Lawasi,

Moh. Andika
....................................................................................................
(Family name, First name(s))

Palu, 10 Januari 2017

.............................................................................
(Place, Date)

Jl.
Palu Pantoloan No. 24 RT 0001/RW 0001 Kelurahan Kayumalue Ngapa Kecamatan Palu Utara, Sulawesi Tengah
........................................................................................................................................................................................
(Address)

An die
Geschftsstelle der Graduiertenschule
Forst- und Agrarwissenschaften (GFA)
Bsgenweg 5
37077 Gttingen

Declaration according to 6 (2) and 7 (2 f)

In accordance with 6 (2) and 7 (2 f) of the doctoral degree regulations of the GFA, I hereby declare
that

no agent was appointed for locating doctoral opportunities subject to a fee,

in the context of the doctoral process and its preparation, neither fees have been paid, charged
credits obtained nor services that are contrary to the meaning and purpose of an examination
procedure have been claimed free-of-charge,

I remain eligible to sit the examination,

there are no reasons that may give due cause for withdrawal of the doctoral degree,

I have not successfully/unsuccessfully completed a doctoral degree programme in the same

discipline or have not completed it yet. If yes, I have given details in EConsort on when,
where, which topic I worked on and who has acted as my supervisor.

Furthermore, I am aware of the fact that untruthfulness with respect to the above declaration repeals
the admission to complete the doctoral studies and/or subsequently entitle termination of the doctoral
process or withdrawal of the title attained.

Signature of the applicant: ................................................................................................