FORM FOR THE TRANSMISSION OF A DECISION ON AN APPLICATION FOR COMPENSATION IN CROSS-BORDER SITUATIONS

ANNEX II

FORM FOR THE TRANSMISSION OF A DECISION ON AN APPLICATION FOR COMPENSATION IN CROSS-BORDER SITUATIONS
(Article 10 of Directive 2004/80/EC)

FORM FOR THE TRANSMISSION OF A DECISION ON AN APPLICATION FOR COMPENSATION IN CROSS-BORDER SITUATIONS

(Article 10 of Directive 2004/80/EC)

1. Case reference:

2. Date of the decision:

3. Language of the decision:

Other (please specify):

4. Decision transmitted by

Details of the deciding authority (transmitting authority)

Name of the authority:

Member State:

Contact person or the department responsible for handling the matter:

Address:

Telephone (including code):

Fax:

E-mail:

5. To:

Details of the assisting authority (receiving authority):

Member State

Find a competent court/authority

Country:

Instrument: Compensation to Crime victims

Competence type: Deciding Authorities

Name of the authority:

Member State:

Contact person or the department responsible for handling the matter:

Address:

Telephone (including code):

Fax:

E-mail:

6. And to:

Details of the applicant

Name of the applicant:

Address:

Telephone (including code):

Fax:

E-mail:

Legal representative (if applicable):

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