Document to be elaborated to carry out any procedure during the state of emergency for coronavirus

I declare low my responsibility, that they are certain details that I consign in the current application, that I subscribe so that the financial assistance recognises me to him that I request stating that I am privy to the obligation of communicating to Mutua Universal any variation of the same that it can produce while it receives the provision.

Entreaty authorise the presentation of the application without signature for not having suitable means, while it lasts the recognised state of emergency for the R.D. 463/2020, of 14 March through which the state of emergency is declared for the management of the health crisis situation brought about by the COVID-19. Once is without effect this standard, is my responsibility again send the signed original application.

Signed

Name and surnames

DNI

Date