Source: OJ L, 2024/2494, 25.9.2024

Current language: EN

Annex IV


Form for provision of unsolicited exchange of information

  1. Unsolicited exchange of information

    1. Reference number:

      Date:

      FROM:

      Submitting Body:

      Address:

      (Contact details of the contact point designated in accordance with Article 2 of Implementing Regulation (EU) 2024/2494)

      Name:

      Telephone:

      Email:

      TO:

      Member State:

      Receiving Body:

      Address:

      (Contact details of the contact point designated in accordance with Article 2 of Implementing Regulation (EU) 2024/2494)

      Name:

      Telephone:

      Email:

      Dear [insert appropriate name]

      In accordance with Article 9 of Implementing Regulation (EU) 2024/2494, we are providing the following information we believe may be of assistance in carrying out your duties.

      Information provided

      [Please set out the details of the information provided, including if relevant a description of any supporting documents or material attached.]

      The information provided is confidential and is disclosed to [Insert name of the submitting body] pursuant to [Insert provision of the applicable sectoral legislation] and on the basis that the information shall remain confidential in accordance with Article 10 of Implementing Regulation (EU) 2024/2494 and Article 100 of Regulation (EU) 2023/1114.

      The [Insert name of the receiving body] shall observe the requirements of Article 10 of Implementing Regulation (EU) 2024/2494 with respect to the permissible uses of that information, and of Article 101 of Regulation (EU) 2023/1114 with respect to the processing and transfer of personal datameans personal data as defined in Article 4, point (1), of Regulation (EU) 2016/679;.

      Yours sincerely,

      [signature]

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