ALLEGATO 7.2

MODALITÀ DI RISCOSSIONE DEL CONTRIBUTO – NON RESIDENTI IN ITALIA
SUPPLIER FORM 	

SUPPLIER INFORMATION  
	
Company name (for companies, organizations, associations, etc) or name and surname for sole traders
	
ONLY IF sole trader please indicate:	
GENDER
•	M
•	F	DATE OF BIRTH (dd/mm/yyyy)	COUNTRY OF BIRTH 	TOWN OF BIRTH	

PLACE OF RESIDENCE FOR TAX  PURPOSES 	
STREET		
TOWN		
POSTCODE		STATE/COUNTRY		
COUNTRY		
PHONE No.		FAX No.		
E-MAIL ADDRESS		
stable organisation in italy 
Please choose the right option:
	•	NO

•	YES	

FOREIGN TAXPAYER CODE 
(issued by the tax authority of the country of residence)
required field		
VAT CODE
(TVA/Vat number/Federal Tax/Business number) 
For economic operators 		
In the absence of a VAT registration number, please tick the box below:

  I am not liable to register for VAT as my taxable supplies are below the VAT registration threshold set by the tax authority of my country of residence/of the place where the economic activity is carried out.

Please write the legal references…………………………………………….. 

Business address
	
STREET		
TOWN		
POSTCODE		STATE/COUNTRY		
COUNTRY		
PHONE No.		FAX No.		
E MAIL ADDRESS		

For companies, organizations, associations, etc., please complete in full the details of the person who signs this declaration:

Acting as:
	
•	Owner	•	Legal representative	•	Other (indicate)	
NAME	SURNAME	
GENDER
•	M
•	F	DATE OF BIRTH (dd/mm/yyyy)	COUNTRY OF BIRTH 	TOWN OF BIRTH	

PAYMENT OF COMPENSATION
	
IBAN BANKING ACCOUNT – Credit on bank current account	
PAESE	CIN EUR	CIN	ABI	CAB	CONTO CORRENTE	

SWIFT BIC code (for foreign  banking account)		
BANK__________________
	AGENCY_____________	
ADDRESS		TOWN
CITY
POST CODE		

DECLARATION	
I declare that the data and the information given are true and correct. I also declare to be aware of the implications of criminal liability in case of false statements as stated in Art. 76 of D.P.R. 28.12.2000, No. 445. I will take care to communicate any change of data indicated, if necessary.

DATE……………………………                                                              SIGNATURE

                                                                                         _________________________

Please enclose copy of a valid identification document of the signatory.	

DECLARATION FOR EU SUPPLIER	
I declare that the information I provided are shown on the invoice issued. In case VAT number is not indicated I attach the certification ID attributed to the company issued by the tax authority of the country of residence. I undertake to inform of any change of the data supplied by myself. 

DATE……………………………                                                                    SIGNATURE

                                                                                         _________________________

Please return the completed form to the following address:

	REGIONE EMILIA ROMAGNA
c.a. Mr. 
Servizio
viale Aldo Moro 52 
40127 Bologna BO - Italia
e mail: …………………………..@regione.emilia-romagna.it
PEC