ANNEX IV — Form for provision of unsolicited exchange of information

Unsolicited exchange of information

Reference number:
Date:
FROM:
Submitting Body:
Address:
(Contact details of the contact point designated in accordance with Article 2 of Implementing Regulation (EU) 2024/2494)
Name:
Telephone:
Email:
TO:
Member State:
Receiving Body:
Address:
(Contact details of the contact point designated in accordance with Article 2 of Implementing Regulation (EU) 2024/2494)
Name:
Telephone:
Email:
Dear [insert appropriate name]
In accordance with Article 9 of Implementing Regulation (EU) 2024/2494, 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 provided, 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 submitting body] pursuant to [Insert provision of the applicable sectoral legislation] and on the basis that the information shall remain confidential in accordance with Article 10 of Implementing Regulation (EU) 2024/2494 and Article 100 of Regulation (EU) 2023/1114.
The [Insert name of the receiving body] shall observe the requirements of Article 10 of Implementing Regulation (EU) 2024/2494 with respect to the permissible uses of that information, and of Article 101 of Regulation (EU) 2023/1114 with respect to the processing and transfer of personal data.
Yours sincerely,
[signature]