CONFER THE APPOINTMENT OF PRESENTER FOR

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Edmund Banks
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1 Il Direttore Progr. n Date I, the undersigned Prof. Roberto Giacobazzi, Director of the Department of Computer Science, on the proposal of Prof. CONFER THE APPOINTMENT OF PRESENTER FOR (title of the seminar / mini-course / talk ) to be given on (dd/mm/yyyy) to the following speaker ( Contractor ): PERSONAL DETAILS Surname First name Gender M F Place of birth Date of birth Country Italian tax number (codice fiscale) (if already issued) FISCAL ADDRESS: City Country Postcode/ZIP Street name & number Phone I authorise payment allocated from the fund (leave blank ) for: The gross 1 honorarium of Verona, THE CONTRACTOR (signature) THE DIRECTOR Prof. Roberto Giacobazzi 1 In accordance with Italian fiscal law, payment is made after receiving an invoice or debit note for the honorarium. Please also complete and submit the Declaration for verifying excess of the 5, exemption limit. Dipartimento di Informatica Strada le Grazie T segreteria.di@ateneo.univr.it P. IVA C.F

3 UNIVERSITÀ DEGLI STUDI DI VERONA DICHIARAZIONE PER VERIFICA SUPERAMENTO DELLA FRANCHIGIA 5.000,00* DECLARATION FOR VERIFICATION OF EXCEEDING THE 5, EXEMPTION LIMIT* (art. 44 Legge 326/2003 Circolare INPS n. 103/2004) (Article 44 Law 326/2003 INPS Circular n 103/2004 Il/La sottoscritto/a The undersigned (si prega di scrivere in stampatello ed in forma leggibile) (Please print legibly) DICHIARA HEREBY DECLARES (barrare l ipotesi che interessa) (mark the box that applies) che fino ad oggi ha percepito nel periodo d imposta compensi per attività di lavoro autonomo non esercitato abitualmente di cui all art. 67 (c.d. occasionale) d importo complessivo non superiore a Euro 5.000,00= e pari a Euro e comunque erogati da Enti pubblici e/o privati diversi dall Università degli Studi di Verona. Si dichiara, inoltre, disponibile a provvedere autonomamente al versamento dei contributi dovuti, sollevando codesto Ente da oneri e responsabilità per l omesso involontario alla gestione separata INPS. Si impegna, nel contempo, a comunicare l eventuale superamento del limite al fine di permettere l applicazione della ritenuta e consentire all Ente il versamento degli importi dovuti. that he/she has received remuneration to date, in the tax year, for independent work activities not performed habitually, in accordance with Article 67 (so-called occasional work) for a total amount not exceeding 5,000.00, of and in any case disbursed by public and/or private institutions other than the University of Verona. Furthermore, the undersigned also declares that he/she is willing to provide independently for deposit of the contributions due, relieving this institution from any burdens and responsibilities for having involuntarily omitted separate INPS management. At the same time, the undersigned also hereby promises to communicate possible income in excess of the limit in order to permit application of the withholding taxes and permit the institution to pay in the amounts due. Si raccomanda l indicazione degli eventuali compensi già percepiti. In mancanza indicare ZERO 0. Please remember to indicate any remuneration already received. If there has been no previous remuneration, indicate ZERO ( 0 ).

4 UNIVERSITÀ DEGLI STUDI DI VERONA che fino ad oggi ha percepito nel periodo d imposta compensi per attività di lavoro autonomo non esercitato abitualmente di cui all art. 67 (c.d. occasionale) superiori a Euro 5.000,00=. that he/she has received remuneration to date, in the tax year, for independent work activities not performed habitually, in accordance with Article 67 (so-called occasional labour) for an amount exceeding 5, and hereby S IMPEGNA AGREES inoltre a comunicare tempestivamente eventuali variazioni relative ai dati sopra dichiarati, sollevando fin d ora l Università degli Studi di Verona da ogni responsabilità in merito. to communicate any variations in the aforementioned data in a timely manner, holding the University of Verona exempt from any responsibility in this connection., (data) (place and date) (Firma leggibile dell interessato) (Applicant s Legible ) * Da compilare e consegnare alla struttura conferente l incarico di lavoro autonomo occasionale al momento del pagamento. * To be filled in and delivered to the structure conferring the appointment for occasional independent work, at the time of payment.

5 PERSONAL DETAILS FORM FOR NON ITALIAN RESIDENTS I, the undersigned Passport 1 (or other official identity document from country of origin) no. Italian tax ID number (Please attach a photocopy of your tax ID number for non-italian residents, issued by the Agenzia delle Entrate.) Tax ID number in country of origin Born in (country:) on / / Permanent address: (town:) (province/country:) postcode street n. Contact details where you can be reached (phone; ) REQUEST that financial compensation be made to the following current account: IBAN INTERNATIONAL BANK ACCOUNT NUMBER (27 alphanumerical characters) ATTENTION: only provide the details of a Current Account for which you are the HOLDER or CO-HOLDER IBAN BANK BIC/SWIFT CODE AGENCY OR BRANCH CITY Aware of the criminal sanctions concerning false or misleading statements and the creation or use of false documents as referred to in Art. 76 of Presidential Decree 445/00, I STATE THAT MY POSITION IS AS FOLLOWS: a) Coordinated, continuous, non employed collaborator ( Collaboratore coordinato e continuativo senza vincolo di subordinazione ) as per Art. 50(1)(c bis) of Presidential Decree 917/86. COMPLETE THE SOCIAL SECURITY SECTION b) Self employed, not regularly involved in professional work and therefore only occasionally performing work activities as per Art. 67(1)(l) of Presidential Decree 917/86. COMPLETE THE SOCIAL SECURITY SECTION 1 Attach a photocopy Trattamenti Economici Personale Strutturato e non Strutturato Phone: 045/ /8497/ Fax: 045/ Ufficio.stipendi@ateneo.univr.it Tax no VAT no /2

6 SOCIAL SECURITY Regarding social security cover, I declare: (Signing letter A must be accompanied by signing one of the successive letters A 1. Failure to sign one of the options below will result in not being paid until your social security status has been officialised.) A) I have registered / will register (cross out the option that does not apply) for separate social security management at the relevant INPS office (pursuant to Art. 4, Legislative Decree 166/96). Aa 1 ) A) I do not have compulsory social security cover and/or an indirect or survivor s pension and am therefore subject to pay contributions of 32.72%. If my position changes, I undertake to inform the university so that my contributions will be managed correctly. B) B) I surpass the annual contribution limit of 100, with separate social security management (Law 335/95) and therefore request that the university administration does not to make contribution deductions. The following section must be completed by applicants who wish to request the application of an established bilateral agreement: Pursuant to Art.s of Presidential Decree no. 445/2000, and aware of the criminal sanctions concerning false or misleading statements and the creation or use of false documents, I DECLARE I am a non-resident in Italy, I do not have a stable organisation in Italy and I do not declare my income in Italy. In accordance with the Bilateral International Agreement against Double Taxation between Italy and pursuant to Law Art. (transposed by the internal regulations in Official Gazette no. of ) which provides that compensation received will be taxed in the subject s country of residence, these payments will be completely or partially exempt from taxation in Italy. To be exempt from paying income tax in Italy, please attach your certificate of residence for fiscal purposes in the country of (for those with fiscal residence in the EU, a self-declaration is sufficient as per Art. 46 of Presidential Decree no. 445 of 28/12/2000) and a statement proving you meet the necessary conditions for the formal agreement, issued or countersigned by the relevant foreign financial authority, indicating that you are liable to pay these taxes in your country of residence. If this statement is not written in an easily translatable language, it is necessary to attach a complete translation of the statement by the Italian Consulate in the your country of residence. If this documentation is not submitted, taxes will be deducted from your payments. PLEASE NOTE Legislative Decree no. 196 of 30/06/2003 provides for the protection of persons and other subjects with respect to the processing of personal data. According to this legislative degree, such processing must follow the principles of correctness, lawfulness and transparency and the protection of one s privacy and rights. Pursuant to Art. 13 of the aforementioned decree, the university informs you that the processing we intend to perform: a) is to permit the validation, authorisation and payment of compensation due to you, and to carry out the compensation, social security and fiscal procedures required by law; b) will be performed predominantly by computerised procedures; c) the data given to the University may be provided to other public entities (e.g. Ministry of Economy and Finance and/or INPS) in order for them to carry out their respective official duties, within the limits established by law. I UNDERTAKE to inform the university of any changes in the information here within, thereby from this moment relieving the University of Verona of any responsibilities in this matter. (Date) (Legible signature of the applicant) Trattamenti Economici Personale Strutturato e non Strutturato Phone: 045/ /8497/ Fax: 045/ Ufficio.stipendi@ateneo.univr.it Tax no VAT no /2

7 Declaration pursuant to Article 15 of Legislative Decree No. 33/2013 and Articles 46 and 47 of Presidential Decree 445/2000 (tick and complete the relevant statement) I, the undersigned,... tax number aware of the criminal liability that may be incurred in the event of a false declaration, pursuant to Article 76 of Presidential Decree 445/2000, declare: that I do not hold a position at, or carry out tasks for, any private law entity that is regulated or financed by the Italian government; that I hold the following position at, or carry out the following tasks for, a private law entity that is regulated or financed by the Italian government: entity.... task/position from to. entity.... task/position from.. to. that I do not perform any paid professional work (including contract or freelance work, business ownership or otherwise); that I perform the following paid professional activities: I agree to communicate any change in circumstances that occur during the period of my relationship with the University of Verona. Place and date.. Declarant.

The undersigned place of birth Prov. date of birth, Citizenship Italian fiscal code (1),

PERSONAL DETAILS AND INFORMATION FOR TAX AND SOCIAL SECURITY PURPOSES FOR COORDINATED AND CONTINOUS COLLABORATION The undersigned place of birth Prov. date of birth, Citizenship Italian fiscal code (1),