--- title: "\"Исполнительный протокол о порядке реализации Соглашения между Правительством Российской Федерации и Правительством Исламской Республики Пакистан о реадмиссии\" [рус., англ.]" status: действует canonical: "https://bukva.ai/docs/ispolnitelnyy-protokol-o-poryadke-realizatsii-13/statya-12" --- # Статья 12 ### Статья 12 **Заключительные положения** 1. Настоящий Исполнительный протокол вступает в силу и прекращает свое действие одновременно с [Соглашением](https://bukva.ai/docs/soglashenie-mezhdu-pravitelstvom-rossiyskoy-3214/statya-1). 2. Стороны по взаимному согласию могут вносить в настоящий Исполнительный протокол изменения, которые оформляются отдельными протоколами. Совершено в г. Бишкеке 5 июня 2026 г. в двух экземплярах, каждый на русском и английском языках, причем оба текста имеют одинаковую силу.

(Подписи)

Приложение N 1
к Исполнительному протоколу
о порядке реализации Соглашения между
Правительством Российской Федерации
и Правительством Исламской Республики
Пакистан о реадмиссии (форма)

СВЕДЕНИЯ
о лице, подлежащем реадмиссии в соответствии с [Соглашением](https://bukva.ai/docs/soglashenie-mezhdu-pravitelstvom-rossiyskoy-3214/statya-1)
между Правительством Российской Федерации и Правительством
Исламской Республики Пакистан о реадмиссии

1. Фамилия _________________________________________________________
2. Имя _____________________________________________________________
3. Отчество (при наличии) ____________________________________________
4. Прежние фамилия, имя, отчество (при наличии) ________________________
5. Дата и место рождения _____________________________________________
6. Документ, удостоверяющий личность, ________________________________
7. Пол _____________________________________________________________
8. Гражданство ______________________________________________________
9. Сведения о близких родственниках, проживающих на территории государства запрашиваемой Стороны, ____________________________________________
10. Адрес места жительства на территории государства запрашиваемой Стороны ___________________________________________________________________
11. Дата въезда на территорию государства запрашивающей Стороны
___________________________________________________________________
12. Способ въезда на территорию государства запрашивающей Стороны
___________________________________________________________________
13. Цель въезда на территорию государства запрашивающей Стороны
___________________________________________________________________
14. Иные сведения __________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Личная подпись
"__ " _____________ 20__ г.
Место составления ___________________________________________________

Подпись представителя центрального компетентного органа государства запрашивающей Стороны

___________

Приложение N 2 к Исполнительному протоколу о порядке реализации Соглашения между Правительством Российской Федерации и Правительством Исламской Республики Пакистан о реадмиссии

(форма)

Герб государства запрашивающей Стороны
________________________________________ ________________________________________ (наименование центрального компетентного органа государства запрашивающей Стороны) Номер __________________________________ Кому ___________________________________ ________________________________________ (наименование центрального компетентного органа государства запрашиваемой Стороны)	_______________________ (место и дата)
ХОДАТАЙСТВО О ПРОВЕДЕНИИ СОБЕСЕДОВАНИЯ (статья 4 Исполнительного протокола о порядке реализации Соглашения между Правительством Российской Федерации и Правительством Исламской Республики Пакистан о реадмиссии)
A. Персональные данные 1. Фамилия ____________________________________________ 2. Имя ________________________________________________ 3. Отчество (при наличии) _______________________________ 4. Прежние фамилия, имя, отчество (при наличии) ___________ 5. Дата и место рождения _________________________________		Фото
6. Пол и описание внешности (рост, цвет глаз, отличительные приметы и т.д.) ___________________________________________________________________ 7. Известен также как (прежние имена, иные имена, используемые лицом, под которыми оно известно, или псевдонимы) ______________________________ 8. Гражданство и язык _______________________________________________ 9. Семейное положение ______________________________________________ ☐ женат, замужем ☐ холост, не замужем ☐ разведен (а) ☐ вдовец, вдова Фамилия, имя, отчество (при наличии) супруга (если женат, замужем) и его местонахождение ___________________________________________________________________ ___________________________________________________________________ Фамилии, имена, отчества (при наличии) и возраст детей (если есть) и их местонахождение ___________________________________________________________________ ___________________________________________________________________ 10. Последнее местонахождение на территории государства запрашивающей Стороны ___________________________________________________________________ 11. Последний адрес пребывания (проживания) на территории государства запрашиваемой Стороны _____________________________________________ 12. Сведения о маршрутах передвижения _______________________________ ___________________________________________________________________ 13. Состояние здоровья _______________________________________________ 14. Документы, имеющиеся у лица:
a) _____________________________________ (вид документа) _______________________________________ (орган, выдавший документ)	_______________________ (дата и место выдачи) _______________________ (дата истечения срока действия)
b) _____________________________________ (вид документа) _______________________________________ (орган, выдавший документ)	_______________________ (дата и место выдачи) _______________________ (дата истечения срока действия)
c) _____________________________________ (вид документа) _______________________________________ (орган, выдавший документ)	_______________________ (дата и место выдачи) _______________________ (дата истечения срока действия)
B. Примечание ___________________________________________________________________ ___________________________________________________________________ Место проведения собеседования ______________________________________
Подпись представителя центрального компетентного органа государства запрашивающей Стороны		_______
МП

Приложение N 3
к Исполнительному протоколу
о порядке реализации Соглашения между
Правительством Российской Федерации
и Правительством Исламской Республики
Пакистан о реадмиссии (форма)

Герб государства запрашивающей Стороны
________________________________________ ________________________________________ (наименование центрального компетентного органа государства запрашивающей Стороны) Номер __________________________________ Кому ___________________________________ (наименование центрального компетентного органа государства запрашиваемой Стороны)	_______________________ (место и дата)
ХОДАТАЙСТВО О РЕАДМИССИИ (статья 5 Исполнительного протокола о порядке реализации Соглашения между Правительством Российской Федерации и Правительством Исламской Республики Пакистан о реадмиссии)
A. Персональные данные 1. Фамилия ____________________________________________ 2. Имя ________________________________________________ 3. Отчество (при наличии) _______________________________ 4. Прежние фамилия, имя, отчество (при наличии) ___________ 5. Дата и место рождения _________________________________		Фото
6. Пол и описание внешности (рост, цвет глаз, отличительные приметы и т.д.) ___________________________________________________________________ 7. Известен также как (прежние имена, иные имена, используемые лицом, под которыми оно известно, или псевдонимы) ______________________________ 8. Гражданство и язык _______________________________________________ 9. Сведения о выданных видах на жительство, разрешениях на временное проживание или визах __________________________________________________________ ___________________________________________________________________ 10. Семейное положение ______________________________________________ ☐ женат, замужем ☐ холост, не замужем ☐ разведен (а) ☐ вдовец, вдова Фамилия, имя, отчество (при наличии) супруга (если женат, замужем) и его местонахождение ___________________________________________________________________ ___________________________________________________________________ Фамилии, имена, отчества (при наличии) и возраст детей (если есть) и их местонахождение ___________________________________________________________________ ___________________________________________________________________ 11. Последнее местонахождение на территории государства запрашивающей Стороны ___________________________________________________________________ 12. Последний адрес пребывания (проживания) на территории государства запрашиваемой Стороны _____________________________________________ ___________________________________________________________________ 13. Сведения о маршрутах передвижения _______________________________ ___________________________________________________________________ 14. Основания для признания въезда и (или) пребывания (проживания) лица на территории государства запрашивающей Стороны незаконными ___________________________________________________________________ ___________________________________________________________________
B. Особые обстоятельства, относящиеся к передаваемому лицу 1. Состояние здоровья (например, возможные указания на необходимость особого медицинского ухода, название инфекционной болезни) ___________________________________________________________________ 2. Отметка об особой опасности лица (например, подозревается в совершении преступления, склонность к агрессивному поведению) ___________________________________________________________________
C. Прилагаемые доказательства гражданской принадлежности 1. Документы, подтверждающие гражданскую принадлежность:
a) _____________________________________ (вид документа) _______________________________________ (орган, выдавший документ)	_______________________ (дата и место выдачи) _______________________ (дата истечения срока действия)
b) _____________________________________ (вид документа) _______________________________________ (орган, выдавший документ)	_______________________ (дата и место выдачи) _______________________ (дата истечения срока действия)
c) _____________________________________ (вид документа) _______________________________________ (орган, выдавший документ)	_______________________ (дата и место выдачи) _______________________ (дата истечения срока действия)
2. Документы, дающие основание предполагать гражданскую принадлежность, __ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
D. Примечания ___________________________________________________________________ ___________________________________________________________________
Подпись представителя центрального компетентного органа государства запрашивающей Стороны		_______
МП

ON THE PROCEDURE OF IMPLEMENTATION OF THE AGREEMENT BETWEEN THE GOVERNMENT OF THE RUSSIAN FEDERATION AND THE GOVERNMENT OF THE ISLAMIC REPUBLIC OF PAKISTAN ON READMISSION (Bishkek, 5.VI.2026) The Government of the Russian Federation and the Government of the Islamic Republic of Pakistan, hereinafter referred to as "the Parties", expressing mutual desire to settle the issues related to the implementation of the Agreement between the Government of the Russian Federation and the Government of the Islamic Republic of Pakistan on readmission of 5th June 2026 (hereinafter the Agreement), taking into account the provisions of paragraphs 3 and 7 of Article 2 and Article 7 of the Agreement, have agreed as follows: Article 1 Competent authorities 1. Competent authorities responsible for the implementation of the Agreement (hereinafter the competent authorities) shall be: from the Russian Federation: the central competent authority - the Ministry of the Interior of the Russian Federation; other competent authorities - the Ministry of Foreign Affairs of the Russian Federation and the Federal Security Service of the Russian Federation; from the Islamic Republic of Pakistan: the central competent authority - the Ministry of Interior and Narcotics Control of the Islamic Republic of Pakistan. 2. The Parties shall immediately inform each other of the changes relating to the competent authorities in writing through diplomatic channels. 3. In order to implement the provisions of the Agreement and this Implementing Protocol the central competent authorities shall interact directly. 4. In order to implement the provisions of this Implementing Protocol within 30 calendar days from the date of its entry into force the central competent authorities shall inform each other of their contact details in writing through diplomatic channels. 5. The central competent authorities shall immediately inform each other of any changes of their contact details in writing. Article 2 Documents to be the basis to determine the persons' nationality of the State of one of the Parties 1. The nationality of the Russian Federation shall be proved by the following documents: a) diplomatic passport; b) service passport; c) passport of a national of the Russian Federation proving the identity of the national of the Russian Federation outside the territory of the Russian Federation, including that with an electronic data carrier; d) passport of a national of the Russian Federation, proving the identity of the national of the Russian Federation in the territory of the Russian Federation; e) certificate of the acquisition of the nationality of the Russian Federation by birth issued by a competent authority of the Russian Federation (with regard to children under the age of 14); f) birth certificate with a mark confirming the nationality of the Russian Federation put by an official of a competent authority of the Russian Federation and with a stamp of this authority (with regard to children under the age of 14); g) document issued by an authorized body of a foreign State (with translation into the Russian language) with a mark confirming the nationality of the Russian Federation put by an official of a competent authority of the Russian Federation and with a stamp of this authority (with regard to children under the age of 14); h) documents specified in subparagraphs a - d of this paragraph with information entered about the children and certified with the signature of an official of a competent authority of the Russian Federation and a stamp of this authority (with regard to children under the age of 14). 2. The nationality of the Islamic Republic of Pakistan shall be proved by the following documents: a) computerized national identification card (CNIC); b) machine-readable or electronic ordinary passport; c) machine-readable or electronic official passport; d) machine-readable or electronic diplomatic passport; e) child registration certificate (CRC) (with regard to children under the age of 14); f) national identity card for overseas Pakistanis (NICOP). 3. There are reasons to believe that a person has the nationality of the Russian Federation if the following is available: a) documents specified in subparagraphs a - d, h of paragraph 1 of this Article that are no longer valid; b) copies or duplicates of the documents specified in paragraph 1 of this Article; c) passport of a national of the USSR with an insert card on the nationality of the Russian Federation; d) passport of a national of the USSR with a stamp of registration at the place of residence on the territory of the Russian Federation as of February 6, 1992; e) birth certificate with information entered on the nationality of the Russian Federation of both parents, of one of the parents or of a single parent (with regard to children under the age of 14); f) identity document of a military serviceman with an insert card certifying the nationality of the Russian Federation, military card with a mark on military registration in the territory of the Russian Federation; g) seaman's identity document issued by authorized bodies of the Russian Federation; h) certificate for entry (return) to the Russian Federation; i) other documents issued by authorized bodies of the Russian Federation; j) information about a person to be readmitted filled in the form according to Annex N 1 to this Implementing Protocol; k) written explanations of witnesses taken on legal grounds by the authorized bodies of the Russian Federation; l) written explanations of officials;

**m) positive results of an interview with a person to be readmitted.**

**4. There are reasons to believe that a person has the nationality of Islamic Republic of Pakistan if the following is available:**

**a) documents specified in paragraph 2 of this Article that are no longer valid;**

b) copies or duplicates of documents specified in paragraph 2 of this Article; c) emergency travel (return) document (ETD); d) seaman service book (SSB); e) documents issued by authorized bodies of the Islamic Republic of Pakistan; f) information about a person to be readmitted filled in the form according to Annex N 1 to this Implementing Protocol; g) written explanations of witnesses taken on legal grounds by authorized bodies of the Islamic Republic of Pakistan; h) written explanations of officials; i) positive results of an interview with a person to be readmitted. Article 3

**Other documents**

**1. If the Requesting Party believes that other documents not specified by Article 2 of this Implementing Protocol can be of essential value to determine the nationality of the person to be readmitted, such documents can also be annexed to the request for readmission sent to the central competent authority of the State of the Requested Party.** **2. The central competent authority of the State of the Requested Party shall decide whether it is possible to take into account the documents specified in paragraph 1 of this Article when considering the request for readmission.**

**Article 4** **Interview**

1. According to paragraph 4 of Article 2 of the Agreement an interview shall be held with the person specified in paragraph 1 of Article 2 of the Agreement upon the application of the central competent authority of the State of the Requesting Party by a representative of the central competent authority of the State of the Requested Party staying in the territory of the State of the Requesting Party. 2. In the absence of a representative of the central competent authority of the State of the Requested Party specified in paragraph 1 of this Article the interview shall be held by an official of the diplomatic mission or of a consular office of the State of the Requested Party in the State of the Requesting Party. 3. The interview shall be held within a timeframe not exceeding 14 calendar days from the date the representative of the central competent authority of the State of the Requested Party staying in the territory of the State of the Requesting Party or (in a case envisaged by paragraph 2 of this Article) officials of the diplomatic mission or of a consular office of the State of the Requested Party in the State of the Requesting Party receives an application for an interview filled in a form according to Annex N 2 to this Implementing Protocol. 4. The day, time and place of the interview shall be agreed on a case-by-case basis. Article 5 Content of and procedure to submit a request for readmission and reply to it 1. A request for readmission filled in a form according to Annex N 3 to this Implementing Protocol shall be submitted by the central competent authority of the State of the Requesting Party to the central competent authority of the State of the Requested Party by mail, courier or by means of technical equipment of information transmission complying with the legislation of the States of the Parties on personal data protection. 2. The documents at the disposal of the Requesting Party specified in Articles 2 and 3 of this Implementing Protocol that prove or give grounds to believe that the person to be readmitted has the nationality of the State of the Requested Party shall be annexed to the request for readmission. 3. If necessary the central competent authority of the State of the Requesting Party shall indicate additional information about special danger and state of health of the person to be readmitted in paragraph B of the request for readmission. 4. The reply to the request for readmission shall be submitted to the central competent authority of the State of the Requesting Party by the central competent authority of the State of the Requested Party by mail or courier within the timeframe set by Article 3 of the Agreement and if necessary additionally by means of technical equipment of information transmission complying with the legislation of the States of the Parties on personal data protection. Article 6 Escorting of a person to be readmitted 1. If it is necessary to readmit a person with escort the central competent authority of the State of the Requesting Party shall inform the central competent authority of the State of the Requested Party of the names, surnames and positions of the escorting persons, type, number, date of issuance and validity period of their passports as well as supposed timeframe of their staying in the territory of the State of the Requested Party. 2. The escorting persons shall be obliged to comply with the legislation of the State of the Requested Party during the stay in the territory of the State of the Requested Party. 3. The escorting persons must wear civilian clothes, have valid passports and documents proving the agreement reached by the Parties relating to readmission. 4. The escorting persons may not have weapon or other items whose circulation is prohibited or limited in the territory of the State of the Requested Party. 5. The competent authorities shall interact in all matters related to the provision of stay of escorting persons in the territory of the State of the Requested Party. The competent authorities of the State of the Requested Party shall provide possible assistance to escorting persons if necessary. Article 7 Readmission procedure 1. With a view to readmission the Parties shall determine the state border crossing points of the States of the Parties in all international airports in the territories of the States of the Parties. 2. The central competent authority of the State of the Requesting Party shall inform the central competent authority of the State of the Requested Party about the day, time, state border crossing point of the State of the Requested Party and other conditions of transfer not later than within 14 calendar days before the planned day of transfer of a person to be readmitted. 3. The central competent authority of the State of the Requested Party shall inform the central competent authority of the State of the Requesting Party whether the transfer conditions are acceptable as soon as possible but not later than within 10 calendar days from the date the information specified in paragraph 2 of this Article is received. 4. In case the transfer conditions proposed by the central competent authority of the State of the Requesting Party are unacceptable for the central competent authority of the State of the Requested Party, other conditions of transfer must be arranged as soon as possible. Article 8 Language With a view to implement the provisions of the Agreement and this Implementing Protocol the documents provided for by Annexes N 1 - 3 to this Implementing Protocol shall be drawn in the language of the State of the Requesting Party with annexed translation into the language of the State of the Requested Party or into the English language. Article 9

**Procedure for mutual settlements in wrongful readmission**

**When implementing wrongful readmission provided for by paragraph 5 of Article 2 of the Agreement, the costs determined by paragraph 2 of Article 6 of the Agreement shall be compensated by the Party whose acts or inaction have resulted in the transfer of a person the reasons for whose readmission were absent, to the other Party in the national currency of that other Party within 30 calendar days from the date the central competent authority of the State of the Party responsible for the wrongful readmission of the person receives the notification of the other Party about the costs incurred with annexed financial documents confirming the expenses incurred.** **Article 10**

**Settlement of disputes**

1. All disputes between the Parties in connection with the implementation or interpretation of this Implementing Protocol shall be settled by means of consultations and negotiations between them. 2. The procedure of consultations and negotiations shall be subject to mutual agreement of the Parties.

**Article 11**

**Annexes** **Annexes N 1 - 3 to this Implementing Protocol shall be its integral part.**

**Article 12**

Final provisions 1. This Implementing Protocol shall enter into force and terminate at the same time as the Agreement shall. 2. Upon mutual consent the Parties may make amendments to this Implementing Protocol which shall be formalized by separate protocols. **Done in Bishkek on the 5th day of June in the year 2026 in duplicate, each copy in the Russian and English languages, both texts being equally authentic.**

**Annex N 1**
**to the Implementing Protocol**

on the procedure of implementation of the Agreement between the Government of the Russian Federation and the Government

**of the Islamic Republic**

**of Pakistan on readmission**

**FORM**

INFORMATION about a person to be readmitted according to the Agreement between the Government of the Russian Federation and the Government of Islamic Republic of Pakistan on readmission

1. Surname: _________________________________________________________
2. Name: ___________________________________________________________
3. Patronymic name (if any): _____________________________________________
4. Previous surname, name, patronymic name (if any): __________________________
5. Date and place of birth: _______________________________________________
6. Identity document: ___________________________________________________
7. Sex: _____________________________________________________________
8. Nationality: ________________________________________________________
9. Information about close relatives residing in the territory of the State of the Requested Party: ___________________________________________________________________
10. Address of the place of residence on the territory of the State of the Requested Party: ___________________________________________________________________
11. Date of entry into the territory of the State of the Requesting Party: ______________
___________________________________________________________________
12. Means of entry into the territory of the State of the Requesting Party: ____________
___________________________________________________________________
13. Purpose of entry into the territory of the State of the Requesting Party: ___________
___________________________________________________________________
14. Other information:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Personal signature
__ _____________ 20__
Place of application ____________________________________________________

Signature of the representative of the central competent authority of the State of the Requesting Party

___________

Annex N 2

**to the Implementing Protocol**

**on the procedure of implementation**

**of the Agreement between**

the Government of the Russian Federation and the Government of the Islamic Republic of Pakistan on readmission FORM

National emblem of the State of the Requesting Party
________________________________________ ________________________________________ (name of the central competent authority of the State of the Requesting Party) N. ______________________________________ To _____________________________________ (name of the central competent authority of the State of the Requested Party)	_______________________ place and date
APPLICATION FOR AN INTERVIEW (Article 4 of the Implementing Protocol on the procedure of implementation of the Agreement between the Government of the Russian Federation and the Government of the Islamic Republic of Pakistan on readmission)
A. Personal data: 1. Surname: ____________________________________________ 2. Name: ______________________________________________ 3. Patronymic name (if any): ________________________________ 4. Previous surname, name, patronymic name (if any): _____________ 5. Date and place of birth: _________________________________		Photo
6. Sex and description of appearance (height, color of eyes, characteristic features, etc.): ___________________________________________________________________ 7. Also known as (previous names, other names used by the person under which he/she is known, or alias): ____________________________________________________________ 8. Nationality and language: ______________________________________________ 9. Marital status: ☐ married ☐ single ☐ divorced ☐ widow(er) Surname, name, patronymic name (if any) of the spouse (if married) and his/her location: ___________________________________________________________________ ___________________________________________________________________ Surname, name, patronymic name (if any) and age of children (if any) and their location: ___________________________________________________________________ ___________________________________________________________________ 10. Last location in the territory of the State of the Requesting Party: ___________________________________________________________________ 11. Last address of stay (residence) in territory of the State of the Requested Party: ___________________________________________________________________ 12. Information about travel routes: ___________________________________________________________________ 13. Health state: _______________________________________________________ 14. Documents carried by the person:
a) _____________________________________ (type of the document) _______________________________________ (issuing authority)	_______________________ (date and place of issuance) _______________________ (expiry date)
b) _____________________________________ (type of the document) _______________________________________ (issuing authority)	_______________________ (date and place of issuance) _______________________ (expiry date)
c) _____________________________________ (type of the document) _______________________________________ (issuing authority)	_______________________ (date and place of issuance) _______________________ (expiry date)
B. Note: ___________________________________________________________________ ___________________________________________________________________ Place of the interview: __________________________________________________
Signature of the representative of the central competent authority of the State of the Requesting Party		_______
seal

Annex N 3
to the Implementing Protocol
on the procedure of implementation
of the Agreement between
the Government of the Russian
Federation and the Government
of the Islamic Republic
of Pakistan on readmission FORM

National emblem of the State of the Requesting Party
________________________________________ ________________________________________ (name of the central competent authority of the State of the Requesting Party) N. ______________________________________ To _____________________________________ (name of the central competent authority of the State of the Requested Party)	_______________________ place and date
REQUEST FOR READMISSION (Article 5 of the Implementing Protocol on the procedure of implementation of the Agreement between the Government of the Russian Federation and the Government of the Islamic Republic of Pakistan on readmission)
A. Personal data: 1. Surname: ____________________________________________ 2. Name: ______________________________________________ 3. Patronymic name (if any): ________________________________ 4. Previous surname, name, patronymic name (if any): _____________ 5. Date and place of birth: _________________________________		Photo
6. Sex and description of appearance (height, color of eyes, characteristic features, etc.): ___________________________________________________________________ 7. Also known as (previous names, other names used by the person under which he/she is known, or alias): ____________________________________________________________ 8. Nationality and language: ______________________________________________ 9. Information about issued permits for residence, permits for temporal residence or visas: ___________________________________________________________________ ___________________________________________________________________ 10. Marital status: ☐ married ☐ single ☐ divorced ☐ widow(er) Surname, name, patronymic name (if any) of the spouse (if married) and his/her location: ___________________________________________________________________ ___________________________________________________________________ Surname, name, patronymic name (if any) and age of children (if any) and their location: ___________________________________________________________________ ___________________________________________________________________ 11. Last location in the territory of the State of the Requesting Party: ___________________________________________________________________ 12. Last address of stay (residence) in territory of the State of the Requested Party: ___________________________________________________________________ 13. Information about travel routes: ___________________________________________________________________ 14. Grounds to recognize entry and (or) stay (residence) of the person in the territory of the State of the Requesting Party as illegal: __________________________________________ ___________________________________________________________________
B. Special circumstances relating to the transferred person: 1. Health state (for example, possible indications on necessary special medical care, name of the infectious disease): ____________________________________________________ ___________________________________________________________________ 2. Mark about special danger of the person (for example, suspected in a crime, inclination towards aggressive behavior): ___________________________________________________ ___________________________________________________________________
C. Annexed proofs of the nationality: 1. Documents proving the nationality:
a) _____________________________________ (type of the document) _______________________________________ (issuing authority)	_______________________ (date and place of issuance) _______________________ (expiry date)
b) _____________________________________ (type of the document) _______________________________________ (issuing authority)	_______________________ (date and place of issuance) _______________________ (expiry date)
c) _____________________________________ (type of the document) _______________________________________ (issuing authority)	_______________________ (date and place of issuance) _______________________ (expiry date)
2. Documents giving grounds to suppose nationality: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
D. Note: ___________________________________________________________________ ___________________________________________________________________
Signature of the representative of the central competent authority of the State of the Requesting Party		_______
seal

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