Certificate proving the need to cross the border

This form is provided to the employer to certify the employment relationship with the employee. This certificate
serves as proof of the need to cross the border in the COVID-19 situation.

Employer’s data

Company name
(business name) This Street Hurts Me film
production
Surname of the Kapanadze First name
representative
Ketevani

Street Number #46

R. Tabukashvili
Postcode 0108 City
Tbilisi

Phone number
+995 598506466

Employee’s data

Surname of the MGEBRISHVILI First name MARI

employee

National
identification 10CC30732
number

Street Machabeli Number 16

Postcode 0105 City Tbilisi

Nationality GEORGIA Countr Georgia

y

Job Title Start Date 02-11-2020

Place Date (dd-mm-yyyy) Place Date (dd-mm-yyyy)

Oelbronn/Duerrn 02-10-2020 02-10-2020

(Employee's signature) (Employer's signature and
stamp)
It is confirmed that this declaration is complete and accurate. The undersigned employer hereby declares that the
above-mentioned employee is employed by him/her. In accordance with the legal provisions on data protection, the
undersigned are hereby informed that the answers given in this form may only be used as proof of the need to
cross the border.