1. The screening authorities shall, with regard to the persons referred to in Articles 5 and 7, complete a form containing the following:

(a) name, date and place of birth and gender;

(b) indication of nationalities or statelessness, countries of residence prior to arrival and languages spoken;

(c) the reason for which the screening was performed;

(d) information on the preliminary health check carried out in accordance with Article 12(1), including where, based on the circumstances concerning the general state of each individual third-country national, no further health check was necessary;

(e) relevant information on the preliminary vulnerability check carried out in accordance with Article 12(3), in particular any vulnerability or special reception or procedural needs identified;

(f) information as to whether the third-country national concerned has made an application for international protection;

(g) information provided by the third-country national concerned as to whether he or she has family members located on the territory of any Member State;

(h) whether the consultation of relevant databases in accordance with Article 15 resulted in a hit;

(i) whether the third-country national concerned has complied with his or her obligation to cooperate in accordance with Article 9.

2. Where available, the form referred to in paragraph 1 shall include:

(a) the reason for irregular arrival or entry;

(b) information on routes travelled, including the point of departure, places of previous residence, third countries of transit, third countries where international protection may have been sought or granted, and intended destination within the Union;

(c) travel or identity documents carried by the third-country nationals;

(d) any comments and other relevant information, including any related information in cases of suspected smuggling or trafficking in human beings.

3. The information in the form referred to in paragraph 1 shall be recorded in such a way that it is amenable to administrative and judicial review during any ensuing asylum or return procedure.

It shall be specified whether the information referred to in paragraph 1, points (a) and (b), is confirmed by the screening authorities or declared by the person concerned.

Information contained in the form shall be made available either on paper or in electronic format to the person concerned. Information referred to in point (h) of paragraph 1 of this Article shall be redacted. Before the form is transmitted to the relevant authorities as referred to in Article 18(1), (2), (3) and (4), the person subject to the screening shall have the possibility to indicate that the information contained in the form is incorrect. The screening authorities shall record any such indication under the relevant information as referred to in this Article.