The member of the staff of the workshop having removed or broken a tachograph seal due to vehicle repair or modification, as referred to in Article 22(5) of Regulation (EU) No 165/2014, shall complete, sign and stamp a written statement with the information laid down in the Annex to this Regulation. The original written statement shall be kept on board the vehicle, and a stamped copy shall stay in the workshop where the seal was removed or broken.