Annex
United Kingdom
‘ANNEX I
EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS NOT SUBJECT TO PROCEEDINGS FOR RECOGNITION OR A DECLARATION OF ENFORCEABILITY
(Articles 20 and 48 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf1)
IMPORTANT
To be issued by the court of origin
To be issued only if the decision or court settlement is enforceable in the Member State of origin
Mention only information which is given in the decision or court settlement or of which the court of origin has been made aware
1.
NATURE OF THE DOCUMENT
Decision Court settlement Date and reference number: …
The decision/court settlement is recognised and enforceable in another Member State without any possibility of opposing its recognition and without the need for a declaration of enforceability (Articles 17 and 48 of Regulation (EC) No 4/2009).
2.
COURT OF ORIGIN
2.1.
Name: …
2.2.
Address:
- 2.2.1.
Street and number/PO box: …
- 2.2.2.
Place and postal code: …
- 2.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
2.3.
Telephone/Fax/E-mail: …
3.
3.1.
Person A
3.1.1.
Surname and given name(s): …
3.1.2.
Date (dd/mm/yyyy) and place of birth: …
3.1.3.
Identity number or social security number: …
3.1.4.
Address:
- 3.1.4.1.
Street and number/PO box: …
- 3.1.4.2.
Place and postal code: …
- 3.1.4.3.
Country: …
3.1.5.
Has benefited from
3.1.5.1.
legal aid:
Yes No 3.1.5.2.
exemption from costs and expenses:
Yes No 3.1.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 3.2.
Person B
3.2.1.
Surname and given name(s): …
3.2.2.
Date (dd/mm/yyyy) and place of birth: …
3.2.3.
Identity number or social security number: …
3.2.4.
Address:
- 3.2.4.1.
Street and number/PO box: …
- 3.2.4.2.
Place and postal code: …
- 3.2.4.3.
Country: …
3.2.5.
Has benefited from
3.2.5.1.
legal aid:
Yes No 3.2.5.2.
exemption from costs and expenses:
Yes No 3.2.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 3.3.
Person C
3.3.1.
Surname and given name(s): …
3.3.2.
Date (dd/mm/yyyy) and place of birth: …
3.3.3.
Identity number or social security number: …
3.3.4.
Address:
- 3.3.4.1.
Street and number/PO box: …
- 3.3.4.2.
Place and postal code: …
- 3.3.4.3.
Country: …
3.3.5.
Has benefited from
3.3.5.1.
legal aid:
Yes No 3.3.5.2.
exemption from costs and expenses:
Yes No 3.3.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 4.
4.1.
Person A
4.1.1.
Surname and given name(s): …
4.1.2.
Date (dd/mm/yyyy) and place of birth: …
4.1.3.
Identity number or social security number: …
4.1.4.
Address:
- 4.1.4.1.
Street and number/PO box: …
- 4.1.4.2.
Place and postal code: …
- 4.1.4.3.
Country: …
4.1.5.
Has benefited from
4.1.5.1.
legal aid:
Yes No 4.1.5.2.
exemption from costs and expenses:
Yes No 4.1.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 4.2.
Person B
4.2.1.
Surname and given name(s): …
4.2.2.
Date (dd/mm/yyyy) and place of birth: …
4.2.3.
Identity number or social security number: …
4.2.4.
Address:
- 4.2.4.1.
Street and number/PO box: …
- 4.2.4.2.
Place and postal code: …
- 4.2.4.3.
Country: …
4.2.5.
Has benefited from
4.2.5.1.
legal aid:
Yes No 4.2.5.2.
exemption from costs and expenses:
Yes No 4.2.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 4.3.
Person C
4.3.1.
Surname and given name(s): …
4.3.2.
Date (dd/mm/yyyy) and place of birth: …
4.3.3.
Identity number or social security number: …
4.3.4.
Address:
- 4.3.4.1.
Street and number/PO box: …
- 4.3.4.2.
Place and postal code: …
- 4.3.4.3.
Country: …
4.3.5.
Has benefited from
4.3.5.1.
legal aid:
Yes No 4.3.5.2.
exemption from costs and expenses:
Yes No 4.3.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 5.
TERMS OF THE DECISION/COURT SETTLEMENT
5.1.
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
5.2.
Maintenance claim f6
5.2.1.
Maintenance claim A
5.2.1.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.1.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.1.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.1.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event): …
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
…
Indexation applicable as from: … (dd/mm/yyyy)
5.2.1.5.
Amount due retroactively
Period covered: … ([dd/mm/yyyy] to [dd/mm/yyyy])
Amount: …
Form of payment: …
…
…
5.2.1.6.
Interest (if specified in the decision/court settlement)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.1.7.
Payment in kind (please specify): …
…
…
…
5.2.1.8.
Other form of payment (please specify): …
…
…
…
5.2.2.
Maintenance claim B
5.2.2.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.2.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.2.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.2.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event): …
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
Indexation applicable as from: … (dd/mm/yyyy)
5.2.2.5.
Amount due retroactively
Period covered: … ([dd/mm/yyyy] to [dd/mm/yyyy])
Amount: …
Form of payment: …
…
…
5.2.2.6.
Interest (if specified in the decision/court settlement)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.2.7.
Payment in kind (please specify): …
…
…
…
5.2.2.8.
Other form of payment (please specify): …
…
…
…
5.2.3.
Maintenance claim C
5.2.3.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.3.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.3.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.3.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
Indexation applicable as from: … (dd/mm/yyyy)
5.2.3.5.
Amount due retroactively
Period covered: … ([dd/mm/yyyy] to [dd/mm/yyyy])
Amount: …
Form of payment: …
…
…
5.2.3.6.
Interest (if specified in the decision/court settlement)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.3.7.
Payment in kind (please specify): …
…
…
…
5.2.3.8.
Other form of payment (please specify): …
…
…
…
5.3.
Costs and expenses
The decision/court settlement provides that
… (surname and given name(s))
must pay the sum of …
to: … [surname and given name(s)].
If additional pages have been attached, state the number of pages: …
Done at: … on: … (dd/mm/yyyy)
Signature and/or stamp of the court of origin:
…
ANNEX II
EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF ENFORCEABILITY
(Articles 28 and 75(2) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf7)
IMPORTANT
To be issued by the court of origin
To be issued only if the decision or court settlement is enforceable in the Member State of origin
Mention only information which is given in the decision or court settlement or of which the court of origin has been made aware
1.
NATURE OF THE DOCUMENT
Decision Court settlement Date and reference number: …
2.
COURT OF ORIGIN
2.1.
Name: …
2.2.
Address:
- 2.2.1.
Street and number/PO box: …
- 2.2.2.
Place and postal code: …
- 2.2.3.
Member State
Belgium Bulgaria Czech Republic Denmark Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
2.3.
Telephone/Fax/E-mail: …
3.
3.1.
Person A
3.1.1.
Surname and given name(s): …
3.1.2.
Date (dd/mm/yyyy) and place of birth: …
3.1.3.
Identity number or social security number: …
3.1.4.
Address:
- 3.1.4.1.
Street and number/PO box: …
- 3.1.4.2.
Place and postal code: …
- 3.1.4.3.
Country: …
3.1.5.
Has benefited from
3.1.5.1.
legal aid:
Yes No 3.1.5.2.
exemption from costs and expenses:
Yes No 3.1.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009f10:
Yes No 3.2.
Person B
3.2.1.
Surname and given name(s): …
3.2.2.
Date (dd/mm/yyyy) and place of birth: …
3.2.3.
Identity number or social security number: …
3.2.4.
Address:
- 3.2.4.1.
Street and number/PO box: …
- 3.2.4.2.
Place and postal code: …
- 3.2.4.3.
Country: …
3.2.5.
Has benefited from
3.2.5.1.
legal aid:
Yes No 3.2.5.2.
exemption from costs and expenses:
Yes No 3.2.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009f11:
Yes No 3.3.
Person C
3.3.1.
Surname and given name(s): …
3.3.2.
Date (dd/mm/yyyy) and place of birth: …
3.3.3.
Identity number or social security number: …
3.3.4.
Address:
- 3.3.4.1.
Street and number/PO box: …
- 3.3.4.2.
Place and postal code: …
- 3.3.4.3.
Country: …
3.3.5.
Has benefited from
3.3.5.1.
legal aid:
Yes No 3.3.5.2.
exemption from costs and expenses:
Yes No 3.3.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009f12:
Yes No 4.
4.1.
Person A
4.1.1.
Surname and given name(s): …
4.1.2.
Date (dd/mm/yyyy) and place of birth: …
4.1.3.
Identity number or social security number: …
4.1.4.
Address:
- 4.1.4.1.
Street and number/PO box: …
- 4.1.4.2.
Place and postal code: …
- 4.1.4.3.
Country: …
4.1.5.
Has benefited from
4.1.5.1.
legal aid:
Yes No 4.1.5.2.
exemption from costs and expenses:
Yes No 4.1.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009f15:
Yes No 4.2.
Person B
4.2.1.
Surname and given name(s): …
4.2.2.
Date (dd/mm/yyyy) and place of birth: …
4.2.3.
Identity number or social security number: …
4.2.4.
Address:
- 4.2.4.1.
Street and number/PO box: …
- 4.2.4.2.
Place and postal code: …
- 4.2.4.3.
Country: …
4.2.5.
Has benefited from
4.2.5.1.
legal aid:
Yes No 4.2.5.2.
exemption from costs and expenses:
Yes No 4.2.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009f16:
Yes No 4.3.
Person C
4.3.1.
Surname and given name(s): …
4.3.2.
Date (dd/mm/yyyy) and place of birth: …
4.3.3.
Identity number or social security number: …
4.3.4.
Address:
- 4.3.4.1.
Street and number/PO box: …
- 4.3.4.2.
Place and postal code: …
- 4.3.4.3.
Country: …
4.3.5.
Has benefited from
4.3.5.1.
legal aid:
Yes No 4.3.5.2.
exemption from costs and expenses:
Yes No 4.3.5.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009f17:
Yes No 5.
TERMS OF THE DECISION/COURT SETTLEMENT
5.1.
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Danish krone (DKK) Pound sterling (GBP) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
5.2.
Maintenance claim f18
5.2.1.
Maintenance claim A
5.2.1.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.1.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.1.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.1.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:
…
Indexation applicable as from: … (dd/mm/yyyy)
5.2.1.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.1.6.
Interest (if specified in the decision/court settlement)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.1.7.
Payment in kind (please specify): …
…
…
…
5.2.1.8.
Other form of payment (please specify): …
…
…
…
5.2.2.
Maintenance claim B
5.2.2.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.2.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.2.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.2.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
Indexation applicable as from: … (dd/mm/yyyy)
5.2.2.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.2.6.
Interest (if specified in the decision/court settlement)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.2.7.
Payment in kind (please specify): …
…
…
…
5.2.2.8.
Other form of payment (please specify): …
…
…
…
5.2.3.
Maintenance claim C
5.2.3.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.3.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.3.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.3.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
Indexation applicable as from: … (dd/mm/yyyy)
5.2.3.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.3.6.
Interest (if specified in the decision/court settlement)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.3.7.
Payment in kind (please specify): …
…
…
…
5.2.3.8.
Other form of payment (please specify): …
…
…
…
5.3.
Costs and expenses
The decision/court settlement provides that
… (surname and given name(s))
must pay the sum of …
to: … (surname and given name(s)).
If additional pages have been attached, state the number of pages: …
Done at: … on: … (dd/mm/yyyy)
Signature and/or stamp of the court of origin:
…
ANNEX III
EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS NOT SUBJECT TO PROCEEDINGS FOR RECOGNITION OR A DECLARATION OF ENFORCEABILITY
(Article 48 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf19)
IMPORTANT
To be issued by the competent authority in the Member State of origin
To be issued only if the authentic instrument is enforceable in the Member State of origin
Mention only information which is given in the authentic instrument or of which the competent authority has been made aware
1.
DATE AND REFERENCE NUMBER OF THE AUTHENTIC INSTRUMENT: …
The authentic instrument is recognised and enforceable in another Member State without any possibility of opposing its recognition and without the need for a declaration of enforceability (Article 48 of Regulation (EC) No 4/2009).
2.
NATURE OF THE AUTHENTIC INSTRUMENT
2.1.
Instrument formally drawn up or registered on: … (dd/mm/yyyy)
Agreement concluded or authenticated on: … (dd/mm/yyyy)
2.2.
Competent authority:
- 2.2.1.
Name: …
- 2.2.2.
Address:
- 2.2.2.1.
Street and number/PO box: …
- 2.2.2.2.
Place and postal code: …
- 2.2.2.3.
Member State
X1 Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
- 2.2.3.
Telephone/Fax/E-mail: …
3.
CREDITOR(S)f20
3.1.
Person A
3.1.1.
Surname and given name(s): …
3.1.2.
Date (dd/mm/yyyy) and place of birth: …
3.1.3.
Identity number or social security number: …
3.1.4.
Address:
- 3.1.4.1.
Street and number/PO box: …
- 3.1.4.2.
Place and postal code: …
- 3.1.4.3.
Country: …
3.2.
Person B
3.2.1.
Surname and given name(s): …
3.2.2.
Date (dd/mm/yyyy) and place of birth: …
3.2.3.
Identity number or social security number: …
3.2.4.
Address:
- 3.2.4.1.
Street and number/PO box: …
- 3.2.4.2.
Place and postal code: …
- 3.2.4.3.
Country: …
3.3.
Person C
3.3.1.
Surname and given name(s): …
3.3.2.
Date (dd/mm/yyyy) and place of birth: …
3.3.3.
Identity number or social security number: …
3.3.4.
Address:
- 3.3.4.1.
Street and number/PO box: …
- 3.3.4.2.
Place and postal code: …
- 3.3.4.3.
Country: …
4.
DEBTOR(S)f21
4.1.
Person A
4.1.1.
Surname and given name(s): …
4.1.2.
Date (dd/mm/yyyy) and place of birth: …
4.1.3.
Identity number or social security number: …
4.1.4.
Address:
- 4.1.4.1.
Street and number/PO box: …
- 4.1.4.2.
Place and postal code: …
- 4.1.4.3.
Country: …
4.2.
Person B
4.2.1.
Surname and given name(s): …
4.2.2.
Date (dd/mm/yyyy) and place of birth: …
4.2.3.
Identity number or social security number: …
4.2.4.
Address:
- 4.2.4.1.
Street and number/PO box: …
- 4.2.4.2.
Place and postal code: …
- 4.2.4.3.
Country: …
4.3.
Person C
4.3.1.
Surname and given name(s): …
4.3.2.
Date (dd/mm/yyyy) and place of birth: …
4.3.3.
Identity number or social security number: …
4.3.4.
Address:
- 4.3.4.1.
Street and number/PO box: …
- 4.3.4.2.
Place and postal code: …
- 4.3.4.3.
Country: …
5.
CONTENTS OF THE AUTHENTIC INSTRUMENT
5.1.
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
5.2.
Maintenance claim f22
5.2.1.
Maintenance claim A
5.2.1.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.1.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.1.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.1.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:
…
Indexation applicable as from: … (dd/mm/yyyy)
5.2.1.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.1.6.
Interest (if specified in the authentic instrument)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.1.7.
Payment in kind (please specify): …
…
…
…
5.2.1.8.
Other form of payment (please specify): …
…
…
…
5.2.2.
Maintenance claim B
5.2.2.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.2.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.2.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.2.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:
…
Indexation applicable as from: … (dd/mm/yyyy)
5.2.2.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.2.6.
Interest (if specified in the authentic instrument)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.2.7.
Payment in kind (please specify): …
…
…
…
5.2.2.8.
Other form of payment (please specify): …
…
…
…
5.2.3.
Maintenance claim C
5.2.3.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.3.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.3.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.3.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
Indexation applicable as from: … (dd/mm/yyyy)
5.2.3.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.3.6.
Interest (if specified in the authentic instrument)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.3.7.
Payment in kind (please specify): …
…
…
…
5.2.3.8.
Other form of payment (please specify): …
…
…
…
5.3.
Costs
The authentic instrument provides that
… (surname and given name(s))
must pay the sum of …
to: … (surname and given name(s)).
If additional pages have been attached, state the number of pages: …
Done at: … on: … (dd/mm/yyyy)
Signature and/or stamp of the competent authority:
…
ANNEX IV
EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF ENFORCEABILITY
(Articles 48 and 75(2) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf23)
IMPORTANT
To be issued by the competent authority in the Member State of origin
To be issued only if the authentic instrument is enforceable in the Member State of origin
Mention only information which is given in the authentic instrument or of which the competent authority has been made aware
1.
DATE AND REFERENCE NUMBER OF THE AUTHENTIC INSTRUMENT: …
2.
NATURE OF THE AUTHENTIC INSTRUMENT
2.1.
Instrument formally drawn up or registered on: … (dd/mm/yyyy)
Agreement concluded or authenticated on: … (dd/mm/yyyy)
2.2.
Competent authority:
- 2.2.1.
Name: …
- 2.2.2.
Address:
- 2.2.2.1.
Street and number/PO box: …
- 2.2.2.2.
Place and postal code: …
- 2.2.2.3.
Member State:
Belgium Bulgaria Czech Republic Denmark Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
- 2.2.3.
Telephone/Fax/E-mail: …
3.
CREDITOR(S)f24
3.1.
Person A
3.1.1.
Surname and given name(s): …
3.1.2.
Date (dd/mm/yyyy) and place of birth: …
3.1.3.
Identity number or social security number: …
3.1.4.
Address:
- 3.1.4.1.
Street and number/PO box: …
- 3.1.4.2.
Place and postal code: …
- 3.1.4.3.
Country: …
3.2.
Person B
3.2.1.
Surname and given name(s): …
3.2.2.
Date (dd/mm/yyyy) and place of birth: …
3.2.3.
Identity number or social security number: …
3.2.4.
Address:
- 3.2.4.1.
Street and number/PO box: …
- 3.2.4.2.
Place and postal code: …
- 3.2.4.3.
Country: …
3.3.
Person C
3.3.1.
Surname and given name(s): …
3.3.2.
Date (dd/mm/yyyy) and place of birth: …
3.3.3.
Identity number or social security number: …
3.3.4.
Address:
- 3.3.4.1.
Street and number/PO box: …
- 3.3.4.2.
Place and postal code: …
- 3.3.4.3.
Country: …
4.
DEBTOR(S)f25
4.1.
Person A
4.1.1.
Surname and given name(s): …
4.1.2.
Date (dd/mm/yyyy) and place of birth: …
4.1.3.
Identity number or social security number: …
4.1.4.
Address:
- 4.1.4.1.
Street and number/PO box: …
- 4.1.4.2.
Place and postal code: …
- 4.1.4.3.
Country: …
4.2.
Person B
4.2.1.
Surname and given name(s): …
4.2.2.
Date (dd/mm/yyyy) and place of birth: …
4.2.3.
Identity number or social security number: …
4.2.4.
Address:
- 4.2.4.1.
Street and number/PO box: …
- 4.2.4.2.
Place and postal code: …
- 4.2.4.3.
Country: …
4.3.
Person C
4.3.1.
Surname and given name(s): …
4.3.2.
Date (dd/mm/yyyy) and place of birth: …
4.3.3.
Identity number or social security number: …
4.3.4.
Address:
- 4.3.4.1.
Street and number/PO box: …
- 4.3.4.2.
Place and postal code: …
- 4.3.4.3.
Country: …
5.
CONTENTS OF THE AUTHENTIC INSTRUMENT
5.1.
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Danish krone (DKK) Pound sterling (GBP) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
5.2.
Maintenance claim f26
5.2.1.
Maintenance claim A
5.2.1.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
Person for whom maintenance is owed:
… (surname and given name(s))
5.2.1.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.1.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.1.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
…
Indexation applicable as from: … (dd/mm/yyyy)
5.2.1.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.1.6.
Interest (if specified in the authentic instrument)
If the maintenance claim is subject to interest, please indicate the rate: …
…
Interest due as from: … (dd/mm/yyyy)
5.2.1.7.
Payment in kind (please specify): …
…
…
…
5.2.1.8.
Other form of payment (please specify): …
…
…
…
5.2.2.
Maintenance claim B
5.2.2.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
…
Person for whom maintenance is owed: … (surname and given name(s))
5.2.2.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.2.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.2.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
Indexation applicable as from: … (dd/mm/yyyy)
5.2.2.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.2.6.
Interest (if specified in the authentic instrument)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.2.7.
Payment in kind (please specify): …
…
…
…
5.2.2.8.
Other form of payment (please specify): …
…
…
…
5.2.3.
Maintenance claim C
5.2.3.1.
The maintenance is to be paid
by … (surname and given name(s))
to … (surname and given name(s) of the person to whom the sum must actually be paid)
…
Person for whom maintenance is owed: … (surname and given name(s))
5.2.3.2.
Amount to be paid in one sum
Period covered, where applicable:
…
(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)
Due date: … (dd/mm/yyyy)
Amount: …
5.2.3.3.
Amount to be paid in instalments
Maturity date(dd/mm/yyyy) Amount 5.2.3.4.
Sum to be paid regularly
Once a week
Once a month
Other (state frequency): …
Amount: …
From: … (dd/mm/yyyy)
Due day/date: …
If applicable, until (date (dd/mm/yyyy) or event):
…
If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: …
…
Indexation applicable as from: … (dd/mm/yyyy)
5.2.3.5.
Amount due retroactively
Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy))
Amount: …
Form of payment: …
…
…
5.2.3.6.
Interest (if specified in the authentic instrument)
If the maintenance claim is subject to interest, please indicate the rate: …
Interest due as from: … (dd/mm/yyyy)
5.2.3.7.
Payment in kind (please specify): …
…
…
…
5.2.3.8.
Other form of payment (please specify): …
…
…
…
5.3.
Costs
The authentic instrument provides that
… (surname and given name(s))
must pay the sum of …
to … (surname and given name(s)).
If additional pages have been attached, state the number of pages: …
Done at: … on: … (dd/mm/yyyy)
Signature and/or stamp of the competent authority:
…
ANNEX V
REQUEST FOR SPECIFIC MEASURES
(Article 53 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf27)
PART A
To be completed by the requesting Central Authority
1.
REQUESTING CENTRAL AUTHORITY
1.1.
Name: …
1.2.
Address:
- 1.2.1.
Street and number/PO box: …
- 1.2.2.
Place and postal code: …
- 1.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
1.3.
Telephone: …
1.4.
Fax …
1.5.
E-mail: …
1.6.
Reference number: …
1.7.
Person responsible for following up the request:
- 1.7.1.
Surname and given name(s): …
- 1.7.2.
Telephone: …
- 1.7.3.
E-mail: …
2.
REQUESTED CENTRAL AUTHORITY
2.1.
Name: …
2.2.
Address:
- 2.2.1.
Street and number/PO box: …
- 2.2.2.
Place and postal code: …
- 2.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
3.
REQUEST
3.1.
The purpose of the specific measure requested is to:
- 3.1.1.
help locate the debtor or the creditor (see points 3.3. and 3.4.)
- 3.1.2.
facilitate the search for information on the income or assets of the debtor or the creditor (see points 3.3. and 3.4.)
- 3.1.3.
facilitate the obtaining of documentary or other evidence
- 3.1.4.
obtain assistance in establishing parentage
- 3.1.5.
initiate or facilitate the institution of proceedings to obtain a necessary provisional measure which is territorial in nature
- 3.1.6.
facilitate service of a document
3.2.
Grounds for the request:
…
…
…
…
…
3.3.
The information requested relates to:
3.3.1.
the following debtor
3.3.1.1.
Surname and given name(s): …
3.3.1.2.
Date (dd/mm/yyyy) and place of birthf28: …
3.3.1.3.
Last known address: …
3.3.1.4.
Identity number or social security numberf29: …
3.3.1.5.
Any other information which may be usefulf30:
…
…
3.3.2.
the following creditor
3.3.2.1.
Surname and given name(s): …
3.3.2.2.
Date (dd/mm/yyyy) and place of birthf31: …
3.3.2.3.
Last known address: …
3.3.2.4.
Identity number or social security numberf32: …
3.3.2.5.
Any other information which may be usefulf33:
…
…
3.4.
Information requested
3.4.1.
Current address of the debtor/creditor
3.4.2.
Income of the debtor/creditor
3.4.3.
Assets of the debtor/creditor, including the location of the assets of the debtor/creditor
The creditor has produced a copy of the decision, court settlement or authentic instrument to be enforced, if appropriate accompanied by the relevant form.
Yes No There is a risk that notifying the person concerned by the collection of this information may prejudice the effective recovery of the maintenance claim (Article 63(2) of Regulation (EC) No 4/2009).
Done at …, on … (dd/mm/yyyy)
Name and signature of the authorised official of the requesting Central Authority:
…
PART B
To be completed by the requested Central Authority
4.
REFERENCE NUMBER OF THE REQUESTED CENTRAL AUTHORITY:
5.
PERSON RESPONSIBLE FOR FOLLOWING UP THE REQUEST: …
5.1.
Surname and given name(s): …
5.2.
Telephone: …
5.3.
Fax …
5.4.
E-mail: …
6.
MEASURES TAKEN AND RESULTS OBTAINED
…
…
…
…
7.
INFORMATION COLLECTED:
7.1.
Without recourse to Articles 61, 62 and 63 of Regulation (EC) No 4/2009:
7.1.1.
Debtor’s/creditor’s address:
No Yes (please specify): …
…
7.1.2.
Debtor’s/creditor’s revenue:
No Yes (please specify): …
…
7.1.3.
Debtor’s/creditor’s assets:
No Yes (please specify): …
…
7.2.
Pursuant to Articles 61, 62 and 63 of Regulation (EC) No 4/2009:
7.2.1.
Debtor’s/creditor’s address:
No Yes (please specify): …
…
…
7.2.2.
Existence of debtor’s income:
No Yes 7.2.3.
Existence of debtor’s assets:
No Yes IMPORTANT
(In the event of the application of Articles 61, 62 and 63 of Regulation (EC) No 4/2009)
Except for information merely indicating the existence of an address, income or assets in the requested Member State, the information referred to in Article 61(1) may not be disclosed to the person having applied to the requesting Central Authority, subject to the application of procedural rules before a court (Article 62(2), second subparagraph, of Regulation (EC) No 4/2009).
8.
INABILITY TO COMMUNICATE THE REQUESTED INFORMATION
The requested Central Authority is not able to provide the information requested, for the following reasons:
…
…
…
Done at …, on … (dd/mm/yyyy)
Name and signature of the authorised official of the requested Central Authority:
…
ANNEX VI
APPLICATION FORM WITH A VIEW TO THE RECOGNITION, DECLARATION OF ENFORCEABILITY OR ENFORCEMENT OF A DECISION IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS
(Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf34)
PART A
To be completed by the requesting Central Authority
1.
APPLICATION
Application for recognition or for recognition and declaration of enforceability of a decision (Article 56(1)(a))
Application for recognition of a decision (Article 56(2)(a))
Application for enforcement of a decision given or recognised in the requested Member State (Article 56(1)(b))
2.
REQUESTING CENTRAL AUTHORITY
2.1.
Name: …
2.2.
Address:
- 2.2.1.
Street and number/PO box: …
- 2.2.2.
Place and postal code: …
- 2.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
2.3.
Telephone: …
2.4.
Fax …
2.5.
E-mail: …
2.6.
Reference number of the application: …
Application to be handled with the application(s) bearing the following reference number(s): …
2.7.
Person responsible for following up the application:
- 2.7.1.
Surname and given name(s): …
- 2.7.2.
Telephone: …
- 2.7.3.
E-mail: …
3.
REQUESTED CENTRAL AUTHORITY
3.1.
Name: …
3.2.
Address:
- 3.2.1.
Street and number/PO box: …
- 3.2.2.
Place and postal code: …
- 3.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
4.
DOCUMENTS ATTACHEDf35 TO THE APPLICATION IN THE CASE OF A DECISION MADE IN A MEMBER STATE
A copy of the decision/court settlement/authentic instrument
An extract from the decision/court settlement/authentic instrument using the form set out in Annex I, Annex II, Annex III or Annex IV
A transliteration or translation of the contents of the form set out in Annex I, Annex II, Annex III or Annex IV
Where appropriate, a copy of the decision on the declaration of enforceability
A document showing the amount of any arrears and the date such amount was calculated
A document indicating that the applicant has benefited from legal aid or from exemption from costs and expenses
A document indicating that the applicant has benefited from free proceedings before an administrative authority in the Member State of origin, and confirming that the applicant fulfils the financial requirements to qualify for legal aid or exemption from costs and expenses
A document establishing the right of the public body to apply for reimbursement of benefits paid to the creditor and justifying the payment of such benefits
Other (please specify): …
…
…
…
5.
DOCUMENTS ATTACHEDf36 TO THE APPLICATION IN THE CASE OF A DECISION MADE IN A THIRD STATE
The complete text of the decision.
A summary of or extract from the decision drawn up by the competent authority of the State of origin.
A document stating that the decision is enforceable in the State of origin and, in the case of a decision by an administrative authority, a document stating that the requirements of Article 19(3) of the 2007 Hague Convention are met.
If the defendant did not appear and was not represented in the proceedings in the State of origin, a document or documents attesting, as appropriate, either that the defendant had proper notice of the proceedings and an opportunity to be heard, or that the defendant had proper notice of the decision and the opportunity to challenge it or appeal it in fact and law.
A document showing the amount of any arrears and the date such amount was calculated.
A document providing the information necessary to make appropriate calculations in the case of a decision providing for automatic adjustment by indexation.
A document showing the extent to which the applicant received free legal assistance in the State of origin.
Other (please specify): …
…
…
…
Total number of documents attached to the application form: …
Done at: … on … (dd/mm/yyyy)
Name and signature of the authorised official of the requesting Central Authority: …
PART B
To be completed by the applicant or, as appropriate, by the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf
6.
APPLICATION
6.1.
Application for recognition or for recognition and declaration of enforceability of a decision
The application is based on:
- 6.1.1.
Chapter IV, Section 2, of Regulation (EC) No 4/2009
- 6.1.2.
The 2007 Hague Convention
- 6.1.2.1.
Indicate the basis for recognition and enforcement under Article 20 of the 2007 Hague Convention:
- 6.1.2.2.
The defendant has appeared or been represented in the proceedings in the State of origin:
Yes No - 6.1.3.
The national law of the requested Member State
- 6.1.4.
Other (please specify): …
…
…
6.2.
Application for enforcement of a decision given or recognised in the requested Member State
7.
DECISION
7.1.
Date and reference number: …
7.2.
Name of the court of origin: …
8.
APPLICANT
8.1.
Natural person
8.1.1.
Surname and given name(s): …
8.1.2.
Date (dd/mm/yyyy) and place of birth: …
8.1.3.
Identity number or social security numberf37: …
8.1.4.
Nationality: …
8.1.5.
Occupation: …
8.1.6.
Civil status: …
8.1.7.
Address:
The address given below is the applicant’s personal address.
The applicant is in a situation of family violencef38. The address given below is an address care of: … (surname and given name(s))
8.1.7.1.
Street and number/PO box: …
8.1.7.2.
Place and postal code: …
8.1.7.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
8.1.8.
Telephone/E-mail: …
8.1.9.
Has benefited from:
- 8.1.9.1.
legal aid:
Yes No - 8.1.9.2.
exemption from costs and expenses:
Yes No - 8.1.9.3.
free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:
Yes No 8.1.10.
If applicable, surname, given name(s) and contact details of the applicant’s representative (lawyer, etc. …): …
…
8.2.
Public body:
8.2.1.
Name: …
8.2.2.
Address:
- 8.2.2.1.
Street and number/PO box: …
- 8.2.2.2.
Place and postal code: …
- 8.2.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
8.2.3.
Telephone/Fax/E-mail: …
8.2.4.
Name of the person representing the body in the proceedingsf39:
…
8.2.5.
Person responsible for following up the application:
- 8.2.5.1.
Surname and given name(s): …
- 8.2.5.2.
Telephone: …
- 8.2.5.3.
Fax …
- 8.2.5.4.
E-mail: …
9.
DEFENDANT
9.1.
Surname and given name(s): …
9.2.
Date (dd/mm/yyyy) and place of birthf40: …
9.3.
Identity number or social security numberf41: …
9.4.
Nationalityf42: …
9.5.
Occupationf43: …
9.6.
Civil statusf44: …
9.7.
Addressf45:
9.7.1.
Street and number/PO box: …
9.7.2.
Place and postal code: …
9.7.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
10.
ANY OTHER INFORMATION THAT MAY HELP LOCATE THE DEFENDANT: …
…
…
…
11.
PERSON(S) FOR WHOM MAINTENANCE IS SOUGHT OR OWEDf46
11.1.
The person is the same as the applicant named in point 8
11.2.
The person is the same as the defendant named in point 9
11.3.
The applicant The defendant is the representativef47 defending the interests of the following person(s):
11.3.1.
Person A
11.3.1.1.
Surname and given name(s): …
11.3.1.2.
Date (dd/mm/yyyy) and place of birth: …
11.3.1.3.
Identity number or social security numberf48: …
11.3.1.4.
Nationalityf49: …
11.3.1.5.
Occupationf50: …
11.3.1.6.
Civil statusf51: …
11.3.2.
Person B
11.3.2.1.
Surname and given name(s): …
11.3.2.2.
Date (dd/mm/yyyy) and place of birth: …
11.3.2.3.
Identity number or social security numberf52: …
11.3.2.4.
Nationalityf53: …
11.3.2.5.
Occupationf54: …
11.3.2.6.
Civil statusf55: …
11.3.3.
Person C
11.3.3.1.
Surname and given name(s): …
11.3.3.2.
Date (dd/mm/yyyy) and place of birth: …
11.3.3.3.
Identity number or social security numberf56: …
11.3.3.4.
Nationalityf57: …
11.3.3.5.
Occupationf58: …
11.3.3.6.
Civil statusf59: …
12.
DEBTOR
12.1.
The person is the same as the applicant named in point 8
12.2.
The person is the same as the defendant named in point 9
12.3.
The applicant The defendant is the representativef60 defending the interests of the following person:
13.
INFORMATION REGARDING PAYMENT, IF THE APPLICATION IS MADE BY THE CREDITOR
13.1.
Payment by electronic means
13.1.1.
Name of bank: …
13.1.2.
BIC or other relevant bank code: …
13.1.3.
Account holder: …
13.1.4.
International Bank Account Number (IBAN): …
13.2.
Payment by cheque
13.2.1.
Cheque payable to: …
13.2.2.
Cheque to be sent to
13.2.2.1.
Surname and given name(s): …
13.2.2.2.
Address:
- 13.2.2.2.1.
Street and number/PO box: …
- 13.2.2.2.2.
Place and postal code: …
- 13.2.2.2.3.
Country: …
14.
ADDITIONAL INFORMATION (WHERE APPLICABLE):
…
…
…
Done at: … on … (dd/mm/yyyy)
Applicant’s signature: …
and/or, where appropriate:
Name and signature of the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf:
…
ANNEX VII
APPLICATION FORM TO OBTAIN OR HAVE MODIFIED A DECISION IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS
(Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligationsf65)
PART A
To be completed by the requesting Central Authority
1.
APPLICATION
Application to obtain a decision (Article 56(1)(c))
Application to obtain a decision (Article 56(1)(d))
Application for the modification of a decision (Article 56(1)(e))
Application for the modification of a decision (Article 56(1)(f))
Application for the modification of a decision (Article 56(2)(b))
Application for the modification of a decision (Article 56(2)(c))
2.
REQUESTING CENTRAL AUTHORITY
2.1.
Name: …
2.2.
Address:
- 2.2.1.
Street and number/PO box: …
- 2.2.2.
Place and postal code: …
- 2.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
2.3.
Telephone: …
2.4.
Fax …
2.5.
E-mail: …
2.6.
Reference number of the application: …
Application to be handled with the application(s) bearing the following reference number(s): …
2.7.
Person responsible for following up the application:
- 2.7.1.
Surname and given name(s): …
- 2.7.2.
Telephone: …
- 2.7.3.
E-mail: …
3.
REQUESTED CENTRAL AUTHORITY
3.1.
Name: …
3.2.
Address:
- 3.2.1.
Street and number/PO box: …
- 3.2.2.
Place and postal code: …
- 3.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
4.
DOCUMENTS ATTACHEDf66 TO THE APPLICATION, AS APPROPRIATE
Decision of the requested Member State refusing recognition or a declaration of enforceability
Copy of the decision to be modified
Extract from the decision to be modified
Document(s) proving a change in income or any other change in circumstances
Birth certificate(s) or equivalent
Debtor’s acknowledgement of parentage
Document(s) proving biological parentage
Decision by a competent authority in relation to parentage
Results of genetic tests
Adoption certificate
Certificate of marriage or similar relationship
Document(s) proving the date of divorce/separation
Document(s) proving that the parties live together
Certificate(s) regarding schooling
Document(s) relevant to the financial situation
Other (please specify): …
…
…
…
Total number of documents attached to the application form: …
Done at: … on … (dd/mm/yyyy)
Name and signature of the authorised official of the requesting Central Authority:
…
PART B
To be completed by the applicant or, as appropriate, by the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf
5.
APPLICATION
5.1.
Application to obtain a decision
5.1.1.
Parentage has not been established
5.1.2.
No decision exists
5.1.3.
Recognition and a declaration of enforceability of an existing decision are not possible
5.1.4.
Amount requested:
…
…
…
5.2.
Application for modification of a decision
5.2.1.
The decision was given in the requested Member State
5.2.2.
The decision was given in a State other than the requested Member State
5.2.3.
Date (dd/mm/yyyy) and reference number of the decision: …
5.2.4.
Name of the court of origin: …
5.2.5.
Changes in circumstances which have occurred:
Change in income:
of the person(s) for whom maintenance is sought or owed
of the person primarily responsible for the person(s) for whom maintenance is sought or owed
of the debtor
Change in expenses and charges:
of the person(s) for whom maintenance is sought or owed
of the person primarily responsible for the person(s) for whom maintenance is sought or owed
of the debtor
Change in the situation of the child/children
Change in civil status:
of the person(s) for whom maintenance is sought or owed
of the person primarily responsible for the person(s) for whom maintenance is sought or owed
of the debtor
Other (please specify): …
…
…
5.2.6.
Modification(s) requested:
Increase in the amount of maintenance:
The amount of maintenance should be increased by (please specify): …
The new amount of maintenance should be (please specify):
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Pound sterling (GBP) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
Reduction in the amount of maintenance:
The amount of maintenance should be reduced by (please specify): …
The new amount of maintenance should be (please specify):
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Pound sterling (GBP) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
Modification of the frequency of payments (please specify): …
Modification of the arrangements for payment (please specify): …
Modification of the nature of payments (please specify): …
Termination of the maintenance obligation (please specify): …
Other (please specify): …
…
6.
APPLICANT
6.1.
Surname and given name(s): …
6.2.
Address:
The address given below is the applicant’s personal address.
The applicant is in a situation of family violencef67. The address given below is an address care of: … (surname and given name(s))
6.2.1.
Street and number/PO box: …
6.2.2.
Place and postal code: …
6.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
6.3.
Telephone/E-mail: …
6.4.
Date (dd/mm/yyyy) and place of birth: …
6.5.
Identity number or social security numberf68: …
6.6.
Nationality: …
6.7.
Occupation: …
6.8.
Civil status: …
6.9.
If applicable, surname, given name(s) and contact details of the applicant’s representative (lawyer, etc. …):
…
…
7.
DEFENDANT
7.1.
Surname and given name(s): …
7.2.
Addressf69:
- 7.2.1.
Street and number/PO box: …
- 7.2.2.
Place and postal code: …
- 7.2.3.
Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom
7.3.
Date (dd/mm/yyyy) and place of birthf70: …
7.4.
Identity number or social security numberf71: …
7.5.
Nationalityf72: …
7.6.
Occupationf73: …
7.7.
Civil statusf74: …
8.
ANY OTHER INFORMATION THAT MAY HELP LOCATE THE DEFENDANT:
…
…
…
9.
PERSON(S) FOR WHOM MAINTENANCE IS SOUGHT OR OWEDf75
9.1.
The person is the same as the applicant named in point 6
9.2.
The person is the same as the defendant named in point 7
9.3.
The applicant The defendant is the representativef76 defending the interests of the following person(s):
9.3.1.
Person A
9.3.1.1.
Surname and given name(s): …
9.3.1.2.
Date (dd/mm/yyyy) and place of birth: …
9.3.1.3.
Identity number or social security numberf77: …
9.3.1.4.
Nationalityf78: …
9.3.1.5.
Occupationf79: …
9.3.1.6.
Civil statusf80: …
9.3.1.7.
Maintenance is on the basis of the following relationship:
Parentage (please specify relationship): …
Marriage
Analogous relationship to marriage
Alliance (please specify relationship): …
Other (please specify): …
9.3.2.
Person B
9.3.2.1.
Surname and given name(s): …
9.3.2.2.
Date (dd/mm/yyyy) and place of birth: …
9.3.2.3.
Identity number or social security numberf81: …
9.3.2.4.
Nationalityf82: …
9.3.2.5.
Occupationf83: …
9.3.2.6.
Civil statusf84: …
9.3.2.7.
Maintenance is on the basis of the following relationship:
Parentage (please specify relationship): …
Marriage
Analogous relationship to marriage
Alliance (please specify relationship): …
Other (please specify): …
9.3.3.
Person C
9.3.3.1.
Surname and given name(s): …
9.3.3.2.
Date (dd/mm/yyyy) and place of birth: …
9.3.3.3.
Identity number or social security numberf85: …
9.3.3.4.
Nationalityf86: …
9.3.3.5.
Occupationf87: …
9.3.3.6.
Civil statusf88: …
9.3.3.7.
Maintenance is on the basis of the following relationship:
Parentage (please specify relationship): …
Marriage
Analogous relationship to marriage
Alliance (please specify relationship): …
Other (please specify): …
10.
DEBTOR
10.1.
The person is the same as the applicant named in point 6
10.2.
The person is the same as the defendant named in point 7
10.3.
The applicant The defendant is the representativef89 defending the interests of the following person:
- 10.3.1.
Surname and given name(s): …
- 10.3.2.
Date (dd/mm/yyyy) and place of birth: …
- 10.3.3.
Identity number or social security numberf90: …
- 10.3.4.
Nationalityf91: …
- 10.3.5.
Occupationf92: …
- 10.3.6.
Civil statusf93: …
- 10.3.7.
Maintenance is on the basis of the following relationship:
-
Parentage (please specify relationship): …
-
Marriage
-
Analogous relationship to marriage
-
Alliance (please specify relationship): …
Other (please specify): …
11.
INFORMATION ON THE FINANCIAL SITUATION OF THE PERSONS CONCERNED BY THE APPLICATION (ONLY GIVE INFORMATION WHICH IS RELEVANT FOR THE PURPOSE OF OBTAINING OR MODIFYING A DECISION)
11.1.
Currency
Euro (EUR) Lev (BGN) Czech koruna (CZK) Pound sterling (GBP) Kuna (HRK) Forint (HUF) Zloty (PLN) Leu (RON) Krona (SEK) Other (please specify ISO code): …
11.2.
The person(s) for whom maintenance is sought or owed and the person primarily responsible for that person (those persons)
11.2.1.
Gross income
Monthly Annual Person primarily responsible for the person(s) for whom maintenance is sought or owed Spouse or current partner of the person primarily responsible for the person(s) for whom maintenance is sought or owed Person for whom maintenance is sought or owed(Person A) Person for whom maintenance is sought or owed(Person B) Person for whom maintenance is sought or owed(Person C) Salary (including payments in kind), pensions, disability pensions, maintenance payments, allowances, annuities, unemployment benefits Income from non-salaried occupations Income from securities/floating capital/real property Other sources of income TOTAL 11.2.2.
Expenses and charges
Monthly Annual Person primarily responsible for the person(s) for whom maintenance is sought or owed Spouse or current partner of the person primarily responsible for the person(s) for whom maintenance is sought or owed Person for whom maintenance is sought or owed(Person A) Person for whom maintenance is sought or owed(Person B) Person for whom maintenance is sought or owed(Person C) Taxes Insurance premiums, mandatory social security and professional contributions Rent/cost of co-ownership, mortgage payments Food and clothing Medical expenses Maintenance paid to a third party by virtue of a legal obligation and/or expenditure for other dependent persons not covered by the application Education costs of children Loan repayments, other debts Other expenditure TOTAL 11.2.3.
Other assets
…
…
…
11.3.
The debtor
11.3.1.
Gross income
Monthly Annual Debtor Current spouse or partner of the debtor Salary (including payments in kind), pensions, disability pensions, maintenance payments, allowances, annuities, unemployment benefits Income from non-salaried occupations Income from securities/floating capital/real property Other sources of income TOTAL 11.3.2.
Expenses and charges
Monthly Annual Debtor Current spouse or partner of the debtor Taxes Insurance premiums, mandatory social security and professional contributions Rent/cost of co-ownership, mortgage payments Food and clothing Medical expenses Maintenance paid to a third party by virtue of a legal obligation and/or expenditure for other dependent persons not covered by the application Education costs of children Loan repayments, other debts Other expenditure TOTAL 11.3.3.
Other assets
…
…
…
12.
INFORMATION REGARDING PAYMENT, IF THE APPLICATION IS MADE BY THE CREDITOR
12.1.
Payment by electronic means
12.1.1.
Name of bank: …
12.1.2.
BIC or other relevant bank code: …
12.1.3.
Account holder: …
12.1.4.
International Bank Account Number (IBAN): …
12.2.
Payment by cheque
12.2.1.
Cheque payable to: …
12.2.2.
Cheque to be sent to
12.2.2.1.
Surname and given name(s): …
12.2.2.2.
Address:
- 12.2.2.2.1.
Street and number/PO box: …
- 12.2.2.2.2.
Place and postal code: …
- 12.2.2.2.3.
Country: …
13.
ADDITIONAL INFORMATION (WHERE APPLICABLE):
…
…
…
Done at: … on … (dd/mm/yyyy)
Applicant’s signature: …
and/or, where appropriate:
Name and signature of the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf:
…’
Annotations
Editorial notes
Footnotes
- f1
- f2
-
If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.
- f3
-
If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.
- f4
-
If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.
- f5
-
If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.
- f6
-
If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet.
- f7
- f8
-
If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.
- f9
-
If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.
- f10
-
For Denmark, the administrative authorities listed in the agreement between the European Community and the Kingdom of Denmark on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 251, 21.9.2013, p. 1).
- f11
-
For Denmark, the administrative authorities listed in the agreement between the European Community and the Kingdom of Denmark on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 251, 21.9.2013, p. 1).
- f12
-
For Denmark, the administrative authorities listed in the agreement between the European Community and the Kingdom of Denmark on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 251, 21.9.2013, p. 1).
- f13
-
If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.
- f14
-
If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.
- f15
-
For Denmark, the administrative authorities listed in the agreement between the European Community and the Kingdom of Denmark on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 251, 21.9.2013, p. 1).
- f16
-
For Denmark, the administrative authorities listed in the agreement between the European Community and the Kingdom of Denmark on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 251, 21.9.2013, p. 1).
- f17
-
For Denmark, the administrative authorities listed in the agreement between the European Community and the Kingdom of Denmark on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 251, 21.9.2013, p. 1).
- f18
-
If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet.
- f19
- f20
-
If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.
- f21
-
If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.
- f22
-
If the authentic instrument concerns more than three maintenance claims, attach an additional sheet.
- f23
- f24
-
If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.
- f25
-
If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.
- f26
-
If the authentic instrument concerns more than three maintenance claims, attach an additional sheet.
- f27
- f28
-
If available.
- f29
-
If available.
- f30
-
For example, the name of a previous employer, names and addresses of family members, details of a vehicle or property which the person in question might own.
- f31
-
If available.
- f32
-
If available.
- f33
-
For example, the name of a previous employer, names and addresses of family members, details of a vehicle or property which the person in question might own.
- f34
- f35
-
Tick the relevant boxes and number the documents in the order in which they are attached.
- f36
-
Tick the relevant boxes and number the documents in the order in which they are attached.
- f37
-
If available.
- f38
-
The national law of the requested Member State may, however, require the applicant to provide his/her personal address for the purposes of the proceedings (see Article 57(3) of Regulation (EC) No 4/2009].
- f39
-
If relevant.
- f40
-
If available.
- f41
-
If available.
- f42
-
If available.
- f43
-
If available.
- f44
-
If available.
- f45
-
If available.
- f46
-
If more than three persons, attach an additional sheet.
- f47
-
For example, the person with parental responsibility or the guardian of a protected adult.
- f48
-
If available and/or relevant.
- f49
-
If available and/or relevant.
- f50
-
If available and/or relevant.
- f51
-
If available and/or relevant.
- f52
-
If available and/or relevant.
- f53
-
If available and/or relevant.
- f54
-
If available and/or relevant.
- f55
-
If available and/or relevant.
- f56
-
If available and/or relevant.
- f57
-
If available and/or relevant.
- f58
-
If available and/or relevant.
- f59
-
If available and/or relevant.
- f60
-
For example, the person with parental responsibility or the guardian of a protected adult.
- f61
-
If available.
- f62
-
If available.
- f63
-
If available.
- f64
-
If available.
- f65
- f66
-
Tick the relevant boxes and number the documents in the order in which they are attached.
- f67
-
The national law of the requested Member State may, however, require the applicant to provide his/her personal address for the purposes of the proceedings (see Article 57(3) of Regulation (EC) No 4/2009).
- f68
-
If available.
- f69
-
If available.
- f70
-
If available.
- f71
-
If available.
- f72
-
If available.
- f73
-
If available.
- f74
-
If available.
- f75
-
If more than three persons, attach an additional sheet.
- f76
-
For example the person with parental responsibility or the guardian of a protected adult.
- f77
-
If available and/or relevant.
- f78
-
If available and/or relevant.
- f79
-
If available and/or relevant.
- f80
-
If available and/or relevant.
- f81
-
If available and/or relevant.
- f82
-
If available and/or relevant.
- f83
-
If available and/or relevant.
- f84
-
If available and/or relevant.
- f85
-
If available and/or relevant.
- f86
-
If available and/or relevant.
- f87
-
If available and/or relevant.
- f88
-
If available and/or relevant.
- f89
-
For example the person with parental responsibility or the guardian of a protected adult.
- f90
-
If available.
- f91
-
If available.
- f92
-
If available.
- f93
-
If available.