I, the undersigned, hereby declare on my own responsibility that the information provided is complete and correct and that the provided personal identification number (CNP) belongs to me. I understand and agree that SelfPay and/or the fiscal authority has the right to request, for the purpose of verifying and confirming this declaration, any supporting documents that I possess.

I understand that if this declaration is not in accordance with reality, I may be liable for violating the applicable laws of Romania, including the criminal law regarding false statements.