This attestation must be drawn up on headed paper or with the company stamp

EVERY FALSE DECLARACION SHALL BE KEPT ON THE DECLARER'S RESPONSIBILITY
(all sections must be completed)

I the undersigned ____________________________________________________________________

residing in _________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

since (date) ________________________________________________________________________

Certify on my honour thath I am coming on holiday to the European Union

from ______________________________________________________________________________

to ________________________________________________________________________________

and thath I shall return to my country of residence on conclusion of it.

Singed in ________________________________ on (date) __________________________________