Student Services Department Admissions Office Declaration of the exercising of Membership Rights (for students enrolled at HTW Berlin and at another Berlin university) Family Name: .................................................................................. First Name: .................................................................................. Date of Birth: .................................................................................. HTW Programme: .................................................................................. Student ID: .................................................................................. Name of the other Berlin university: ............................................................................................................... In accordance with § 14, paragraph 5 of the Berlin Higher Education Act (Berliner Hochschulgesetz - BerlHG), students who are enrolled at more than one Berlin university must declare at which institution they wish to exercise their membership rights. I hereby declare that I wish to exercise my membership rights at the Berlin university named below (cross as appropriate): Hochschule für ......................................... Technik und Wirtschaft Berlin (Name of the other institution) Berlin, ............................................. Signature Fees for the Studentenwerk Berlin, semester fees and semester ticket fees shall only be paid by me to the university selected above.