Annexes to COM(2005)690 - Organisation and content of the exchange of information extracted from criminal records between Member States - Main contents
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This page contains a limited version of this dossier in the EU Monitor.
| dossier | COM(2005)690 - Organisation and content of the exchange of information extracted from criminal records between Member States. |
|---|---|
| document | COM(2005)690  |
| date | February 26, 2009 |
Form referred to in Articles 6, 7, 8, 9 and 10 of the Council Framework Decision 2009/315/JHA on the organisation and content of the exchange of information extracted from the criminal record between Member States
Request for information extracted from the criminal record
Members States are to consult the Manual of Procedures for assistance in filling in this form correctly
| (a) | Information on the requesting Member State: Member State: Central authority(ies): Contact person: Telephone (with STD code): Fax (with STD code): E-mail address: Correspondence address: File reference, if known: |
| (b) | Information on the identity of the person concerned by the request (1): Full name (forenames and all surnames) Previous names: Pseudonym and/or alias, if any: Gender: M F Nationality: Date of birth (in figures: dd/mm/yyyy): Place of birth (town and State): Father’s name: Mother’s name: Residence or known address: Person’s identity number or type and number of the person’s identification document: Fingerprints: Other available identification information: |
| (c) | Purpose of the request: Please tick the appropriate box |
| (1) | | criminal proceedings (please identify the authority before which the proceedings are pending and, if available, the case reference number) … … | |||||||||
| (2) | | request outside the context of criminal proceedings (please identify the authority before which the proceedings are pending and, if available, the case reference number, while ticking the relevant box):
|
Purpose for which the information is requested:
Requesting authority:
| | the person concerned does not consent for this information to be divulged (if the person concerned was asked for its consent in accordance with the law of the requesting Member State). |
Contact person for any further information needed:
Name:
Telephone:
E-mail address:
Other information (e.g. urgency of the request):
Reply to the request
Information relating to the person concerned
Please tick the appropriate box
The undersigned authority confirms that:
| | there is no information on convictions in the criminal record of the person concerned |
| | there is information on convictions entered in the criminal record of the person concerned; a list of convictions is attached |
| | there is other information entered in the criminal record of the person concerned; such information is attached (optional) |
| | there is information on convictions entered in the criminal record of the person concerned but the convicting Member State intimated that the information about these convictions may not be retransmitted for any purposes other than that of criminal proceedings. The request for more information may be sent directly to …(please indicate the convicting Member State) |
| | in accordance with the national law of the requested Member State, requests made for any purposes other than that of criminal proceedings may not be dealt with. |
Contact person for any further information needed:
Name:
Telephone:
E-mail address:
Other information (limitations of use of the data concerning requests outside the context of criminal proceedings):
Please indicate the number of pages attached to the reply form:
Done at
on
Signature and official stamp (if appropriate):
Name and position/organisation:
If appropriate, please attach a list of convictions and send the complete package to the requesting Member State. It is not necessary to translate the form or the list into the language of the requesting Member State.
(1) To facilitate the identification of the person as much information as possible is to be provided.