1.

The name and type of the AI system, as well as any additional unambiguous references by which the AI system can be identified and traced;

2.

the name and address of the provider and, if applicable, his or her agent;

3.

an indication that the EU declaration of conformity referred to in Article 47 is provided under the sole responsibility of the provider;

4.

a statement that the AI system complies with this Regulation and, where applicable, with any other relevant Union legislation providing for the issue of the EU declaration of conformity referred to in Article 47;

5.

if an AI system involves the processing of personal data, a statement that that AI system complies with Regulations (EU) 2016/679 and (EU) 2018/1725 and Directive (EU) 2016/680;

6.

the indication of any relevant harmonized standards applied, or other common specifications to which conformity is declared;

7.

where applicable, the name and identification number of the notified body, a description of the conformity assessment procedure carried out and identification of the certificate issued;

8.

the place and date of issue of the statement, the name and position of the person who signed the statement as well as an indication of the person for and on behalf of whom that person signs, a signature.