English Translation

14-M Personnel note (fill with typewriter) Exact company name and address: Family name: First name: (For women also birth name) (Remark call name) Born on: Place of birth: District: Country: Marital status (lone - married - widowed - divorced): (Not to be deleted) Exercised: Occupation: learner: Pre- and family name (birth name), respectively. of the former spouse: first and last name of the father: first name and birth name of mother: current place of residence: (including street and house number) nationality: nationality: home community: home district: short curriculum vitae: ......... the 194 ......... signature of the person indicating the identity 207