ANNEX IV
\text{Form for the provision of unsolicited assistance}
Form for the provision of unsolicited assistance
Unsolicited assistance
Reference number:
Date:
Annexes: [Specify the number of documents/supporting documents attached]
General information
FROM:
Member State:
Transmitting Authority:
Legal address:
[Insert the contact details of the contact point designated pursuant to Article 2 of Commission Implementing Regulation (EU) 2018/292]
Name:
Telephone:
Email:
TO:
Member State:
Recipient Authority:
Legal address:
[Insert the contact details of the contact point designated pursuant to Article 2 of Commission Implementing Regulation (EU) 2018/292]
Name:
Telephone:
Email:
Dear [Insert appropriate name]
In accordance with Article 10 of Commission Implementing Regulation (EU) 2018/292, 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 here, 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 competent authority receiving the unsolicited information] pursuant to Article 25 of Regulation (EU) No 596/2014 and on the basis that the information shall remain confidential in accordance with Article 11 of Commission Implementing Regulation (EU) 2018/292 andArticle 27 of Regulation (EU) No 596/2014.
The [Insert name of the competent authority receiving the unsolicited information] shall observe the requirements of the Article 11 of Commission Implementing Regulation (EU) 2018/292 with respect to the permissible uses of that information, and of Article 28 of Regulation (EU) No 596/2014 with respect to personal data processing and transfer.
If the [Insert name of the competent authority receiving the unsolicited information] intends to use or disclose the information received for purposes different than those stated in Article 11(3) of Commission Implementing Regulation (EU) 2018/292, it shall notify [Insert name of the competent authority providing the unsolicited information] and, unless the exception referred to in Article 27(3) of Regulation (EU) No 596/2014 applies, shall obtain the prior consent of [Insert name of the competent authority providing the unsolicited information]. If [Insert name of the competent authority providing the unsolicited information] consents to such a use or disclosure of the information, it may subject it to certain conditions.
Yours sincerely,
[Name and signature]