ANNEX VSupplementary provisions
ANNEX V FORM FOR THE SUBMISSION OF STATEMENTS OF SUPPORT TO THE MEMBER STATES’ COMPETENT AUTHORITIES 1. Full names, postal addresses and e-mail addresses of the contact persons: 2. Title of proposed citizens’ initiative: 3. Commission registration number: 4. Date of registration: 5. Number of signatories coming from (name of Member State): 6. Annexes: (Include all statements of support from signatories to be verified by the relevant Member State. If applicable, include the relevant certificate(s) of conformity of the online collection system with Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative.) 7. Date and signature of the contact persons: