ANNEX VIISupplementary provisions
ANNEX VII FORM FOR THE SUBMISSION OF A CITIZENS’ INITIATIVE TO THE COMMISSION 1. Title of citizens’ initiative: 2. Commission registration number: 3. Date of registration: 4. Number of valid statements of support received (must be at least one million): 5. Number of signatories certified by Member States: BE BG CZ DK DE EE IE EL ES FR IT CY LV LT LU Number of signatories HU MT NL AT PL PT RO SI SK FI SE UK TOTAL Number of signatories 6. Full names, postal addresses and e-mail addresses of the contact persons ( 1 ) . 7. Indicate all sources of support and funding received for the initiative, including the amount of financial support at the time of submission ( 1 ) : 8. We hereby declare that the information provided in this form is correct. Date and signature of the contact persons: 9. Annexes: (Include all certificates) ( 1 ) Privacy statement: in accordance with Article 11 of Regulation (EC) No 45/2001 of the European Parliament and of the Council of 18 December 2000 on the protection of individuals with regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data, data subjects are informed that these personal data are compiled by the Commission for the purpose of the procedure in respect of the citizens’ initiative. Only the full names of the organisers, the e-mail addresses of the contact persons and information relating to the sources of support and funding will be made available to the public on the Commission’s online register. Data subjects are entitled to object to the publication of their personal data on compelling legitimate grounds relating to their particular situation, and to request the rectification of that data at any time and its removal from the Commission’s online register after the expiry of a period of two years from the date of registration of the proposed citizens’ initiative.