This form should be completed as fully as possible and submitted to the registry of the WAEMU Competition Directorate. Please attach any relevant documents or information in support of your application. The information provided in this form is kept confidential as far as possible to enable the WAEMU Competition Directorate to examine your application. However, the WAEMU Competition Directorate may disclose this information where necessary to assist it in carrying out its functions. The WAEMU Competition Directorate will contact the applicant when it considers it necessary to disclose this information. However, for the avoidance of doubt, you are entitled to identify the information you consider confidential by submitting a confidentiality request together with this application.

I declare that the information contained in this application form and all supporting documents I have attached are accurate and are provided to the WAEMU Competition Directorate in good faith. I am aware that providing false or misleading information to the WAEMU Competition Directorate is an offence, and I undertake to cooperate fully and honestly with the WAEMU Competition Directorate until the investigation is concluded.