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Name: First Name: Street + no.

: City/Town:

I hereby certify the following points: The coordinator specifically informed me that in order to successfully complete the visit for McDonalds, the following points must be fulfilled: 1. I have never been employed by McDonalds and I also do not work for McDonalds at this moment. 2. I do not have friends or family members working for McDonalds or that have worked for McDonalds before.

3. I have never been employed by a competitor of McDonalds and I do not work at the
moment for a competitor of McDonalds

Signature: _________________________________

Date: ________________________

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