Division 12 Box 16:F1

Indicate in block letters the name of the applicant or, where appropriate, of his authorised representative who signs this application.

The signature by the applicant or his authorised representativeF2... indicates that the person concerned is declaring that all the particulars provided on the application are correctly and fully stated. Without prejudice to the possible application of penal provisions, this declaration is equivalent to the engagement of responsibility, under the provisions in force ..., in respect of the following:

• the accuracy of the information;

• the authenticity of any documents attached;

• the observance of all other obligations.

Whenever the authorisation is issued by means of a computerised procedure, that authorisation may not contain the signature of the applicant in this box, if the application as such contains such signature.