Personal declaration regarding the casting of a written vote (postal voting)
under § 24 Sec. 1 Nr. 4 WO

I,………………..……………….. (first and last name in block letters), hereby declare that I personally marked the voting ballot in the enclosed envelope for the works council election in the following company ………………..………………...

In ………………..……………….., Date ………………..

………………..………………..
(Signature)