Commission notice

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: 
71
Judgment of the Court of Justice of 6 September 2016, Petruhhin, C-182/15, ECLI:EU:C:2016:630. 

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Further relevant information: 
 
Contact details of the State transmitting information on the extradition request 
State: 
Competent authority: 
Contact person: 
Post held: 
File reference: 
Contact details (email/phone numbers): 
Central authority: 
Date and signature 
 
 

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ANNEX 5 Template to request an extension of the time limit to inform the requested 
authority pursuant to the Petruhhin mechanism 
Following the notification received from .…..……… on …. [date], on the extradition 
request for the purpose of prosecution against the national of this State…………….. 
[name of the person concerned] and issued by…................. [third State], this State kindly 
requests an extension of the time limit provided by the requested State to be informed 
about the decision on the issuance of a European arrest warrant/EU-IC/No arrest warrant 
pursuant to the application of the Petruhhin mechanism. 
In particular, it is requested to extend the time limit for…………. [period of time/days] 
and therefore to inform the requested State about such decision by…….. [date]. 
Please provide further information on the need for the extension: