Diebold_Cert

Certification of Named Plaintiff Pursuant to Federal Securities Laws

Individual Investors - register below or CLICK HERE TO OPEN UP ADOBE ACROBAT .PDF form YOU CAN FILL IN FIELDS FORMAT ALLOWS, (DO NOT PRESS SUBMIT) AND PRINT OUT then Fax or Mail into the Office. FAX: 216.522.9007 or Address: 1360 W. 9th Street Suite #200, Cleveland Ohio 44113

First Name: *	Middle Initial:	Last Name: *

Mailing Address 1: *

Mailing Address 2:

City: *	State: *	Zip Code: *

Country: *

Phone: * (555) 555-5555	Fax: (555) 555-5555

Email: *johndoe@email.com	Date of Signing:

Are you a current or former employee of the company?*
Yes No

I ("Plaintiff"), being duly sworn, declares as to the claims asserted under the federal securities laws against DIEBOLD, INC. ("BLUD"), et al., that::

1.	I have reviewed the Complaint and authorized its filing.
2.	Plantiff did not purchase the security that is the subject of this action, at the direction of plaintiff's counsel or in order to participate in any private action.
3.	I am willing to serve as a representative party on behalf of a class, including providing testimony at deposition and trial, if necessary.
4.	My transaction(s) in the security that is the subject of this action during the class period are as follows:

Enter Share Information - for additional entry fields click "more fields"

PURCHASES:
	Number of Shares: ex: 150	Buy Date: ex: MM/DD/YYYY	Price Per Share: ex: 50.00
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SALES:
	Number of Shares: ex: 150	Sell Date: ex: MM/DD/YYYY	Price Per Share: ex: 50.00
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5.	I (Plaintiff) has sought to serve as a class representative in the following cases within the last three years:

6.	I (Plaintiff) will not accept any payment for serving as a representative party on behalf of the class beyond Plaintiff's pro rata share of any recovery, except such reasonable costs and expenses (including lost wages) directly relating to the representation of the class as ordered or approved by the court.

Terms - please verify below

I declare under penalty of perjury that the information above is true and correct.

I authorize and retain Landskroner Grieco Madden, Ltd. to file an action, or amend a current action, under the federal securities laws to recover damages and to seek relief against DIEBOLD, INC. ("BLUD"), et al.. Landskroner Grieco Madden, Ltd. will prosecute the action on a contingent fee basis and will advance all costs and expenses.

The Complaint provided to me is incorporated by reference. the Retention Agreement will be provided upon calling our office at 216.522.9000 or toll free: 866.522.9500.

Enter Additional Share Information

Shares Purchased:
	Number of Shares: ex: 150	Buy Date: ex: MM/DD/YYYY	Price Per Share: ex: 50.00
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Shares Sold:
	Number of Shares: ex: 150	Sell Date: ex: MM/DD/YYYY	Price Per Share: ex: 50.00
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