Template: Non-High-Risk Assessment

This form documents the assessment of an Annex III system as not high-risk pursuant to Art. 6(3)–(4).

System Identification

Field	Value
System ID	AI-BGI-XXXX
Name
Annex III category	No. ___
Date
Conducted by

Review of Exception Criteria (Art. 6(3))

Criterion 1: No Profiling

Does the system carry out profiling of natural persons (automated processing of personal data to evaluate personal aspects)?

• [ ] No — Criterion met
• [ ] Yes — Exception does NOT apply → System is HIGH-RISK

Justification: ___

Criterion 2: No Autonomous Decision-Making

Does the system make autonomous decisions that significantly affect fundamental rights?

• [ ] No — Criterion met
• [ ] Yes — Exception does NOT apply → System is HIGH-RISK

Justification: ___

Criterion 3: Narrow, Preparatory Scope

Does the system have a narrow, preparatory scope (preparation for a human decision, not a substitute)?

• [ ] Yes — Criterion met
• [ ] No — Exception does NOT apply → System is HIGH-RISK

Justification: ___

Result

• [ ] All three criteria met → NOT HIGH-RISK → Registration pursuant to Art. 49(2) required
• [ ] At least one criterion not met → HIGH-RISK → Go/No-Go assessment

Signature

Conducted by	Date:
Approved by	Date: