ANNEX IISupplementary provisions
ANNEX II Form of the request for reimbursement REQUEST FOR REIMBURSEMENT (Article 14(2) and (3) of Directive (EU) 2015/637) 1. Requesting Member State's embassy or consulate 2. Competent embassy or consulate or Ministry of Foreign Affairs of assisted citizen's Member State of nationality 3. Identification of the event (date, place) 4. Data of assisted citizen(s) (to be attached separately) Full name Place and date of birth Name and number of the travel document Kind of assistance provided Costs 5. Total costs 6. Bank account for the reimbursement 7. Attachment: undertaking to repay (if applicable)