31996Y0919(11)

ANNEX III.3

Form of a laissez-passer for the transfer of an asylum applicant from one Member-State to another (Text adopted by the Council on 20 June 1994)

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(MEMBER STATE) (COMPETENT AUTHORITY) Reference No (*) LAISSEZ-PASSER Issued pursuant to Articles 11 and 13 of the Dublin Convention of 15 June 1990 determining the State responsible for examining applications for asylum lodged in one of the Member States of the European Communities Valid only for transfer from .......... (1) to .......... (2), with the asylum applicant required to present him/herself at .......... (3) by .......... (4).

Issued at: .

NAME: .

FORENAMES: .

PLACE AND DATE OF BIRTH: .

NATIONALITY: .

Date of issue: .

PHOTO SEAL .

For the competent authority

The bearer of this laissez-passer has been identified by the authorities .......... (5) (6).

This document is issued pursuant to Articles 11 and 13 of the Dublin Convention only and cannot under any circumstances be regarded as equivalent to a travel document permitting the external frontier to be crossed or to a document proving the individual's identity.

(*) Reference number to be given by the country from which the transfer takes place.(1) Member State from which transferred.(2) Member State to which transferred.(3) Place at which asylum applicant has to present him/herself upon arrival in the second Member State.(4) Deadline by which the asylum applicant has to present him/herself upon arrival in the second Member State.(5) On the basis of the following travel or identity documents presented to the authorities.(6) On the basis of a statement by the asylum applicant or of documents other than a travel or identity document.> END OF GRAPHIC>