I, THE UNDERSIGNED

Surname and Name			_________________________         born on___________________  
at 		____________ Country of Birth 				 Nationality ________________

-	Residence: Street   		 Number  	 
Town 	Province/Region 		 
Post Code _____   Phone   	   E-mail 		
- Additional Address (if any)  
Street    	   Number  	 
Town   _________________________ Province/Region	 Post Code _____  

WISHING TO 
Choose the University of Florence as Host Institution for the following project to be submitted within the Framework of Notice No. 247 published by the Italian Ministry of University and Research (MUR) on 19.08.2022

UNIFI Host Department ____________________________________________________
Project Title  	 
Project Acronym  		 
Abstract (maximum 2000 characters, spaces excluded)
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

To this end, I DECLARE UNDER MY OWN RESPONSIBILITY

- that I obtained my doctoral degree on	by discussing a
thesis entitled 		 that the degree was issued by__________	______
-	I have held the following positions and tasks since obtaining my doctoral degree: 
from	to	: _________________________________
from	to	: _________________________________
from	to	: _________________________________
from	to	: _________________________________
from	to	: _________________________________
from	to	: _________________________________

I DECLARE TO BE

□	winner of the following MSCA Individual Fellowship/Postdoctoral Fellowship project
-	Title:  	
-	Acronym:  	
-	Contract Number:  	
-	Project Start and End Date:  	
□	winner of the 'Seal of Excellence' award received on  	

and attach to the application:

-	Project proposal (Annex 5b for MSCA IF or PF project winners or 4c for Seal of Excellence winners);
-	The business and financial plan, where applicable (Annex 4b);
-	Applicants Curriculum Vitae;
-	Copy of an identity document;
-	Complete version of the submitted/funded MSCA Individual Fellowship or Post Doctoral Fellowship proposal;
-	Evaluation Summary Report of the submitted MSCA project;
-	Copy of the Seal of Excellence obtained, where applicable;
-	Declaration of Compliance with the DNSH Principle (Annex 2c)
-	Ethics Self Assessment (Annex 3c)

                                 Date                                                         Signature

                  __________________________                  ___________________________