C 223/28
EN
Official Journal of the European Union
8.6.2022
ANNEX 4
Template to provide additional information to the State of nationality For the attention of the competent authority of: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Following the notification sent on . . . . . . . [date], pursuant to the obligation to initiate a consultation procedure established in the Petruhhin judgment (1) of the Court of Justice of the European Union, this State is transmitting additional information which may be useful in view of the issuance of the European arrest warrant / EU-IC/NO arrest warrant.
Information on the identity of the requested person Name: Forename(s): Maiden name, where applicable: Aliases, where applicable: Sex: Nationality: Date of birth: Place of birth: Residence and/or known address: Language(s) that the requested person understands (if known): Distinctive marks/description of the requested person: Information regarding the requesting third State authority Issuing third State: (Judicial) authority which issued the arrest warrant / extradition request: Name of its representative: Post held (title/grade): File reference: Address: Contact details: Further relevant information:
(1) Judgment of the Court of Justice of 6 September 2016, Petruhhin, C-182/15, ECLI:EU:C:2016:630.