# L_2015178EN.01000101.xml

| 8.7.2015 | EN | Official Journal of the European Union | L 178/1 |
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8.7.2015

EN

Official Journal of the European Union

L 178/1

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COMMISSION DELEGATED REGULATION (EU) 2015/1070

of 31 March 2015

amending Annexes III, V and VII of Regulation (EC) No 211/2011 of the European Parliament and of the Council on the citizens' initiative

THE EUROPEAN COMMISSION,

Having regard to the Treaty on the Functioning of the European Union,

Having regard to Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens' initiative (1) and in particular Article 16 thereof,

Whereas:

| (1) | Three Member States requested modifications in the data required in the forms set out in Annex III to Regulation (EU) No 211/2011. |
| --- | --- |

(1)

Three Member States requested modifications in the data required in the forms set out in Annex III to Regulation (EU) No 211/2011.

| (2) | The information in Annexes III, V and VII needs to be amended to clarify or facilitate the procedures concerned. |
| --- | --- |

(2)

The information in Annexes III, V and VII needs to be amended to clarify or facilitate the procedures concerned.

| (3) | As regards amendments to Annex III, the Commission should take into account information forwarded to it by the Member States. |
| --- | --- |

(3)

As regards amendments to Annex III, the Commission should take into account information forwarded to it by the Member States.

| (4) | Several organisers of initiatives registered with the Commission are currently collecting statements of support in accordance with Article 5 of Regulation (EU) No 211/2011. Therefore, it is necessary to allow them to use both the forms set out in Annex I to this Regulation and the forms in their previous version set out in Annex II to Commission Delegated Regulation (EC) No 887/2013 (2), |
| --- | --- |

(4)

Several organisers of initiatives registered with the Commission are currently collecting statements of support in accordance with Article 5 of Regulation (EU) No 211/2011. Therefore, it is necessary to allow them to use both the forms set out in Annex I to this Regulation and the forms in their previous version set out in Annex II to Commission Delegated Regulation (EC) No 887/2013 (2),

HAS ADOPTED THIS REGULATION:

Article 1

Regulation (EU) No 211/2011 is amended as follows:

| 1) | Annex III is replaced by the text set out in Annex I to this Regulation. |
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1)

Annex III is replaced by the text set out in Annex I to this Regulation.

| 2) | Annex V is replaced by the text set out in Annex II to this Regulation. |
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2)

Annex V is replaced by the text set out in Annex II to this Regulation.

| 3) | Annex VII is replaced by the text set out in Annex III to this Regulation. |
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3)

Annex VII is replaced by the text set out in Annex III to this Regulation.

Article 2

Forms complying with Annex III of Regulation (EU) No 211/2011 as amended by Delegated Regulation (EU) No 887/2013 may continue to be used for the collection of statements of support from signatories for proposed citizens' initiatives which have been registered in accordance with Article 4 of Regulation (EU) No 211/2011 before the date of entry into force of this Regulation.

Article 3

This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

This Regulation shall be binding in its entirety and directly applicable in all Member States.

Done at Brussels, 31 March 2015.

For the Commission

The President

Jean-Claude JUNCKER

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(1)  
  OJ L 65, 11.3.2011, p. 1.

1

(2)  
  OJ L 247, 18.9.2013, p. 11.

2

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ANNEX I

‘ANNEX III

Image 1

STATEMENT OF SUPPORT FORM — PART A (1)

(for Member States that do not require the provision of a personal identification number/personal identification document number)

Unless stated otherwise, all fields on this form are mandatory.

TO BE PRE-COMPLETED BY THE ORGANISERS:

1. All signatories on this form are

Please mark only one Member State per list.

residents in:

IE

UK

residents in or citizens of:

EE

NL

SK

FI

residents in or citizens of (citizens living abroad only if they have informed their national authorities about their place of residence):

BE

DK

DE

LU

2. European Commission registration number:

3. Date of registration:

4. Web address of this proposed citizens’ initiative in the European Commission’s register:

5. Title of this proposed citizens’ initiative:

6. Subject matter:

7. Main objectives:

8. Names and email addresses of registered contact persons:

9. Names of the other registered organisers:

10. Website of this proposed citizens’ initiative (if any):

TO BE COMPLETED BY THE SIGNATORIES IN CAPITAL LETTERS:

‘I hereby certify that the information that I have provided in this form is correct and that I have not already supported this proposed citizens’ initiative.’

Image 2

FULL FIRST NAMES

FAMILY NAMES (2)

RESIDENCE (street, number, postal code, city, country) (3)

DATE AND PLACE (4) OF BIRTH

NATIONALITY

DATE AND SIGNATURE (5)

(1) The form shall be printed on one sheet. Organisers may use a double-sided sheet.

(2) For the Netherlands and Slovakia, please also state the name at birth.

(3) For Finland, please only state the country of permanent residence.

(4) For Ireland, Finland and the United Kingdom, please only state the date of birth.

(5) Signature is not mandatory if the form is submitted electronically via an online collection system as referred to in Article 6 of Regulation (EU) No 211/2011.

Privacy statement: in accordance with Article 10 of Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, the personal data provided on this form to the organisers of the proposed initiative will only be made available to the competent authorities for the purpose of verification and certification of the number of valid statements of support received for this proposed citizens’ initiative (see Article 8 of Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative) and, if necessary, further processed for the purpose of administrative or legal proceedings relating to this proposed citizens’ initiative (see Article 12 of Regulation (EU) No 211/2011). The data may not be used for any other purpose. Data subjects are entitled to obtain access to their personal data. All statements of support will be destroyed at the latest 18 months after the date of registration of the proposed citizens’ initiative, or, in the case of administrative or legal proceedings, at the latest one week after the date of conclusion of the said proceedings.

Image 3

STATEMENT OF SUPPORT FORM — PART B (1)

(for Member States that require the provision of a personal identification number/personal identification document number)

Unless stated otherwise, all fields on this form are mandatory.

TO BE PRE-COMPLETED BY THE ORGANISERS:

1. All signatories on this form hold personal identification numbers/personal identification document numbers of:

Please mark only one Member State per list.

BG

CZ

EL

ES

FR

HR

IT

CY

LV

LT

HU

MT

AT

PL

PT

RO

SI

SE

See Part C for personal identification numbers/personal identification document numbers one of which must be provided.

2. European Commission registration number:

3. Date of registration:

4. Web address of this proposed citizens’ initiative in the European Commission’s register:

5. Title of this proposed citizens’ initiative:

6. Subject matter:

7. Main objectives:

8. Names and email addresses of registered contact persons:

9. Names of the other registered organisers:

10. Website of this proposed citizens’ initiative (if any):

TO BE COMPLETED BY THE SIGNATORIES IN CAPITAL LETTERS:

‘I hereby certify that the information that I have provided in this form is correct and that I have not already supported this proposed citizens’ initiative.’

Image 4

FULL FIRST NAMES

FAMILY NAMES (2)

RESIDENCE (street, number, postal code, city, country) (3)

DATE AND PLACE OF BIRTH (4)

NATIONALITY

PERSONAL IDENTIFICATION NUMBER/PERSONAL IDENTIFICATION DOCUMENT TYPE AND NUMBER (5)

DATE AND SIGNATURE (6)

(1) The form shall be printed on one sheet. Organisers may use a double-sided sheet.

(2) For Bulgaria and Greece, please also state the father’s name. For Greece, please also state the name at birth.

(3) Only for France, Croatia, Italy, Austria, Poland and Romania.

(4) For Greece, Spain, Malta, Portugal and Romania, please only state the date of birth. For France, Italy, Austria, Slovenia, please state both the date and place of birth. For the other Member States, do not state anything.

(5) For Italian identification documents, please also state the issuing authority.

(6) Signature is not mandatory if the form is submitted electronically via an online collection system as referred to in Article 6 of Regulation (EU) No 211/2011.

Privacy statement: in accordance with Article 10 of Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, the personal data provided on this form to the organisers of the proposed initiative will only be made available to the competent authorities for the purpose of verification and certification of the number of valid statements of support received for this proposed citizens’ initiative (see Article 8 of Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative) and, if necessary, further processed for the purpose of administrative or legal proceedings relating to this proposed citizens’ initiative (see Article 12 of Regulation (EU) No 211/2011). The data may not be used for any other purpose. Data subjects are entitled to obtain access to their personal data. All statements of support will be destroyed at the latest 18 months after the date of registration of the proposed citizens’ initiative, or, in the case of administrative or legal proceedings, at the latest one week after the date of conclusion of the said proceedings.

Part C

Part C

1.   Requirements for the Member States that do not require the provision of a personal identification number/personal identification document number (statement of support form — Part A)

Requirements for the Member States that do not require the provision of a personal identification number/personal identification document number (statement of support form — Part A)

| Member State | Signatories whose statement of support is to be submitted to the Member State concerned |
| --- | --- |
| Belgium | — | residents in Belgium |

Member State

Signatories whose statement of support is to be submitted to the Member State concerned

Belgium

—

residents in Belgium

| — | Belgian nationals residing outside the country if they have informed their national authorities of their place of residence |
| --- | --- |

—

Belgian nationals residing outside the country if they have informed their national authorities of their place of residence

Denmark

| — | residents in Denmark |
| --- | --- |

—

residents in Denmark

| — | Danish nationals residing outside the country if they have informed their national authorities of their place of residence |
| --- | --- |

—

Danish nationals residing outside the country if they have informed their national authorities of their place of residence

Germany

| — | residents in Germany |
| --- | --- |

—

residents in Germany

| — | German nationals residing outside the country if they have informed their national authorities of their place of residence |
| --- | --- |

—

German nationals residing outside the country if they have informed their national authorities of their place of residence

Estonia

| — | residents in Estonia |
| --- | --- |

—

residents in Estonia

| — | Estonian nationals residing outside the country |
| --- | --- |

—

Estonian nationals residing outside the country

Ireland

| — | residents in Ireland |
| --- | --- |

—

residents in Ireland

Luxembourg

| — | residents in Luxembourg |
| --- | --- |

—

residents in Luxembourg

| — | Luxembourgish nationals residing outside the country if they have informed their national authorities of their place of residence |
| --- | --- |

—

Luxembourgish nationals residing outside the country if they have informed their national authorities of their place of residence

Netherlands

| — | residents in the Netherlands |
| --- | --- |

—

residents in the Netherlands

| — | Dutch nationals residing outside the country |
| --- | --- |

—

Dutch nationals residing outside the country

Slovakia

| — | residents in Slovakia |
| --- | --- |

—

residents in Slovakia

| — | Slovak nationals residing outside the country |
| --- | --- |

—

Slovak nationals residing outside the country

Finland

| — | residents in Finland |
| --- | --- |

—

residents in Finland

| — | Finnish nationals residing outside the country |
| --- | --- |

—

Finnish nationals residing outside the country

United Kingdom

| — | residents in the United Kingdom |
| --- | --- |

—

residents in the United Kingdom

2.   List of Member States that require the provision of one of the personal identification numbers/personal identification document numbers specified below and issued by the Member State concerned (statement of support form — Part B

List of Member States that require the provision of one of the personal identification numbers/personal identification document numbers specified below and issued by the Member State concerned (statement of support form — Part B

BULGARIA

| — | Единен граждански номер (personal number) |
| --- | --- |

—

Единен граждански номер (personal number)

CZECH REPUBLIC

| — | Občanský průkaz (national identity card) |
| --- | --- |

—

Občanský průkaz (national identity card)

| — | Cestovní pas (passport) |
| --- | --- |

—

Cestovní pas (passport)

GREECE

| — | Δελτίο Αστυνομικής Ταυτότητας (identity card) |
| --- | --- |

—

Δελτίο Αστυνομικής Ταυτότητας (identity card)

| — | Διαβατήριο (passport) |
| --- | --- |

—

Διαβατήριο (passport)

| — | Βεβαίωση Εγγραφής Πολιτών Ε.Ε./Έγγραφο πιστοποίησης μόνιμης διαμονής πολίτη Ε.Ε. (residence certificate/permanent residence certificate) |
| --- | --- |

—

Βεβαίωση Εγγραφής Πολιτών Ε.Ε./Έγγραφο πιστοποίησης μόνιμης διαμονής πολίτη Ε.Ε. (residence certificate/permanent residence certificate)

SPAIN

| — | Documento Nacional de Identidad (identity card) |
| --- | --- |

—

Documento Nacional de Identidad (identity card)

| — | Pasaporte (passport) |
| --- | --- |

—

Pasaporte (passport)

| — | Número de Identidad de Extranjero, de la tarjeta o certificado, correspondiente a la inscripción en el Registro Central de Extranjeros (foreigner's identification number (NIE), of the card or certificate, corresponding to the registration in the Foreigners' Central Registry) |
| --- | --- |

—

Número de Identidad de Extranjero, de la tarjeta o certificado, correspondiente a la inscripción en el Registro Central de Extranjeros (foreigner's identification number (NIE), of the card or certificate, corresponding to the registration in the Foreigners' Central Registry)

FRANCE

| — | Passeport (passport) |
| --- | --- |

—

Passeport (passport)

| — | Carte nationale d'identité (national identity card) |
| --- | --- |

—

Carte nationale d'identité (national identity card)

CROATIA

| — | Osobni identifikacijski broj (personal identification number) |
| --- | --- |

—

Osobni identifikacijski broj (personal identification number)

ITALY

| — | Passaporto (passport), inclusa l'indicazione dell'autorità di rilascio (including issuing authority) |
| --- | --- |

—

Passaporto (passport), inclusa l'indicazione dell'autorità di rilascio (including issuing authority)

| — | Carta di identità (identity card), inclusa l'indicazione dell'autorità di rilascio (including issuing authority) |
| --- | --- |

—

Carta di identità (identity card), inclusa l'indicazione dell'autorità di rilascio (including issuing authority)

CYPRUS

| — | Δελτίο Ταυτότητας (identity card of the national or resident) |
| --- | --- |

—

Δελτίο Ταυτότητας (identity card of the national or resident)

| — | Διαβατήριο (passport) |
| --- | --- |

—

Διαβατήριο (passport)

LATVIA

| — | Personas kods (personal identification number) |
| --- | --- |

—

Personas kods (personal identification number)

LITHUANIA

| — | Asmens kodas (personal number) |
| --- | --- |

—

Asmens kodas (personal number)

HUNGARY

| — | személyazonosító igazolvány (identity card) |
| --- | --- |

—

személyazonosító igazolvány (identity card)

| — | útlevél (passport) |
| --- | --- |

—

útlevél (passport)

| — | személyi azonosító szám (személyi szám) (personal identification number) |
| --- | --- |

—

személyi azonosító szám (személyi szám) (personal identification number)

MALTA

| — | Karta tal-Identità (identity card) |
| --- | --- |

—

Karta tal-Identità (identity card)

| — | Dokument ta' residenza (residence document) |
| --- | --- |

—

Dokument ta' residenza (residence document)

AUSTRIA

| — | Reisepass (passport) |
| --- | --- |

—

Reisepass (passport)

| — | Personalausweis (identity card) |
| --- | --- |

—

Personalausweis (identity card)

POLAND

| — | Numer ewidencyjny PESEL (PESEL identification number) |
| --- | --- |

—

Numer ewidencyjny PESEL (PESEL identification number)

PORTUGAL

| — | Bilhete de identidade (identity card) |
| --- | --- |

—

Bilhete de identidade (identity card)

| — | Passaporte (passport) |
| --- | --- |

—

Passaporte (passport)

| — | Cartão de Cidadão (citizen's card) |
| --- | --- |

—

Cartão de Cidadão (citizen's card)

ROMANIA

| — | carte de identitate (identity card) |
| --- | --- |

—

carte de identitate (identity card)

| — | pașaport (passport) |
| --- | --- |

—

pașaport (passport)

| — | certificat de înregistrare (registration certificate) |
| --- | --- |

—

certificat de înregistrare (registration certificate)

| — | carte de rezidență permanentă pentru cetățenii UE (permanent residence card for EU citizens) |
| --- | --- |

—

carte de rezidență permanentă pentru cetățenii UE (permanent residence card for EU citizens)

| — | Cod Numeric Personal (personal identification number) |
| --- | --- |

—

Cod Numeric Personal (personal identification number)

SLOVENIA

| — | Enotna matična številka občana (personal identification number) |
| --- | --- |

—

Enotna matična številka občana (personal identification number)

SWEDEN

| — | Personnummer (personal identification number)’ |
| --- | --- |

—

Personnummer (personal identification number)’

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ANNEX II

‘ANNEX V

FORM FOR THE SUBMISSION OF STATEMENTS OF SUPPORT TO THE MEMBER STATES' COMPETENT AUTHORITIES

Image 5

1. Full names, postal addresses and email addresses of the contact persons (representative and substitute of the citizens’ committee):

2. Title of proposed citizens’ initiative:

3. Commission registration number:

4. Date of registration:

5. Number of signatories coming from (name of Member State):

6. Total number of collected statements of support:

7. Number of Member States where the threshold has been reached:

8. Annexes:

(Include all statements of support from signatories to be verified by the relevant Member State.

If applicable, include the relevant certificate(s) of conformity of the online collection system with Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative.)

9. I hereby declare that the information provided in this form is correct and that the statements of support have been collected in accordance with Article 5 of Regulation (EU) No 211/2011.

10. Date and signature of one of the contact persons (representative/substitute (1)):

(1) Delete as appropriate

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ANNEX III

‘ANNEX VII

FORM FOR THE SUBMISSION OF A CITIZENS' INITIATIVE TO THE EUROPEAN COMMISSION

Image 6

1. Title of citizens’ initiative:

2. Commission registration number:

3. Date of registration:

4. Number of valid statements of support received (must be at least one million):

5. Number of signatories certified by Member States:

BE

BG

CZ

DK

DE

EE

IE

EL

ES

FR

HR

IT

CY

LV

LT

LU

Number of signatories

HU

MT

NL

AT

PL

PT

RO

SI

SK

FI

SE

UK

TOTAL

Number of signatories

6. Full names, postal addresses and email addresses of the contact persons (representative and substitute of the citizens’ committee) (1).

7. Indicate all sources of support and funding received for the initiative, including the amount of financial support at the time of submission (1):

8. I hereby declare that the information provided in this form is correct and that all relevant procedures and conditions set out in Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative have been complied with.

Date and signature of one of the contact persons (representative/substitute (2)):

9. Annexes:

(Include all certificates)

(1) Privacy statement: in accordance with Article 11 of Regulation (EC) No 45/2001 of the European Parliament and of the Council of 18 December 2000 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data, data subjects are informed that these personal data are compiled by the Commission for the purpose of the procedure in respect of the citizens’ initiative. Only the full names of the organisers, the email addresses of the contact persons and information relating to the sources of support and funding will be made available to the public on the Commission’s online register. Data subjects are entitled to object to the publication of their personal data on compelling legitimate grounds relating to their particular situation, and to request the rectification of that data at any time and its removal from the Commission’s online register after the expiry of a period of two years from the date of registration of the proposed citizens’ initiative.

(2) Delete as appropriate

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