ANNEX ISupplementary provisions
ANNEX I Form for reporting fraud and irregularities under Article 5(1) of Regulation (EU, Euratom) No 608/2014 Text of image 1. CASE ID 1.1. Member State 1.2. Serial number (format CC/YYYY/NNNNNN/V) 1.3. Year and quarter of discovery or establishment (format: yyyy/q) 1.4. Department or agency which made the establishment or detected the case 1.5. Date of transmission (format: dd/mm/yyyy) 1.6. Status 2. CASE DESCRIPTION 2.1. TARIC code (10 digits) 2.1.1. Presumed 2.1.2. Declared 2.1.3. Established 2.2. Dispatching country 2.2.1. Presumed 2.2.2. Declared 2.2.3. Established 2.3. Country of origin 2.3.1. Presumed 2.3.2. Declared 2.3.3. Established 2.4. Quantity 2.4.1. Presumed 2.4.2. Declared 2.4.3. Established 2.5. Customs value 2.5.1. Presumed 2.5.2. Declared 2.5.3. Established 2.6. Customs procedure 2.7. Type of check that led to discovery 3. RECOVERY STAGE 3.1. Administrative stage code 3.2. Financial stage code 3.3. Non-recovery due to criminal investigation Text of image 4. ADDITIONAL INFORMATION 4.1. Date of establishment (format: dd/mm/yyyy) 4.2. Reference of the establishment 4.3. Date in the B accounts (format: dd/mm/yyyy) 4.4. Reference of the B account 4.5. Date of last appeal decision (format: dd/mm/yyyy) 4.6. Amounts of traditional own resources 4.6.1. Estimated amount 4.6.2. Established amount 4.6.3. Amount of the correction 4.6.4. Amount written-off 4.6.5. Recovered amount 4.6.6. Amount to be recovered 4.7. Information on fraud or irregularity: 4.7.1. Designation 4.7.2. Type of fraud or irregularity 4.7.3. Concise description of fraud mechanism 4.8. Case already notified under mutual assistance agreements (Council Regulation (EC) No 515/97 (1)) 4.8.1. MA-reference (format: yyyy/nnnn) 4.8.2. OLAF case reference (format: LL/yyyy/nnnn) (2) 4.8.3. JCO (Joint Customs Operation) reference 4.9. CPCA reference (Common Priority Control Area) 4.10. RIF reference (Risk Information Form) 4.11. WOMIS (write-off management information system) Reference (if applicable) (format: cc/yyyy/nnnn 4.12. Measures taken or planned to prevent recurrence 4.13. Member States involved 4.14. Other information (1) Council Regulation (EC) No 515/97 of 13 March 1997 on mutual assistance between the administrative authorities of the Member States and cooperation between the latter and the Commission to ensure the correct application of the law on customs and agricultural matters (OJ L 82, 22.3.1997, p. 1). (2) Where the case is linked to a financial recommendation made by OLAF this shall be also indicated.