Annexes to COM(2017)344 - Centralised system for the identification of Member States holding conviction information on third country nationals and stateless persons (ECRIS-TCN system)

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dossier COM(2017)344 - Centralised system for the identification of Member States holding conviction information on third country nationals and ...
document COM(2017)344 EN
date April 17, 2019
ANNEX

STANDARD INFORMATION REQUEST FORM AS REFERRED TO IN ARTICLE 17(1) OF REGULATION (EU) 2019/816 IN ORDER TO OBTAIN INFORMATION ON WHICH MEMBER STATE, IF ANY, HOLDS CRIMINAL RECORDS INFORMATION OF A THIRD-COUNTRY NATIONAL

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This form, which is available at www.eurojust.europa.eu in all 24 official languages of the institutions of the Union, should be addressed in one of those languages to ECRIS-TCN@eurojust.europa.eu

Requesting state or international organisation:

Name of state or international organisation:

Authority submitting the request:

Represented by (name of person):

Title:

Address:

Telephone number:

Email address:

Criminal proceedings for which the information is sought:

Domestic reference number:

Competent authority:

Type of crimes under investigation (please mention relevant article(s) of criminal code):

Other relevant information (e.g. urgency of the request):

Identity information of the person having the nationality of a third country in respect of whom information regarding the convicting Member State is sought:

NB: please provide as much available information as possible.

Surname (family name):

First name(s) (given names):

Date of birth:

Place of birth (town and country):

Nationality or nationalities:

Gender:

Previous name(s), if applicable:

Parents’ names:

Identity number:

Type and number of the person’s identification document(s):

Issuing authority of document(s):

Pseudonyms or aliases:

If fingerprint data are available, please provide these.

In case of multiple persons, please indicate them separately

A drop down panel would allow the insertion of additional subjects

Place

Date

(Electronic) signature and stamp: