [start date of the contract] ……………………. To [end date of the contract] :  ….………………………………………………..

Weekly commitment in hours : ……………………………………………………………………………..………. 

□ to carry out an external activity of other nature, as specified below :

…………………………………………………………………………………………………………………………..

□ not to carry out any external activity 

 Date ………………………………………	…………….	Signature…………………………………………………