Coming from by means of (indicate means of transport used, e.g. flight number), he/she is hereby informed that he/she is refused entry into the country pursuant to (indicate references to the national law in force), for the following reasons:
Ag teacht ó ar/i (sonraigh an modh iompair a úsáideadh, e.g. uimhir eitilte), cuirtear in iúl dó/di leis seo go ndiúltaítear cead isteach sa tír dó/di de bhun (sonraigh tagartí don dlí náisiúnta atá i bhfeidhm), ar na cúiseanna seo a leanas