1. Name, address and contact details of the provider; 2. Where submission of information is carried out by another person on behalf of the provider, the name, address and contact details of that person; 3. Name, address and contact details of the authorised representative, where applicable; 4. AI system trade name and any additional unambiguous reference allowing identification and traceability of the AI system; 5. Description of the intended purpose of the AI system; 6. Status of the AI system (on the market, or in service; no longer placed on the market/in service, recalled); 7. Type, number and expiry date of the certificate issued by the notified body and the name or identification number of that notified body, when applicable; 8. A scanned copy of the certificate referred to in point 7, when applicable; 9. Member States in which the AI system is or has been placed on the market, put into service or made available in the Union; 10. A copy of the EU declaration of conformity referred to in Article 48; 11. Electronic instructions for use; this information shall not be provided for high-risk AI systems in the areas of law enforcement and migration, asylum and border control management referred to in Annex III, points 1, 6 and 7. 12. URL for additional information (optional).