ANNEX
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Quick Reaction Mechanism (QRM) ( 1 )
NOTIFICATION FORM
1. Notifying Member State
Name of the Member State:
2. Sector(s) to be covered
Sector(s) concerned:
Description of the goods or services for which a QRM special measure is notified ( 2 ):
3. VAT fraud already detected in the sector(s) for which the notification is made (if more than one sector is concerned, please provide separate answers for each of the sectors concerned)
Description of the type and features of the fraud (including (an estimate of) the number of persons alleged to be committing such fraud) ( 3 ):
The date on which (or period during which) the first case of fraud in this sector was detected ( 3 ):
Actual or estimated VAT losses incurred over the past three months (in (or converted into) million EUR) ( 3 ):
Actual or estimated VAT losses incurred over the last calendar year (in (or converted into) million EUR) ( 3 ):
Actual or estimated VAT losses incurred over the year preceding the last calendar year (in (or converted into) million EUR) ( 3 ):
Latest available figure of total yearly national net VAT receipts:
4. Anticipated future development of the fraud in the sector for which the notification is made (if more than one sector is involved, please provide separate answers for each sector concerned)
Description of the type and features of the risk of fraud:
Member State assessment of how the fraud will develop and any evidence in support of that conclusion:
Estimate of the annual potential losses (in (or converted into) million EUR):
( 1 ) See Article 199b of Directive 2006/112/EC.
( 2 ) Use could be made for goods of the Combined Nomenclature classification.
( 3 ) To be left blank if no VAT losses have occurred yet. Details on future developments are to be indicated in box 4.
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5. Brief description of the urgency (e.g. reasons why other means — conventional anti-fraud measures, a derogation in accordance with Article 395 of Directive 2006/112/EC not entailing notification under Article 199b of that Directive, any legislative initiative… — cannot be used to combat the described fraud or risk of fraud)
6. Describe briefly, if applicable, any envisaged accompanying measures
7. Any other comments or information
8. Person notifying the QRM special measure on behalf of the Member State concerned
Name of the person signing the notification:
Capacity of the person signing the notification:
Signature:
Date ( 1 ):
( 1 ) The date is the one when the electronic notification, referred to in Article 1(2) of this Regulation, is made.