anx_ANNEX__cpt_1__text_1

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:

← 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 · All articles

Source: EUR-Lex (Cellar) · retrieved 2026-11-13 · Text as adopted (Official Journal); later amendments are not incorporated in this text.