Surname First name Telephone Cell phone Fax E-mail Address (street, post/zip code, city) County/State Country Albania Algeria Argentina Australia Austria Belgium Bolivia Bosnia-Herzegovina Brazil Bulgaria Canada China (People Repubblic of) Colombia Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Ecuador Egypt Estonia Finland France Georgia Germany Greece Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kenya Korea Korea (Dem. People's Rep of) Latvia Liechtenstein Lithuania Luxembourg Morocco Netherlands New Zealand Norway Other Poland Portugal Romania Russian Federation Saudi Arabia Slovenia South Africa Spain Sweden Switzerland Taiwan Tajikistan Thailand Tokelau Tunisia Turkey Turkmenistan Ukraine United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam Yugoslavia Zaire Zambia Zimbabwe Other Place of birth Year of birth Nationality VAT reg. no.

Academic qualifications (Specify where and in what year awarded, school examinations, university degrees, post-graduate diplomas and any work towards an incomplete degree) Other qualifications (Attendance at courses, conferences, seminars, etc.) Chamber of Commerce or Court registration (Specify location and reg. number) Membership of professional associations (Specify year of enrollment) Other special areas of interest/competence

Native language Other languages known and self-assessment (written/oral: indicate level of proficiency - elementary, good, excellent) WRITTEN ORAL Language 1 elementary good excellent select elementary good excellent select Language 2 elementary good excellent select elementary good excellent select Language 3 elementary good excellent select elementary good excellent select

SERVICES OFFERED Translation (Specify From:.... into:.....) Special areas of competence (you may also differentiate by language) Interpreting Working languages (Specify active/passive) Liaison Simultaneous Consecutive Chuchotage Teaching Languages: Other services and areas of special competence (e.g., localization, transcription, voice-overs, tour guide, other...)

Work experience (Provide details, including if possible length of time, description of job responsibility; give starting year for professional activity/translator/interpreter/teacher)

RESOURCES/MATERIALS AT YOUR DISPOSAL Software / CAT: Access to terminology data banks (indicate which)

I consent to the use of my data in conformity with the law 196/2003 (If this field is not enabled, the data cannot be entered)

With regard to the policy statement pursuant to legislative decree no. 196/2003, I / we agree to the use of my / our personal data by your company for the purposes connected with the company's business. Under no circumstances may the data be disclosed to others for uses other than those connected to relations with Interlinguae. I / we also agree that my / our personal data may be processed using electronic and/or automatic means suitable to link the data with that of other persons, on the basis of qualitative, quantitative, temporal, recurrent or other criteria defined on a case-by-case basis.

I / we also agree to the use of my / our personal data by companies, entities or consortiums that provide specific data processing services or that perform activities utilised by your company, or parties to whom the right to access my/our personal data is recognized by provisions of law or secondary regulations or EEC rules.