(Please fill in if applicable) Where this declaration is issued not by the bank but by the entity responsible for enforcing the Preservation Order, the name and address of that entity (street and number/PO box, place and postcode, Member State) and the telephone number, fax and email address:
(Líon isteach mas infheidhme) I gcás nach é an banc ach an t-eintiteas atá freagrach as an Ordú um Chaomhnú a fhordheidhmiú a eisíonn an dearbhú, tabhair ainm agus seoladh an eintitis sin (sráid agus an uimhir/bosca oifig phoist, áit agus postchód, an Ballstát) agus a uimhir theileafóin, a uimhir facs agus a sheoladh ríomhphoist: