Any decision to place a person under judicial supervision taken pursuant to this chapter for the purposes of recognition and supervision in the territory of the Republic or in that of another Member State shall be accompanied by a certificate specifying in particular:
1° The designation of the issuing State and the executing State;
2° The designation of the competent authority which ordered the placement under judicial supervision;
3° The designation of the competent authority in the issuing State for the monitoring of these judicial supervision measures;
4° The identity of the person placed under judicial supervision, the address of his last known place(s) of residence in the issuing State, in the executing State or in another State;
5° The reasons for forwarding the decision to place the person under judicial supervision with regard to Article 696-52;
6° The languages understood by the person placed under judicial supervision;
7° The date, place and circumstances in which the offences were allegedly committed, as well as the nature and legal classification of the facts;
8° The date of the decision to place the person under judicial supervision, the date on which it became enforceable, as well as, where applicable, the existence of an appeal lodged against this decision on the date on which the certificate is sent ;
9° The obligations to which the person who is the subject of the decision to place him under judicial supervision is subject, as well as, where applicable, the duration of application and the existence of a possible extension of this decision;
10° Where applicable, the probable duration for which these supervision measures should be necessary having regard to the circumstances of the case known at the time of transmission of the decision to place him under judicial supervision;
11° Where applicable, the specific reasons for the obligations provided for by the decision to place him under judicial supervision.
The certificate shall be signed by the competent authority of the issuing State, which shall attest to the accuracy of the information contained therein.