diff --git a/MIP999/MIP999.md b/MIP999/MIP999.md
index 35c992531..b935f60c7 100644
--- a/MIP999/MIP999.md
+++ b/MIP999/MIP999.md
@@ -129,7 +129,11 @@ The submission message must follow the template *1.1.2.4.1A*
 ###### 1.1.2.4.1A
 
 ```text
-Lorem ipsum
+Title: [Name] Governance Advisory Council Recognition Submission
+[Ecosystem Actor Ethereum address]
+[Cryptographically signed Advisory Council Recognition Submission Message]
+Applicant's name: [Company, team, or individual]
+Any other relevant identifying details:
 ```
 
 #### 1.1.3: Governance Advisory Council Projects and Funding