Commission notice

Further information provided by the third State (if possible, documents provided by 
the third State will be attached to this form as Annexes): 
  
Based on the information above, the competent authorities of the State of nationality are 
invited to take a decision on the issuance of a European arrest warrant/ EU-IC/NO arrest 
warrant against the concerned person in view of undertaking the prosecution related to the 
same offence(s)/act(s) which are the object of the extradition request. 
This authority considers ……… [period of time] as a reasonable time to be informed of 
the decision by ……… [relevant date]. 
After this period of time, if no reply by the State of nationality is received, the requested 
State will proceed with the extradition proceeding. 
 

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Concerning the extradition request to execute a custodial sentence or a detention 
order, please provide any relevant information: 
Alternatively, please indicate and substantiate if a reasonable suspicion exists that 
the extradition request is politically motivated: 
 
Contact details of the competent authority transmitting information on the 
extradition request 
State: 
Competent authority: 
Contact person: 
Post held: 
File reference: 
Contact details (email/phone numbers): 
Date and signature 
 

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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
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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.