MEMBERS OF SENIOR MANAGEMENT AND THE BOARD OF THE APPLICANT
ANNEX IVSupplementary provisions
ANNEX IV MEMBERS OF SENIOR MANAGEMENT AND THE BOARD OF THE APPLICANT Name Board member Member of senior management Date of birth Place of birth Role Submitted documents CV Proof of the absence of criminal records referred to in Article 1(2), point (a), of Commission Delegated Regulation (EU) 2025/2180 Declaration of fitness and propriety and conflicts of interest referred to in Article 1(2), point (b), of Commission Delegated Regulation (EU) 2025/2180 [ First name ] [ Last name ] [ Yes/No ] [ Yes/No ] [ DD/MM/YYYY ] [ City, Country ] [ Unique reference number ] [ Unique reference number ] [ Unique reference number ]