ANNEX IV

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]