statement - only after award within 3 days.docx

STATEMENT

regarding the confirmation of the identity of the actual beneficiaries and their failure to be convicted for participating in the activities of a criminal organization or group, for corruption, fraud and/or money laundering.

The undersigned, ________________ authorized representative of _____________ (name of the economic operator) as bidder/associated bidder designated winner in public procurement procedure no. ocds-b3wdp1-MD-1781700192972 dated 17/06/2026, I declare on my own responsibility, under the sanctions applicable to the act of forgery in public documents, that the beneficiary/beneficiaries of the economic operator in the last 5 years have not been convicted by a final court decision for participating in the activities of a criminal organizations or groups, for corruption, fraud and/or money laundering.

Date of completion:______________________

Signed: _____________________________

Name surname: __________________________________

Function: ____________________________

Name of economic operator ________________________

IDNO of the economic operator _____________________________