ANNEX IISupplementary provisions
ANNEX II Standard format of the declaration stating the structure of ownership Article 11(1)(a) of Regulation (EU) No 510/2011 I hereby declare that I am legally empowered to represent [name] (the manufacturer) applying for a derogation as foreseen in Article 11(1) of Regulation (EU) No 510/2011 which is not part of a group of connected manufacturers as defined in Article 3(2) thereof. To the best of my knowledge the [name] (the manufacturer) is eligible to apply for a derogation as foreseen in Article 11(1) of Regulation (EU) No 510/2011 and the information contained in the application is true and accurate. Information on the ownership structure of [name] (the manufacturer) is annexed. Signature Date Director of [manufacturer] Article 11(1)(b) of Regulation (EU) No 510/2011 I hereby declare that I am legally empowered to represent [name] (the manufacturer) applying for a derogation as foreseen in Article 11(1) of Regulation (EU) No 510/2011 which is part of a group of connected manufacturers as defined in Article 3(2) thereof. To the best of my knowledge the [name] (the manufacturer) is eligible to apply for a derogation as foreseen in Article 11(1) of Regulation (EU) No 510/2011 and the information contained in the application is true and accurate. Information on the ownership structure of [name] (the manufacturer) is annexed. Signature Date Director of [manufacturer] Article 11(1)(c) of Regulation (EU) No 510/2011 I hereby declare that I am legally empowered to represent [name] (the manufacturer) applying for a derogation as foreseen in Article 11 of Regulation (EU) No 510/2011 which is part of a group of connected manufacturers as defined in Article 3(2) thereof but operates its own production facilities and design centre as defined in Article 2 of Commission Delegated Regulation (EU) No 114/2013. To the best of my knowledge the [name] (the manufacturer) is eligible to apply for a derogation as foreseen in Article 11(1) of Regulation (EU) No 510/2011 and the information contained in the application is true and accurate. Information on the ownership structure of [name] (the manufacturer) is annexed. Signature Date Director of [manufacturer]