# Council Directive (EU) 2015/637 of 20 April 2015 on the coordination and cooperation measures to facilitate consular protection for unrepresented citizens of the Union in third countries and repealing Decision 95/553/EC, Division Form of the request for reimbursement: REQUEST FOR REIMBURSEMENT (Article 14(2) and (3) of Directive (EU) 2015/637)

Extent: E+W+S+N.I.

1.. Requesting Member State's embassy or consulate
2.. Competent embassy or consulate or Ministry of Foreign Affairs of assisted citizen's Member State of nationality
3.. Identification of the event
(date, place)
4.. Data of assisted citizen(s) (to be attached separately)
Full name
Place and date of birth
Name and number of the travel document
Kind of assistance provided
Costs
5.. Total costs
6.. Bank account for the reimbursement
7.. Attachment: undertaking to repay (if applicable)

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Source: https://www.legislation.gov.uk/eudr/2015/637/annex/II/division/Form (the official version)
Page: https://openlegislation.uk/eu-directive-2015-637/annex-II/division-Form
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.