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Adopted by the T-CY at its 19th Plenary Strasbourg, 9 July 2018 |
T-CY(2018)10 |
[Add logo or use letter head of requesting organization if necessary]
Mutual Legal Assistance Request
for subscriber information
under Article 31 Budapest Convention on Cybercrime[1]
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1 date |
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DD/MM/YYYYY |
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2 reference / case number |
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3 request status |
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r New request r Follow up to previous MLA request (details added below) r Follow up to previous preservation request (details added below) |
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4 REQUESTED AUTHORITY |
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5 REQUESTING Authority |
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Organisation |
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Person in charge of the request |
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Address |
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Telephone number |
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Cell phone number |
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E-mail address |
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Fax number |
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Office Hours |
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Time Zone |
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Response by email or other expedited means preferred |
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Response preferred by means of: |
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6 SHOULD ADDITIONAL confirmation FROM THE requesting authority be needed, PLEASE CONTACT: |
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Name: |
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Job Title: |
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Function: |
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Telephone number |
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Cell phone number |
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E-mail address |
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7 Investigative/Operational AUTHORITY in charge of the case (if different from Requesting Authority) |
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Organisation |
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Person in charge of the case |
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Address |
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Telephone number |
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Cell phone number |
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E-mail address |
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Fax number |
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8 prosecution office or Court in charge if applicable |
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Prosecution office in charge and case number |
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Court in charge and case number |
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Prosecution or Court decisions related to the MLA request |
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9 Information on previous MLA request If applicable |
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Date |
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Ticket/reference number |
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Contact details of authority having requested previous MLA |
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Contact details of authority having responded to (or executed) previous MLA |
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Communication method used to submit previous request (email address, fax number, etc) |
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10 Information on previous preservatiOn request If applicable |
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Date |
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Ticket/reference number |
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Contact details of authority having requested preservation |
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Contact details of authority having responded to (or executed) the preservation request |
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Channel for communication |
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11 Domestic legal basis for request IF APPLICABLE |
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Relevant decision by Court, Prosecution or other authorised body; or other legal basis for request Please attach order or statutory authority |
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12 summary of the case Including: - brief description of the facts - how the data sought is related to the investigation/offences - purpose and necessity of request for disclosure of subscriber information - charges pressed/list of offences (with reference to domestic legal provisions and applicable penalties) |
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13 CASE STATUS |
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r Pretrial phase r On trial r Crime in progress Other details: |
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14 SUBSCRIBER INFORMATION to be Disclosed[2] |
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Subscriber information related to the following IP addresses requested: |
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Subscriber information related to following accounts requested: |
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Period of interest |
Start date: DD/MM/YYYY Start time (and time zone): |
End date: DD/MM/YYYY End time (and time zone): |
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15 information identifying the service provider AND – if available – the location of the computer system |
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Please provide as much information as possible to help identify the service provider (including aliases, telephone numbers and other contact details or associated email addresses) |
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16 URGENCY |
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r URGENT Response expected by: DD/MM/YYYY |
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Brief details for urgency |
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17 CONFIDENTALITY |
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r We request that this request is kept confidential and that customers are not notified. Please inform us if your domestic law requires us to explain the reason for confidentiality; or – before taking any action – whether your domestic law requires customer notification or if you suspect that the provider may not comply with the request for confidentiality. |
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18 Confirmation/notification requested |
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r Confirmation of receipt of request r Whether and what additional information is needed from requesting State to execute the request r Information on availability of data or whether data is beyond the jurisdiction of the requested country r Other: |
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19 Additional NOTES, IF ANY |
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20 Signature and / or stamp of REQUESTING Authority if applicable |
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Name |
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Position |
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Date / place |
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Signature and/or stamp |
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21 Annex: Details of information requested[3]
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Subscriber information needed for IP addresses |
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Subscriber information related to the following IP address/es requested (to the extent permitted by your law): |
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Period of interest: |
Start date and time: |
End date and time: |
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Time zone: |
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Details requested: |
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Subscriber names |
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User names |
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Screen names, or other identities |
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Email, social media and other accounts related to the IP address/es |
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Mailing addresses |
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Residential addresses |
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Business addresses |
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Telephone numbers, other contact information |
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Billing records |
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Billing address |
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Payment method |
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Payment History |
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Billing period |
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Information about length of service and the types of services the subscriber(s) or customer(s) used |
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Any other identifying information, whether such records are in electronic or other form |
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Subscriber information needed for accounts |
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Information on the following accounts /s requested, to the extent permitted by your law: |
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Period of interest: |
Start Date and Time: |
End Date and Time: |
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Time zone: |
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Details requested: |
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Subscriber names |
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User names |
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Screen names, or other identities |
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Mailing addresses |
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Residential addresses |
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Business addresses |
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Email addresses |
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Telephone numbers, other contact information |
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Billing records |
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Billing address |
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Payment method |
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Payment History |
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Billing period |
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Registration date |
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IP address used for the initial registration of the accounts |
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Last registered date of access |
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IP address used for the last registered access to the accounts |
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IP address used for access to the account in the period: Start date: DD/MM/YYYY Time: End date: DD/MM/YYYY Time: Time zone: |
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Other Email, social media and other accounts related to the person or account |
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Information about length of service and the types of services the subscriber(s) or customer(s) used |
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Any other identifying information, whether such records are in electronic or other form |
[1] This template was adopted by the Cybercrime Convention Committee (T-CY) at its 19th Plenary (9-10 July 2018) to facilitate the preparation and acceptance of requests by Parties. Use of this template by Parties to the Budapest Convention is optional.
[2] Use ANNEX for details.
[3] Please note that the law of the requested state may not necessarily consider all of the following data to be subscriber information.