ILLU ILL ST US RAT TRA ED GUIDE TED GUIDE to t complet comple ing Forms ting Forms and Applications and Applications i IL uttili ERN D quaadern

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1 ILLUSTRATED GUIDE to completing Forms and Applications 10 quadern UADERNiuTIL TILi

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3 Printed in November 2008 Translation co-ordinated by Cooperativa Pane e Rose English translation: Sarah Rodgers Text: Mariella Pala Graphics and layout: Fabiana Lastrucci Printed by: Tipografia Bisenzio Sincere thanks to all URP staff for their invaluable help in this project.

4 The aim of this guide is to help all those who immigrate to Italy. Completing forms and submitting applications to Public Administration offices can be very complex for anyone who does not have a good command of the Italian language or who is not familiar with Italian bureaucracy. In the following pages, we try to help foreign nationals to compile the various forms required to obtain residency or to request family reunion. The set of forms that we have have illustrated here are those that are most commonly used when dealing with Public Administration offices. It is necessary that foreign nationals learn to understand and complete these forms autonomously. Knowledge and understanding of application forms and statements to be undersigned are essential tools for a proactive participation in public life. Public Relations Editorial Office December 2008

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6 CONTENTS 6 Postal Services 15 Health care 25 Housing 36 Family 83 Identity

7 POSTAL SERVICES 6 In this section there are some useful tips on how to complete forms such as Post Office bill slips and registered mail. These can be helpful for anyone wishing to pay a utility bill, for instance, or apply for a residence permit.

8 Post Office Bill Slip POSTAL SERVICES 7POSTAL SERVICES The Post Office bill slip is a system for making payments at any post office. The receipt is proof of payment carried out. Post Office Bill payment online: > Pagare > Bollettini online

9 THE CURRENT ACCOUNT NUMBER OF THE PAYEE IS AN OBLIGATORY FIELD POST OFFICE CURRENT ACCOUNT Lodgement Statement POST OFFICE CURRENT ACCOUNT Lodgement Receipt 1 AMOUNT IN LETTERS 2 2 POSTAL SERVICES 8POSTAL SERVICES PAYEE DETAILS OF THE PERSON WHO MAKES THE PAYMENT 1 REASON FOR PAYMENT IMPORTANT: DO NOT WRITE BELOW THIS LINE

10 PAYEE POST OFFICE CURRENT ACCOUNT Lodgement Receipt TOTAL AMOUNT TO BE PAID IN FIGURES THIS SECTION TO BE COMPLETED WITH CARE INSERTING A SINGLE CHARACTER IN EACH SQUARE 2 1 REASON FOR PAYMENT DETAILS OF THE PERSON WHO MAKES THE PAYMENT IMPORTANT: DO NOT WRITE BELOW THIS LINE THIS FORM NEEDS TO BE COMPLETED IN FULL (IN BLACK OR BLUE INK) AND NO PART MUST BE DAMAGED, ERASED OR AMENDED. THE OBJECT OF PAYMENT IS OBLIGATORY FOR ALL LODGEMENTS TOWARDS PUBLIC ADMINISTRATION OFFICES. THE REQUIRED INFORMATION WILL BE USED IN EXACTLY THE SAME FORMAT AS IT IS COMPLETED IN THIS FORM.

11 Registered mail POSTAL SERVICES 10 Registered Mail is required as proof of delivery and is of legal merit. It is recommended in such cases as competitions and contests or for administrative and judiciary purposes. Registered mail is dispatched from post offices and is delivered solely to the addressee or to his/her appointee. If nobody is available to receive the registered mail, it is returned to the post office indicated on the advice slip and held for thirty days, after which time the mail is re-dispatched to the sender. For more information: > Prodotti postali > Lettere > Posta raccomandata

12 IT IS FORBIDDEN TO SEND MONEY IN A REGISTERED LETTER/PARCEL. POSTE ITALIANE DOES NOT ACCEPT ANY RESPONSABILITY DISPATCH BAR CODE POSTAL SERVICES ADDRESSEE SENDER DO NOT REMOVE LABEL SENDER TO COMPLETE USING CAPITAL LETTERS 11 SERVICE TYPE REQUIRED. TICK THE RELEVANT BOX VIA AIRMAIL CHEQUE INSURANCE. CHEQUE AMOUNT TO BE NOTED FOR INSURANCE REASONS ACKNOWLEDGEMENT OF RECEIPT: MARK IF RETURN RECEIPT IS REQUIRED. IN FIGURES

13 Receipt Acknowledgment Slip POSTAL SERVICES 12 This is used to receive confirmation (card signed by the addressee or person who received the mail) of completed delivery to the final destination. The acknowledgement slip confirms the successful delivery. As confirmation of the successful delivery, the sender receives, within one working day of said delivery, the acknowledgement slip signed by the addressee or person who received the mail. For more information: > Prodotti postali > Lettere > Posta raccomandata

14 POSTAL SERVICES 13 RECEIPT ACKNOWLEDGEMENT INSERT HERE THE NAME AND ADDRESS OF THE PERSON/S OR OFFICE TO WHOM THIS CARD NEEDS TO BE RETURNED POSTAL ACKNOWLEDGEMENT CODE: OBLIGATORY FOR ALL TYPES OF DELIVERIES STICK WITHOUT FOLDING STICK WITHOUT FOLDING

15 ADDRESSEE POSTAL SERVICES FROM THE POST OFFICE OF: BAR CODE NUMBER FOR THE REGISTERED DELIVERY FOR OFFICIAL USE ONLY POST OFFICE STAMP 14 MAIL INSURANCE IS REQUIRED TO SEND ANY OBJECTS OF VALUE, IMPORTANT DOCUMENTS, PRECIOUS ITEMS, PAPERS OR SECURITIES REGISTERED PARCEL RECIPIENT S SIGNATURE IN FULL (NAME AND SURNAME) DELIVERY CARRIED OUT IN ACCORDANCE WITH ART. 33 DM MULTIPLE DELIVERIES TO ONE DESTINATION - SUBSCRIPTION REFUSED DISPATCH DATE POSTAL ACKNOWLEDGEMENT CODE: OBLIGATORY FOR ALL TYPES OF DELIVERIES DATE SIGNATURE OF DELIVERY DELEGATE

16 HEALTH CARE 15 Foreign Nationals who are residing legally in Italy are entitled to avail of the health care system. In terms of treatment, their rights are equal to those of Italian citizens. Foreign Nationals who do not have a residence permit are also entitled to health care.

17 STP Health Card (Temporarily Present Foreign Nationals) HEALTH CARE 16 Foreign Nationals without any residence permit can avail of the health service by applying to their local ASL office for an STP Card (renewable, with a declatation of poverty, every 6 months in the office where it was originally issued). Each time the card is issued, the holder must demonstrate that it is necessary. The following services are free to STP card holders: out-patient and hospital care, for illness or injury, in public hospitals or private institutions (if operating under the National Health Service). This applies for emergency situations or for essential treatment, even if on a continuous basis basic Health-Care assistance during pregnancy, assistance for pregnancy terminations, assistance for under-age patients, prevention, diagnosis and treatment for infectious diseases. Free medicine that is considered essential (payment of nominal fee ticket only)please note: No foreign citizen without a Residence Permit will be signalled to the judicial police by hospital personnel with the exception of cases when a medical report is necessary. This applies to Italian citizens and Foreign Nationals alike.

18 AZIENDA USL 4 PRATO RICHIESTA DI RILASCIO DEL CODICE STP PER L ASSISTENZA A CITTADINI STRANIERI NON IN REGOLA CON LE NORME RELATIVE ALL INGRESSO ED AL SOGGIORNO IN ITALIA APPLICATION FOR STP CODE FOR MEDICAL ASSISTANCE FOR FOREIGN NATIONALS WITH NO LEGAL STATUS, IN ACCORDANCE WITH THE RULES RELATING TO ENTRANCE AND RESIDENCE IN ITALY HEALTH CARE 17 Il/La sottoscritto/a I, the undersigned, cittadino/a Citizen of nato/a born in il On sesso sex abitante in living at via/piazza street no. consapevole delle sanzioni penali previste dall art.26 della Legge 4 gennaio 1968 n. 15, nei casi di falsità in atti e dichiarazioni mendaci ivi indicati, am aware of the legal implications that would apply in case of any false acts or declarations as outlined in art.26 of Law 4 January 1968 N. 15. DICHIARO sotto la mia personale responsabilità di avere con me conviventi i seguenti familiari: DECLARE to be personally responsible for and to have living with me the following family members: RELAZIONE FAMILIARE COGNOME NOME DATA DI NASCITA FAMILY RELATION SURNAME NAME DATE OF BIRTH Coniuge Spouse Figlio/a Son/Daughter Figlio/a Son/Daughter Figlio/a Son/Daughter e chiedo il rilascio del documento per l assistenza sanitaria riservato ai cittadini stranieri non in regola con le norme di soggiorno. and request the issue of this document for medical assistance reserved for foreign nationals who do not have any legal status for residency. Firma del dichiarante Signature of Declarant

19 Health Care Card Social Security number (Codice fiscale) HEALTH CARE 18 This card, as well as allowing the holder to avail of the services of the National Health System, shows personal details and the social security number of the card-holder. It is valid for the same period as the Social Security Card. The new Health Care Card has several functions: it replaces the old Codice Fiscale Card (social security 16 character code to identify the holder for tax purposes) as a European Health Insurance Card valid in all EU countries, Iceland, Liechtenstein, Norway and Switzerland (it replaces the E111 form) it must be presented in the pharmacy when purchasing medication. From 1 January 2008, all medical receipts issued by pharmacies must show the Codice Fiscale (social security number) of the recipient, type and quantity of medication purchased. It is only possibile to deduct pharmacy expenses for tax purposes if you are in possession of such receipts. For duplicate cards apply online: > Servizi > Tessera sanitaria > Codice fiscale >Richiedi il duplicato del codice fiscale Illustrated Guide. to To completing forms and applications

20 MEDICAL CARD SOCIAL SECURITY NUMBER EXPIRY DATE SURNAME HEALTH CARE NAME PLACE OF BIRTH PROVINCE OF BIRTH DATE OF BIRTH LETTERS IN BRAILLE (FONT FOR THE VISUALLY IMPAIRED) SHOWING THE CODICE FISCALE SO THAT THIS CARD CAN ALSO BE USED BY VISUALLY IMPAIRED CITIZENS EUROPEAN MEDICAL INSURANCE CARD REGIONAL HEALTH DATA SEX IDENTIFICATION ACRONYM OF THE STATE WHERE THE CARD WAS ISSUED (EG. ITALY: IT) 19 SURNAME NAME SOCIAL SECURITY NUMBER IDENTIFICATION NUMBER OF CARD DATE OF BIRTH EXPIRY DATE MAGNETIC STRIP CONTAINING ALL THE PERSO- NAL DETAILS OF THE CARD-HOLDER TO ALLOW THE CARD TO BE READ ELECTRONICALLY WHEN REQUIRED BAR-CODE THAT HOLDS THE CODICE FISCALE IDENTIFICATION NUMBER OF INSTITUTION

21 MODULARIO 511 MOD AA4/7 MINISTERO DELLE FINANZE DIPARTIMENTO DELLE ENTRATE / INCOME TAX DEPARTMENT UFFICIO FOR OFFICIAL USE DOMANDA DI ATTRIBUZIONE DEL NUMERO DI CODICE FISCALE O VARIAZIONE DATI APPLICATION FOR SOCIAL SECURITY NUMBER OR CHANGE OF PERSONAL DETAILS (PERSONE FISICHE) (PHYSICAL PERSONS) PARTE RISERVATA AL RICHIEDENTE SECTION RESERVED FOR APPLICANT TIPO RICHIESTA / TYPE OF REQUEST HEALTH CARE ATTRIBUZIONE CODICE FISCALE - ASSIGNMENT OF SOCIAL SECURITY NUMBER DUPLICATO DEL CERTIFICATO - DUPLICATE CERTIFICATE DUPLICATO DEL TESSERINO PLASTIFICATO DUPLICATE OF PLASTIC SOCIAL SECURITY CARD AGGIORNAMENTO DATI ANAGRAFICI E - PERSONAL DATA UPDATE AND ASSIGNMENT ATTRIBUZIONE CODlCE FISCALE DEFINITIVO OF DEFINITIVE SOCIAL SECURITY CODE RICHIESTA TESSERINO PLASTIFICATO - APPLICATION FOR PLASTIC SOCIAL SECURITY CARD AGGIORNAMENTO RESIDENZA - PLACE OF RESIDENCE UPDATE RICHIESTA CODICE FISCALE - APPLICATION FOR SOCIAL SECURITY CODE TRASCRIZIONE ATTI GIUDIZIARI ALLE CONSERVATORIE - TRANSCRIPTION OF JUDICIAL ACTS TO THE REGISTRY EVENTUALI ALTRI CODICI ASSEGNATI / ANY OTHER ASSIGNED CODES.. CODICE FISCALE / SOCIAL SECURITY NUMBER DATI ANAGRAFICI PERSONAL INFORMATION COGNOME DI NASCITA BIRTH SURNAME NOME (SENZA ABBREVIAZIONI) NAME (NO ABBREVIATIONS) COMUNE (O STATO ESTERO) DI NASCITA COMUNE (OR FOREIGN COUNTRY) PROV. DI NASCITA (SIGLA) DATA. DI NASCITA SESSO (M o F) OF BIRTH PROVINCE OF BIRTH (INITIALS) DATE OF BIRTH SEX 20 RESIDENZA ANAGRAFICA (o, se diverso, domicilio fiscale) PERSONAL RESIDENCE INFORMATION (or, if different, fiscal residence) COMUNE (SENZA ABBREVIAZIONI) COMUNE NO ABBREVIATIONS) PROV. (SIGLA) PROVINCE (INITIALS) C.A.P. POSTAL CODE INDIRIZZO (O FRAZIONE) ADDRESS (OR ADMINISTRATIVE DIVISION OF MUNICPALITY) N. CIVICO STREET NO. RESIDENZA ESTERA FOREIGN RESIDENCY STATO ESTERO DI RESIDENZA COUNTRY OF FOREIGN RESIDENCY CITTÀ E INDIRIZZO CITY AND ADDRESS DATA _DATE FIRMA DEL RICHIEDENTE APPLICANT SIGNATURE FIRMA DELL INCARICATO SIGNATURE OF APPOINTEE PARTE RISERVATA ALL UFFICIO FOR OFFICIAL USE ONLY ATTRIBUZIONE / ASSIGNMENT ATTRIBUZIONE DIFFERITA DA S.C. AGGIORNAMENTO - UPDATE ACQUISIZIONE RESIDENZA ESTERA ASSIGNMENT DEFERRED BY S.C. ACQUISITION OF FOREIGN RESIDENCY RICHIESTA CODICE FISCALE L. 27/02/85 CODICE PROVVISORIO ASSEGNATO

22 DUPLICATO CERTIFICATO DUPLICATE CERTIFICATE DUPLICATO TESSERINO DUPLICATE CARD RICHIESTA TESSERINO APPLICATION FOR CARD N. 52 APPLICATION FOR SOCIAL SECURITY CODE TRASCRIZIONE ATTI GIUDIZIARI ALLE CONSERVATORIE RR.ii. TRANSCRIPTION OF JUDICIAL ACTS TO THE REGISTRY PROVISIONAL CODE ASSIGNED ESTREMI DEL DOCUMENTO D IDENTITÀ DEL RICHIEDENTE DETAILS FROM APPLICANT S IDENTITY DOCUMENT ESTREMI DEL DOCUMENTO D IDENTITÀ DELL INCARICATO DETAILS FROM THE APPOINTEE S IDENTITY DOCUMENT PLEASE NOTE: HEALTH CARE The application must be undersigned by the relevant party and must be directly submitted, personally or by an appointee, to any office of Imposte Dirette, IVA e Registro. At the moment of presentation of the application, the applicant must show an Identity Document. The appointee must show his/her own Identity Document. For applications for persons under the age of 15 years or for persons residing abroad, the appointee must only show his/her own Identity Document. For the application for update of residential information, the applicant must attach the certificate of residency issued by his/her own Comune. Appropriate sanctions apply for any false declarations made by the applicant in this application. RICHIESTA CODICE FISCALE L. 27/02/85 N. 52 / APPLICATION FOR SOCIAL SECURITY CODE CONSERVATORIA DI / REGISTRY OF ESTREMI DELL'ANNO / DETAILS OF YEAR MOTIVO / REASON ANNOTAZIONI / NOTATIONS 21 ISTRUZIONI PER LA COMPILAZIONE INSTRUCTIONS FOR FORM COMPILATION The form must be completed with utmost care, if possible with type-face or in capital letters. All information entered onto this form must not be abbreviated in any way. (example: ANDREW or MI- CHAEL JOHN and not ANDY or M. JOHN etc) a) Surname and Name must be entered without any titles of honour, study or of any other nature. Married women must enter their maiden surname. b) Comune of birth : Indicate in full the Comune of birth, in cases whereby the place of birth is abroad, indicate the state. c) Province of birth indicate the motor abbreviation (eg. For Rome = RM), if the place of birth is abroad, indicate EE. d) Date of birth this must be transcribed numerically. In relation to the year of birth, this should be indicated by the last 2 digitis (for example: 1942 = 42) e) Personal Residence Information (or, if different, fiscal residence) : fiscal residence usually coincides with personal residence. It is different if stated to be so by the applicant s request or by the Financial Administration. For persons residing abroad, fiscal residency is established in the Comune in which the income is generated or, in cases whereby the income is generated in more than one Comune, fiscal residency is established in that Comune where most income is generated. If no income is generated abroad, an address is required in Italy. Furthermore, persons residing abroad must indicate, in the section reserved for those residing abroad, the city and the address.

23 National Health Service Medical Prescriptions HEALTH CARE 22 The prescription is marked with an optical character recognition code that identifies the issuing doctor, the medication, the request or the service provided. The prescription is valid for a duration of 30 days. The prescription is needed for the following reasons: to obtain free or reduced cost medication from pharmacies operating under the National Health Service to make a further doctor/specialist appointment to request laboratory or diagnostic tests In order for the National Health Service prescription to be valid it must display the following: Name and address of the patient Health Card Number or Social Security Number (the number on the Health Booklet issued by the local HealthCare office of the patient) Name of the medication required or the specialist visit requested Quantity of medication required Date on which the prescription is issued Personal details, signature and stamp of the doctor Acronym of the patient s Regional Health Office ASL (Local Health Centre)

24 NAME OF MEDICINE PRESCRIBED OR DETAILS OF SPECIALIST VISIT HEALTH CARE PRESCRIPTION DATE BAR-CODE THAT HOLDS ASL DATA, YEAR AND PRESCRIPTION NUMBER 23 NATIONAL HEALTH SERVICE TUSCANY REGION BENEFICIARY NAME ADDRESS QUANTITY OF MEDICATION PRESCRIBED INITIALS OF ASL OFFICE IN PATIENT S AREA OF RESIDENCE SOCIAL SECURITY NUMBER STAMP + SIGNATURE OF DOCTOR DATE PRESCRIPTION FILLED/ PHARMACIST STAMP

25 HEALTH CARE 24 NOTE FOR BENEFICIARIES AND MEDICAL PRACTICIONERS - THIS FORM TO BE USED FOR THE PURPOSE OF ADMISSION TO PUBLIC HOSPITALS AS WELL AS PRIVATE REGISTERED NURSING HOMES - ANY FALSIFICATION OR MODIFICATION TO THE EXISTING FORM IS PUNISHABLE BY LAW ACCORDING TO ARTICLES 460, 461 AND 464 OF THE CCP. - ANY FALSE DECLARATION HEREIN IS PUNISHABLE BY LAW ACCORDING TO ART 76 OF THE DPR 28 DECEMBER 2000 N SPECIALIST PRESCRIPTIONS AND DIAGNOSES ARE VALID THROUGHOUT THE ITALIAN STATE. 1) PRESCRIPTIONS CAN BE FILLED IN PHARMACIES LOCATED WITHIN THE REGION ONLY. 2) PRESCRIPTIONS REMAIN VALID FOR A DURATION OF 30 DAYS, EXCLUDING THE DAY IT IS ISSUED. 3) FOR THE FILLING OF ANY PRESCRIPTION DURING THE NIGHT OR OUTSIDE NORMAL WORKING HOURS, ANY ADDITIONAL COSTS ARE TO BE INCURRED BY THE CLIENT, EXCEPT IN URGENT CASES INDICATED BY THE ISSUING DOCTOR OR FOR PRESCRIPTIONS ISSUED BY THE GUARDIA MEDICA. 4) IT IS COMPLETELY FORBIDDEN FOR ANY MEDICINE TO BE GIVEN IN ADVANCE. DECLARATION FOR EXEMPTION CAN BE CERTIFIED EXCLUSIVELY BY THE ISSUING DOCTOR (LAW 638/83) NO TEXT TO BE ENTERED IN THIS SECTION

26 HOUSING 25 Foreign Nationals who have fixed accommodation must submit paperwork that certifies the persons cohabiting and also the type of housing in question.

27 Property Letting HOUSING 26 Any person who lets a property, building or part thereof, to an Italian Citizen, Foreign National or person of stateless status for a period that exceeds a month, must advise the local authorities that he/ she is doing so. Communication to the authorities must be done within 48 hours of the property handover in the following ways: In person to any of the following offices: Questura, Public Security Office or Mayor s Office (when PS Commissariat is not available) Via Registered mail with Receipt Notice. Form available to download: > Moduli > Comunicazioni e richieste > Cessione di fabbricato

28 l sottoscritt..i, the undersigned (1) Il Signor Mr/Mrs/Ms * CEDENTE LEASER COPIA PER L AUTORITA LOCALE DI PUBBLICA SICUREZZA QUESTURA N.RO (Timbro dell Ufficio) Comunicazione di cessione di fabbricato Communication of Property Lease Art. 12 del D.L , n. 59, convertito in legge , n. 191 Cognome Surname Nome Name Data di nascita Date of birth Comune di nascita Provincia o Nazione estera di nascita Comune di residenza Place of birth Province or Foreign Country of Birth Place (Comune) of residence Via /Piazza e numero civico / Street Name/House Number Recapito telefonico / Telephone number Dichiara / declares... (1) che in data / that on the date (2) ha ceduto in / he/she leased as (3) ha comunicato / communicated HOUSING CESSIONARIO - LEASEE per uso (abitazione, negozio, ufficio, ecc.) al Sig.: / to Mr/Mrs/Ms: for the following use (accommodation, shop, office, etc) Nome Full Name Data di nascita Date of birth Comune di nascita / Place of birth Provincia o Nazione estera di nascita / Province or Foreign Country of Birth Cittadinanza / Citizenship Comune di residenza / Place (Comune) of residence Via /Piazza e numero civico / Street Name/House Number Recapito telefonico / Telephone number Tipo di documento / Document type Numero del documento / Document Number Autorità che ha rilasciato il documento / Issuing authority Data di rilascio / Date of issue inerente il fabbricato sottoindicato, già adibito a (abitazione, negozio, ufficio, ecc.) sito in: Property in question as shown below already adapted for (accommodation, shop, office etc) located : 27 FABBRICATO PROPERTY Comune / Comune Provincia / Province Via/Piazza / Street/Square Numero civico / Street Number C.A.P. / Postal Code Piano / Floor Scala / Stairs Interno / Internal No Vani / No. Of Rooms Accessori / No. of bathrooms/auxiliary Rooms Ingressi / No. of entrance..l. DICHIARANTE DECLARANT (1). (DATA) (4) IL COMPILATORE / COMPILER FIRMA / SIGNATURE * in caso di società scrivere i dati del rappresentante legale e aggiungere questa dicitura: PER CONTO DELLA SOCIETA * if either party is a company, then the legal representative of the company must complete the form and add the following text: PER CONTO DELLA SOCIETA (1) Cancellare la parte che non interessa Cross out the section that is not relevant (2) Indicare la data dell atto di cessione. Indicate the date of lease (3) Indicare il motivo della cessione (es. vendita, affitto,ecc.) Indicate the reason for lease (eg. Sale, rent etc) (4) Indicare la data di compilazione del modulo. Indicate the date the form is completed Comunicazioni e richieste Communications and requests SPAZIO RISERVATO ALL UFFICIO ACCETTANTE FOR OFFICIAL USE ONLY Il Signor / lasignora / Mr/Mrs/Ms ha presentato la comunicazione / ha trasmesso la raccomandata n. ai sensi dell Art. 12 del D.L , n. 59, convertito in legge , n presented communication/sent registered letter no. in accordance with Art 12 of D.L , n. 59 converted to law , n.191 Data / Date l incaricato / Delegate

29 Suitable Housing Certificate HOUSING 28 A Suitable Housing Certificate serves the purpose of certifying the number of people that can live in an apartment or house. The Certificate is issued based on technical parametres established by regional laws for public residential buildings. These parametres outline the individual functional rooms within the accommodation. Application for a Suitable Housing Certificate is possible either in the applicant s local Comune or Local Health Centre (ASL-Azienda Sanitaria Locale) for the following reasons: Nulla Osta for Family Reunion E-C Long Term Residence Permit (only in case of application for own family members) Residence contract to be undersigned by employer. Comune of Prato forms available to download: > Ambiente, casa e territorio > Certificato idoneità alloggio

30 MODELLO 1-RICHIESTA CERTIFICAZIONE IDONEITÀ ALLOGGIO APPLICATION FOR SUITBALE HOUSING CERTIFICATE Marca da bollo Revenue Stamp Al Sindaco del Comune di Prato / To the Mayor of the Comune of Prato Il/la sottoscritto/a I, the undersigned (cognome/surname) (nome/name) cittadino/a / citizenship nato/a a / born in il/on residente/resident domiciliato nel Comune di Prato / domiciled in the Comune of Prato (o altro comune/ or other comune ) in Via/Piazza/Viale/Vicolo / Street/Road/Avenue n. /no. Telefono /Telephone Codice fiscale / Social Security Number HOUSING 29 In qualità di/in the capacity of: Proprietario/Owner Conduttore/Tenant Protocollo/Protocol Ospite/Guest CHIEDE / REQUESTS il rilascio della certificazione attestante che l alloggio situato a Prato: the issuing of a certificate that attests that the property situated in Prato: Via/Piazza/Viale/Vicolo Street/Road/Avenue N. civico/street No. Piano/Floor Interno/Internal No. Scala/Stair rientra nei parametri minimi previsti dalla normativa regionale per gli alloggi di edilizia residenziale per i casi previsti dal D.Lgs. 286/98 e successive modifiche. Falls within the minimum parametres set out by the regional legislation for residential buildings for cases foreseen by D.Lgs 286/98 and any subsequent changes. la certificazione su base della planimetria allegata (vedi istruzioni pagina 2) certification based on house plan attached (see instructions on page 2) copia conforme certificato idoneità alloggio N. del / / copy of corresponding Suitable Housing Certificate No. issued on / / per il seguente motivo / for the following reason Da compilare solo in caso di delega / Only to be completed in case of delegation DELEGA per la richiesta di certificazione di idoneità alloggio dell immobile sopraindicato, la seguente DELEGATES the Certificate for Suitable Housing for the aforemention property to the following person: persona: cognome e nome /surname and name nato/a a / born in il /on / / Paese /Country N.B. Allegare copia del documento identità della persona delegata N.B. Attach a copy of delegated party s Identity Document

31 Il/la sottoscritto/a dichiara inoltre di essere informato/a, ai sensi del D.Lgs. n 196/2003 (codice in materia di protezione dei dati personali) che i dati personali raccolti saranno trattati, anche con strumenti informatici, nell ambito del procedimento relativo al rilascio del certificato di idoneità dell alloggio così come disciplinato dallo specifico regolamento comunale approvato con D.C.C. n. 112/2006. Il/la sottoscritto/a dichiara pertanto di aver preso visione del regolamento di cui sopra e di acconsentire al trattamento dei propri dati sopra riportati. Furthermore, I, the undersigned declare to be informed about D.Lgs No. 196/2003 (legislation for the protection of sensitive personal data) that all personal data given will be handled exclusively (including electronically) for the purpose of processing this application for a Suitable Housing Certificate, as is established by the specific communal regulation approved via D.C.C. no. 112/2006. I, the undersigned also declare to have seen this aforementioned regulation and hereby allow my information to be handled as stated previously. Data /Date Firma leggibile /Legible Signature HOUSING 30

32 MODELLO 2 DICHIARAZIONE SOSTITUTIVA DI ATTO DI NOTORIETÀ Modello 2 - Substitute Declaration for Deed of Acknowledgement Art. 21 e 47 D.P.R. 28 dicembre 2000, n. 445 Al Sindaco del Comune di Prato / To the Mayor of the Comune of Prato Il/la sottoscritto/a I, the undersigned (cognome/surname) (nome/name) nato/a a /born in Provincia /Province Paese /Country il /on residente /resident domiciliato / domiciled Provincia / Province in Via/Piazza/Viale/Vicolo / Street/Road/Avenue n. / No. telefono / telephone Codice fiscale / Social Security Number consapevole delle sanzioni penali in caso di dichiarazioni false e della conseguente decadenza dai benefici eventualmente conseguiti (ai sensi degli artt. 75 e 76 D.P.R. 445/2000) sotto la propria responsabilità / acknowledge the penal sanctions that would result from any false declaration and be fully responsible for termination of any eventual benefits (as outlined in Art. 75 e 76 D.P.R. 445/2000) HOUSING 31 DICHIARA / DECLARE di essere / to be PROPRIETARIO / OWNER CONDUTTORE / TENANT dell alloggio posto nel Comune di Prato in / of residential housing located in the Comune of Prato in Via/Piazza/Viale/Vicolo Street/Road/Avenue n./ No. piano / f loor interno / Internal No. scala / stairs ; che il suddetto alloggio è identificato presso / that the aforementioned property is identified by the l Agenzia del Territorio (ex ufficio del Catasto) mediante i seguenti riferimenti / by means of the following references: Foglio/ Paper Particella / Parcel Ref Subalterno / Subordinate ; che il suddetto alloggio è attualmente occupato da n. persone; / that the aforementioned property is currently inhabited by the following number of persons: di ospitare stabilmente nel suddetto alloggio il richiedente del certificato (se la persona che ha compilato il Modello 1 è OSPITE nell alloggio): to have as a regular guest in the aforementioned property the applicant of the certificate (if the person who compiled Modello 1 is a GUEST in the property) Nome e cognome / Name and Surname Nato/a a Born in il /on Stato / State Cittadinanza / Citizenship che l alloggio risulta di proprietà della seguente persona (se il sottoscritto è CONDUTTORE): that the property in question is owned by the following person (if the undersigned is the TENANT) Nome e cognome / Name and Surname Nato/a a Born in Provincia / Province Paese / Country il /on codice fiscale /social security no. e che il contratto di locazione è stato registrato presso l Agenzia delle Entrate nell anno and that the rental contract was registered at the Inland Revenue Commissioners in the year Il/la sottoscritto/a dichiara inoltre di essere informato/a, ai sensi del D.Lgs. n 196/2003 (codice in materia di protezione dei dati personali) che i dati personali raccolti saranno trattati, anche con strumenti informatici, nell ambito del procedimento relativo al rilascio del certificato di idoneità dell alloggio così come disciplinato dallo specifico regolamento comunale approvato con D.C.C. 112/2006. Il/la sottoscritto/a dichiara pertanto di aver preso visione del regolamento di cui sopra e di acconsentire al trattamento dei dati sopra riportati.

33 Furthermore, I, the undersigned declare to be informed about D.Lgs No. 196/2003 (legislation for the protection of sensitive personal data) that all personal data given will be handled exclusively (including electronically) for the purpose of processing this application for a Suitable Housing Certificate, as is established by the specific communal regulation approved via D.C.C. no. 112/2006. I, the undersigned also declare to have seen this aforementioned regulation and hereby allow my information to be handled as stated previously. Data /Date Firma leggibile /Legible Signature Ai sensi dell Art. 38, comma 3 del D.P.R. 445/2000, la presente dichiarazione sostitutiva di atto di notorietà è sottoscritta dall interessato in presenza del dipendente addetto ovvero sottoscritta in originale e presentata unitamente a copia fotostatica non autenticata di un documento di identità del sottoscrittore; ai sensi dell Art. 38, comma 1 dello stesso D.P.R è possibile inviare la presente dichiarazione, sottoscritta e allegando copia del documento di identità del dichiarante, anche a mezzo fax al numero , oppure a mezzo posta elettronica all indirizzo immigrazione@comune.prato.it HOUSING In accordance with Art. 38 comma 3 of D.P.R. 445/2000, this Substitute Declaration for Deed of Acknowledgement has been signed by the relevant party in the presence of the employee responsible for receiving the application and also to be signed along with a photocopy of an official form of identification of the applicant. In accordance with Art 38, comma 1, of the same D.P.R. it is possible to send this declaration, undersigned and attached to a copy of the declarant s Identity Document, via fax to , or via to the following address: immigrazione@comune.prato.it 32