(Bidders Heading)

To be completed, signed and stamped by the representative of the bidder

DECLARATION OF THE BIDDER

Exclusion criteria

I, the undersigned, declare:

- being duly authorised to represent and commit the Supplier;

That the Supplier I represent:

a. has not been sentenced by final judgment on one or more of the following charges: participation in a criminal organisation, corruption, fraud, money laundering;

b. is not in a situation of bankruptcy, liquidation, termination of activity, insolvency or arrangement with creditors or any like situation arising from a procedure of the same kind, or are subject to a procedure of the same kind;

c. has not received a judgment with res judicata force, finding an offence that affects its professional integrity or serious professional misconduct;

d. does comply with its obligations as regards payment of social security contributions, taxes and dues, according to the statutory provisions of its country of incorporation.

Name of Supplier
Name and function of the Signatory
Place of signature
Date of signature
Signature and stamp