trattamento dati personali .pdf
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Original filename: trattamento_dati_personali.pdf
Title: Microsoft Word - AUTORIZZAZIONE AL TRATTAMENTO DEI DATI PERSONALI
Author: dino.cimaglia
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AUTORIZZAZIONE AL TRATTAMENTO DEI DATI PERSONALI
(ARTT. 13 E 23 DEL D.LGS. 196/2003)
Il/La sottoscritto ________________________________________________________________
nato/a a _____________________________________________________ il __________________
residente a ___________________________________ in _________________________________
AUTORIZZA
ai sensi e per gli effetti degli artt. 13 e 23 del D.Lgs. n. 196/2003, con la sottoscrizione del
presente modulo, il proprio consenso al trattamento dei dati personali forniti a seguito della
segnalazione inoltrata.
DATA________________________(Firma leggibile)______________________________________
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