ANNEX IIISupplementary provisions
ANNEX III ‘ANNEX IV FORM FOR THE SUBMISSION OF COMPLAINTS CONCERNING ALLEGED UNLAWFUL STATE AID OR MISUSE OF AID The mandatory fields are marked with a star (*). 1. Information regarding the complainant First Name*: Surname*: Address line 1*: Address line 2: Town/City*: County/State/Province: Postcode*: Country*: Telephone: Mobile Telephone: E-mail address*: 2. I am submitting the complaint on behalf of somebody (a person or a firm) ☐Yes* ☐No* If yes, please also provide the following information Name of the person/firm you represent*: Registration nr. of the entity: Address line 1*: Address line 2: Town/City*: County/State/Province: Postcode*: Country*: Telephone 1: Telephone 2: E-mail address*: Please attach proof that the representative is authorized to act on behalf of this person/firm.* 3. Please select one of the following options, describing your identity* (a) ☐Competitor of the beneficiary or beneficiaries (b) ☐Trade association representing the interests of competitors (c) ☐Non-governmental organisation (d) ☐Trade union (e) ☐EU citizen (f) ☐Other, please specify Please explain why and to what extent the alleged State aid affects your competitive position / the competitive position of the person/firm you represent, or is otherwise likely to have a specific effect on your/its situation. Provide as much concrete evidence as possible. Please be aware that, by virtue of Article 24(2) of Council Regulation (EU) 2015/1589 of 13 July 2015 laying down detailed rules for the application of Article 108 of the Treaty on the Functioning of the European Union ( 1 ) , only interested parties within the meaning of Article 1, point (h), of that Regulation may submit formal complaints. Therefore, in the absence of a demonstration that you are an interested party, the present form will not be registered as a complaint, and the information provided therein will be kept as general market information. 4. Please select one of the following two options* ☐ Yes, you may reveal my identity ☐ No, you may not reveal my identity If not, please specify the reasons: 5. Information regarding the Member State granting the aid* Please be aware: the information provided under this point is regarded as non-confidential. (a) Country: (b) If known, specify which institution or body granted the alleged unlawful State aid: — Central government: — Region (please specify): — Other (please specify): 6. Information regarding the alleged aid measure* Please be aware: the information provided under this point is regarded as non-confidential. In case you add annexes in support to your claim, please indicate in the section below the relevant points/sections of the annex supporting your allegations that the measure is not in line with State aid rules. (a) Please provide a description of the alleged aid, and indicate in what form it was granted (loans, grants, guarantees, tax incentives or exemptions etc.). (b) For what purpose was the alleged aid given (if known)? (c) What is the amount of the alleged aid (if known)? If you do not have the exact figure, please provide an estimate and as much justifying evidence as possible. (d) Who is the beneficiary? Please give as much information as possible, including a description of the main activities of the beneficiary/firm(s) concerned. (e) To your knowledge, when was the alleged aid granted? (f) Please select one of the following options: ☐ According to my knowledge, the State aid was not notified to the Commission. ☐ According to my knowledge, the State aid was notified, but it was granted before the decision of the Commission. If known, please indicate the notification reference number or indicate when the aid was notified. ☐ According to my knowledge, the State aid was notified and approved by the Commission, but its implementation did not respect the applicable conditions. If known, please indicate the notification reference number or indicate when the aid was notified and approved. ☐ According to my knowledge, the State aid was granted under a block exemption regulation, but its implementation did not respect the applicable conditions. 7. Grounds of complaint* Please note that, for a measure to qualify as State aid under Article 107(1) of the Treaty, the alleged aid has to be granted by a Member State or through State resources, it has to distort or threaten to distort competition by favouring certain undertakings or the production of certain goods, and affect trade between Member States. In case you add annexes in support to your claim, please indicate in the section below the relevant points/sections of the annex supporting your allegations that the measure is not in line with State aid rules. (a) Please explain to what extent public resources are involved (if known) and, if the measure was not adopted by a public authority (but for instance by a public undertaking), please explain why, in your view, it is imputable to public authorities of a Member State. (b) Please explain why, in your opinion, the alleged State aid is selective (i.e. favours certain commercial undertakings or the production of certain goods). (c) Please explain how, in your opinion, the alleged State aid provides an economic advantage for the beneficiary or beneficiaries. (d) Please explain why, in your view, the alleged State aid distorts or threatens to distort competition. (e) Please explain why, in your view, the alleged aid affects trade between Member States. 8. Compatibility of the aid Please indicate the reasons why in your view the alleged aid is not compatible with the internal market. In case you add annexes in support to your claim, please indicate in the section below the relevant points/sections of the annex supporting your allegations that the measure is not in line with State aid rules. 9. Information on alleged infringement of other rules of European Union law and on other procedures (a) If known, please indicate what other rules of European Union law you think have been infringed by the granting of the alleged aid. Please be aware that this does not imply necessarily that those potential infringements will be dealt with within the State aid investigation. (b) Have you already approached the Commission's services or any other European institution concerning the same issue?* ☐Yes ☐No If yes, please attach copies of correspondence. (c) Have you already approached national authorities or national courts concerning the same issue?* ☐Yes ☐No If yes, please indicate which authorities or courts; also, if there has already been a decision or judgement, please attach a copy (if available); if, on the contrary, the case is still pending, please indicate its reference (if available). (d) Please provide any other information that may be relevant for the assessment of this case. 10. Supporting documents Please list any documents and evidence which are submitted in support of the complaint and add annexes if necessary — Whenever possible, a copy of the national law or other measure which provides the legal basis for the payment of the alleged aid should be provided. — Whenever possible, please attach any available evidence that the State aid was granted (e.g. press release, published accounts). — If the complaint is submitted on behalf of someone else (a natural person or a firm) please attach proof that you as a representative are authorised to act. — Where applicable, please attach copies of all previous correspondence with the European Commission or any other European or national institution concerning the same issue. — If the issue has already been dealt with by a national court/authority, please attach a copy of the judgement/decision, if available. 11. Confidential information All the information contained in this form and the annexes submitted are not confidential and may be shared with the Member State allegedly granting the State aid. ☐Yes ☐No If no, please identify the confidential part(s) of any documents, explain the reason why you consider it to be confidential and provide a non-confidential version of the document. Please note that the information contained in points 5 and 6 of this form cannot be designated as confidential. In the absence of any indication about confidentiality of certain documents or information, those elements will be treated as non-confidential and may be shared with the Member State allegedly granting the State aid. I hereby declare that all the information in this form and annexes is provided in good faith. Place, date and signature of complainant ’ ( 1 ) OJ L 248, 24.9.2015, p. 9 , ELI: http://data.europa.eu/eli/reg/2015/1589/oj .