ANNEX ISupplementary provisions
ANNEX I PART 1 STANDARD RULES OF FUNCTIONING OF THE ADVISORY COMMISSION OR ALTERNATIVE DISPUTE RESOLUTION COMMISSION (ARTICLE 11(3) OF DIRECTIVE (EU) 2017/1852) [To be filled in by the independent persons of standing and the chair and signed by the competent authorities of the Member States concerned] [Where the advisory commission is set up for the purposes of Article 6(1)(a) of Directive (EU) 2017/1852, fill in items marked with a * only] 1. GENERAL INFORMATION * Name(s) of the affected person(s), address(es), tax identification number(s) (TIN)(s): … Member State of residence for tax purposes of the affected person(s): … Member States concerned: … Full address and details of a contact person for the affected person(s), including phone number and email address: … Names and details of the affected person's counsel ( if applicable ): … 2. COMPOSITION OF THE ADVISORY COMMISSION OR ALTERNATIVE DISPUTE RESOLUTION COMMISSION 2.1. Form: ☐ Advisory Commission ☐ Alternative Dispute Resolution Commission 2.2. Type of resolution process: ☐ ‘ Independent opinion ’ process ☐ ‘ Final offer ’ process ☐ Other , please specify : … 2.3. Number of Members and general information * : — ☐ Chair — ☐ … Independent persons of standing and … Substitutes — ☐ …Competent authorities' representatives Chair: … … Citizenship: … Address and contact details (incl. email address and phone number - optional): … Independent person of standing (appointed by …): … … Citizenship: … Address and contact details (incl. email address and phone number - optional): … Substitute (appointed by …): … … Citizenship: … Address and contact details (incl. email address and phone number - optional): … Independent person of standing (appointed by …): … … Citizenship: … Address and contact details (incl. email address and phone number - optional): … Substitute (appointed by …): … … Citizenship: … Address and contact details (incl. email address and phone number - optional): … Competent authorities (Representative appointed for …) Address and contact details (incl. email address and phone number): … … Competent authorities (Representative appointed for …) Address and contact details (incl. email address and phone number): … … Where applicable, add lines for additional members involved In addition, as regards the independent persons of standing, their CVs and references with details of their competence and qualifications shall optionally be attached to these Standard Rules of Functioning. The Disclosure of any Conflicts of Interest set out in Part 2 shall be lawfully signed and included. 3. DESCRIPTION AND CHARACTERISTICS OF THE QUESTION IN DISPUTE * Subject matter description: … … … … Tax period(s): … … Industry sector: … … … References to applicable laws and treaties: ☐ National law provisions (Detailed reference of the corresponding articles shall be provided – the full provisions can be attached) … … ☐ Double Taxation Convention (Bilateral or multilateral - detailed reference of the corresponding articles shall be provided – the full provisions can be attached) … … ☐ Convention on the elimination of double taxation in connection with the adjustments of profits of associated enterprises (90/436/EEC) ( 1 ) (Detailed reference of the corresponding articles shall be provided – the full provisions can be attached) … … ☐ Any other reference agreed by the competent authorities: … … … Amounts per tax year and other details about the disputed application or interpretation of the agreement or convention as specified in the complaint submitted by the affected person and as verified by the competent authorities: … … … 4. TERMS OF REFERENCE AGREED BY THE COMPETENT AUTHORITIES Description of the legal issues subject to interpretation in the disputed case: … … … … Description of the factual circumstances to be considered and factual issues on which competent authorities need clarification and/or interpretation by the Advisory Commission or Alternative Dispute Resolution Commission: … … … … 5. TIME FRAME FOR THE DISPUTE RESOLUTION PROCEDURE * Latest date for delivering the opinion: … Time-limits for submissions by the competent authorities and affected person(s), including documentary or other evidence and/or expert opinions; consequences of late submission ( if any ): … … Scheduled dates and place of hearings (if any) : … … Scheduled dates for the appearance or representation of the affected person(s) and/or third parties at the hearings (if any) : … … 6. ORGANISATION AND FUNCTIONING * Place(s) of meeting of the Advisory Commission or Alternative Dispute Resolution Commission: … Administrative services that may be required for the Advisory Commission or Alternative Dispute Resolution Commission to carry out their functions: … Working language(s) for the dispute resolution procedure: … Possible need for translation of documents (in full or in part) : … Possible need for interpretation of oral presentations: … Practical details concerning written submissions and evidence (e.g. method of submission, copies, numbering, references) : … Routing of written communications among the competent authorities and affected person(s) (including means of sending documents) : … Arrangements for requests for information by the Advisory Commission or Alternative Dispute Resolution Commission and subsequent replies by the affected person(s) and the competent authorities: … Experts and other possible third parties (terms and conditions for the submission of oral and written opinions): … Conditions for the admissibility of documents ( e.g. original or certified copies, etc.) : … Arrangements for presenting voluminous and complicated documentary evidence (e.g., through summaries, tabulations, charts, extracts or samples) : … Arrangements for a record of the hearings: … Other ( to be specified, including other procedural, evidentiary and logistical arrangements that may be applicable ): … 7. OPINION Possible requirements concerning filing or delivering the opinion: … … 8. COSTS * The costs shall be shared between the Member States: ☐ In proportion of: … ☐ Equally The costs shall include, if any: ☐ The expenses incurred by the independent persons of standing: … ☐ The fees of the independent persons of standing (limited to EUR 1 000 per person per meeting day): … ☐ Translation costs … ☐ Interpretation costs … ☐ Other administrative costs (including Secretariat costs) … Other information and arrangements regarding costs (to be specified) : … … 9. OTHER … … … Date: Signature by the representatives of the competent authorities of the Member States: … … PART 2 DISCLOSURE OF ANY CONFLICTS OF INTEREST [To be filled in by each appointed independent person of standing and his or her substitute] Family name: … First name: … Appointed by: … ☐ I consider myself independent and impartial. To the best of my knowledge, and having made due enquiry, there is no interest, relationship or any other matter, past or present, that I should disclose because it might affect my independence or impartiality or that might reasonably create an appearance of bias in the proceedings. ☐ Confirmation with disclosure: I am objective and intend to remain so. Accordingly, I am also mindful of my obligation to disclose any facts or circumstances, which might be of such nature as to call into question my independence before the competent authorities. In this context, I draw your attention to the matters below: … … This disclosure does not discharge my ongoing duty to disclose any facts and circumstances that might affect my independence. Date: Signature of the appointed independent person or his or her subsitute: … ( 1 ) OJ L 225, 20.8.1990, p. 10 .