| Field                | Value                |
| -------------------- | -------------------- |
| Surname              | FORTELNI             |
| Christian name       | Marius Robert         |
| Profession           | Manager              |
| Nationality          | ÖSTERREICH / AUSTRIA  |
| Passport No. | [Redacted] |
| Date and place of birth | [Redacted] |
| Residence           | [Redacted] |

The image shows a black and white photo of a man wearing a plaid shirt. A stamp is present on the bottom right.

| PERSONSBESCHREIBUNG<br />SIGNALEMENT<br />DESCRIPTION OF BEARER          |
|-|
| Größe<br />Taille 1.84m<br />Height                                      |
| Farbe der Augen<br />Couleur des yeux braun<br />Colour of eyes          |
| Besondere Kennzeichen<br />Signes particuliers<br />Distinguishing marks |
| keine                                                                    |

<signature>
Unterschrift des Inhabers
Signature du titulaire
Signature of bearer

3

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