Annex II — Template for the formal declaration submitted by Union citizens entitled to stand as candidates

I ……………………………………………… (name) solemnly and sincerely declare that: The following information is accurate: Nationality Place of birth Date of birth Last address in the home Member State Identification number issued by the home Member State (where applicable) Type of identity document or travel document issued by the home Member State and its serial number (as an alternative if an identification number is not available) Address in the electoral territory of the Member State of residence Locality or constituency of the home Member State on the electoral roll of which I was last entered (where applicable) Telephone number Email address The date from which I have been a national of the home Member State I am not standing as a candidate for election to the European Parliament in any other Member State. I have not been deprived of the right to stand as a candidate in my home Member State. Date Signature