Grant holder’s details
Surname: .................................................................................................................................
Name: ......................................................................................................................................

Ref.: E-2017-......

Centre at which the stay is to take place

To be completed by the responsible of the research project at the host institution

Centre (Institute/Faculty/Department/Research Centre): .........................................................
Name:  ...................................................................................................................................  
Position: ....................................................................................................................................
 
The undersigned certifies that the above named researcher reported to this Centre on: 
(date of incorporation at the host centre)............................./..................../20..........................

________________________, __________ ______________________  20______

	

	                                                Responsible of the project                                         STAMP                                                                                            

Contact details during the research stay:
Address:..................................................................................................................................... 
...................................................................................................................................................Fax: ..................................................................................................................
Telephone: .......................................................................................................
email: ...................................................................................................................