The Annex to the original proposal from the European Commission for a Framework Decision on the European arrest warrant and the surrender procedures between the Member States contained the following draft for the European arrest warrant:


European Arrest Warrant

I hereby certify that this warrant corresponds to the authentic documents on which the warrant is based and request that the person mentioned below shall be arrested and surrendered to the judicial authority mentioned below:
(a) Information regarding the identity of the requested person:
Surname: ..........................................................................
Forename(s): .......................................................................
Sex: ................ .......................................
Nationality: ........................................................................
Date of birth: ........................................................................
Place of birth: ........................................................................
Residence: .............................................................................
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Distinctive marks: ....................................................................
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Photo and fingerprints of the requested person (if available):
(b) The judicial authority, which issued the request, and to which the person shall be surrendered:
Name of the authority: ..............................................................
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Competent official (title/grade and name): ......................................
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Address: ..............................................................................
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Tel. nr.: .................................... Fax nr: ..................................
Email: ............................................

(c) Enforceable criminal judgement or other judicial decision, within the scope of Article 2 of the Framework Decision [date] on the European arrest warrant and the surrender procedures between the Member States of the European Union:
Type: ......................................................................................
Date: .......................................................................................
(d) Has the judgement has been rendered in absentia in accordance with Article 3(e) of the Framework Decision [date] on the European arrest warrant and the surrender procedures between the Member States of the European Union-
Yes o No o (Mark the appropriate answer with "x")
If the answer is "yes" a statement as to the legal means available to prepare his or her defence or to have the case retried in his or her presence should be provided here:
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Authority to be contacted:...................................................................
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(e) Nature and legal classification of the offence: .......................................
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(f) Description of the circumstances in which the offence was committed, including the time, place and degree of participation in the offence by the person reported:
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(g) The penalty, if there is an enforceable criminal judgement, or else, the prescribed scale of penalty, and, if possible, other consequences of the offence or the offences:
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(h) Other consequences of the offence, particularly as regards the situation of the victim:
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( i) Has the person already been arrested for the same offence and let free, or released under condition of return- If yes how long has been the deprivation of liberty- Has the person escaped from jail-
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(j) Other information:
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Signature of the competent official:
Title/grade and name: