Il/La sottoscritto/a Sig./ra________________________nato/a a _________________________  il__________________ residente in_______________________________________________ via______________________________  cap __________________
con domicilio fiscale nel comune di______________________ tel. ______________________
email_______________________________  cittadinanza _____________________________         codice fiscale ___________________________
su incarico del Dipartimento/Facoltà dichiara di essersi recato a
___________________________________________________________________________
per svolgere la seguente attività: ___________________________________________________________________________
e per la quale il sottoscritto dichiara che non richiederà il pagamento di alcun compenso.

Firenze ______________ Il Richiedente ____________________________

* * 

* * * * *
The/undersigned Mr. /Madam ____________________ born in _____________________
Date_______________resident in ______________________________________________
_____________________________ tel___________________mail ____________________
VAT citizenship ___________________________________
Italian Fiscal Code _________________________________
commissioned by the Department / Faculty declares that he went to
___________________________________________________________________________
to perform the following task:
and for which I hereby declare that does not require the payment of any compensation 

Date ______________ Signature ____________________________