S.I. No. 79/2012 - European Union (Citizens' Initiative) Regulations 2012.

1. All signatories on this form are

Please mark only one Member State per list.

permanent residents in

IE

NL

UK

permanent residents in or citizens of

EE

FI

SK

permanent residents in or citizens of (citizens living abroad only if they have informed their national authorities about their place of residence)

BE

DK

DE

2. Commission registration number

3. Date of registration

4. Web address of this proposed citizens’ initiative on the Commission register

5. Title of this proposed citizens’ initiative

6. Subject matter

7. Main objectives

8. Name of organisers

9. Names and e-mail addresses of contact persons

10. Website of this proposed citizens’ initiative (if any)

TO BE COMPLETED BY THE SIGNATORIES

‘I hereby certify that the information that I have provided in this form is correct and that I have only supported this proposed citizens’ initiative once.’

SIGNATORY

NUMBER

*

FULL FIRST NAMES

FAMILY NAMES

1

PERMANENT RESIDENCE(street, number, postal code, city, country)

2

DATE AND PLACE

3

OF BIRTH

NATIONALITY

DATE AND SIGNATURE

4

* TO BE PRE-COMPLETED BY THE ORGANISERS

1

For the Netherlands and Slovakia, please state also the name at birth.

2

For Finland, please state only the country of permanent residence.

3

For Finland and the United Kingdom, please state only the date of birth.

4

Signature not mandatory when form is submitted electronically without electronic signature.

Privacy statement: in accordance with Article 10 of Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, the personal data provided on this form will only be made available to the competent authorities for the purpose of verification and certification of the number of valid statements of support received for this proposed citizens’ initiative (see Article 8 of Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative) and, if necessary, further processed for the purpose of administrative or legal proceedings relating to this proposed citizens’ initiative (see Article 12 of Regulation (EU) No 211/2011). The data may not be used for any other purpose. Data subjects are entitled to obtain access to their personal data. All statements of support will be destroyed at the latest 18 months after the date of registration of the proposed citizens’ initiative, or, in the case of administrative or legal proceedings, at the latest one week after the date of conclusion of the said proceedings.

GIVEN under my Official Seal,

21 March 2012.

PHIL HOGAN,

Minister for the Environment, Community and Local Government.

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation)

These Regulations make provisions necessary for the purposes of full and effective implementation in Ireland of Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative and EU Commission Implementing Regulation (EU) No 1179/2011 of 17 November 2011.

The Regulations put in place the arrangements that will apply in Ireland to give effect to the European Union Citizens’ Initiative. They designate the Minister for the Environment, Community and Local Government as the Competent Authority for the certification of online collection systems and the verification and certification of Statements of Support. The Regulations provide that the register of European Electors and related registration records may be checked in establishing the eligibility of signatories to sign a citizens’ initiative. They also provide for appropriate penalties in relation to any breach of requirements by organisers of citizens’ initiatives.

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of

23

rd March

, 2012.

I, PHIL HOGAN, Minister for the Environment, Community and Local Government, in exercise of the powers conferred on me by

section 3

of the

European Communities Act 1972

(No. 27 of 1972), for the purpose of giving effect to Regulation (EU) No 211/2011 of the European Parliament and of the Council of 16 February 2011 on the citizens’ initiative and Commission Implementing Regulation (EU) No 1179/2011 of 17 November 2011 laying down technical specifications for online collection systems pursuant to Regulation (EU) No 211/2011 of the European Parliament and of the Council on the citizens’ initiative, hereby make the following Regulations

Citation and Commencement