Annex III Declaration specifying reasons and circumstances for a request for precautionary measures

United Kingdom

The elements put in Italic are optional. It is suggested to remove subsections that are not selected.
Where this form is transmitted by electronic means, its structure and lay-out may be adapted to the requirements and possibilities of the electronic communication system, provided that the set of data and information contained therein is not substantially altered.
Name of the language(s) of this document
Declaration specifying reasons and circumstances for a request for precautionary measures^f1 ^f2
based on:	Article 16 of Directive 2010/24/EU …

This declaration is linked to the request for precautionary measures
with the following reference:	Ref. …
sent by the following applicant State:
to the following requested State:

The following information on specific reasons and circumstances for this request is provided:

1. General information
	1.1. The claim(s) is (are) the subject of an instrument permitting enforcement in the applicant State which is contested.
	1.2. The claim(s) is (are) the subject of an instrument permitting enforcement in the applicant State which is not contested.
	1.3. The claim(s) is (are) not yet subject of an instrument permitting enforcement in the applicant State.
	1.4. The claim(s) is (are) not contested.
	1.5. The claim(s) may no longer be contested by and administrative appeal/by an appeal to the courts.
	1.6. The claim(s) is (are) contested but the laws, regulations and administrative practices in force in the State of the applicant authority allow to take precautionary measures.

2. Justifying documents and/or reasons
	2.1. This request is accompanied by a uniform instrument permitting recovery in the requested State. Note: this uniform instrument permitting enforcement in the requested State also allows the requested State to take precautionary measures (for requests based on Directive 2010/24/EU: see the second subparagraph of Article 12(1) of that Directive).
	2.2. This request is based on an administrative decision (attached) permitting precautionary measures in the applicant State, which contains the following evaluation:
		2.2.1. Administrative evaluation of the need to take precautionary measures assessed by:
		name of the authority:
		address of the authority:
		date of this decision:		DD/MM/YYYY
		details contact person:
		2.2.2. Circumstances
			The instrument permitting enforcement is contested.
			The claim(s) is (are) not yet the subject of an instrument permitting enforcement.
			The contesting of the claim(s) by the debtor was already rejected in first instance, but this decision is not final.
		2.2.3. This authority has allowed precautionary measures in the applicant State in accordance with its national law, on the following date:				DD/MM/YYYY
		2.2.4. The precautionary measures are considered to be justified for the following reasons, demonstrating the urgency and the risk that collection and recovery could be thwarted or seriously hindered:
			high (estimated) amount of the (expected) debt/significant debiting
			suspicion of fraud
			Person(s) concerned making themselves insolvent
			restructuring of assets
			alienation of property
			attempt to hide/conceal/dissipate assets
			careless business management
			frequent change of residence
			relocation of property abroad
			debtor not respecting earlier payment agreements
			other elements/reasons: …
		Short explanation (recommended): …
	2.3. This request is based on a judicial confirmation (attached) that precautionary measures are justified:
		2.3.1. Judicial evaluation of the need to take precautionary measures assessed by:
		name of the Court:
		address of the Court:
		date of the decision:			DD/MM/YYYY
		(Details contact person:)
		2.3.2. The Court decided:
			at the unilateral request of the tax authorities
			following the contesting of the claim by the debtor, by another person liable or by another person subject to the precautionary measures
		2.3.3. This Court has allowed precautionary measures in the applicant State in accordance with its national law, on the following date:				DD/MM/YYYY
	2.4. This request for precautionary measures is based on the reasons mentioned in the attached document(s).
	2.5. Precautionary measures are justified for the following reasons, demonstrating the urgency and the risk that collection and recovery could be thwarted or seriously hindered:
		high (estimated) amount of the (expected) debt/significant levels of debt
		Suspicion of fraud
		Person(s) concerned making themselves insolvent
		restructuring of assets
		alienation of property
		attempt to hide/conceal/dissipate assets
		careless business management
		frequent change of residence
		relocation of property abroad
		debtor not respecting earlier payment agreements
		other elements/reasons: …
		Short explanation (recommended): …

3. Other information
	3.1. The authorities of the requested State are requested not to inform the debtor or other person concerned before the start of the precautionary measures.
	3.2. Other information: …

Annotations

Footnotes

f1: The elements put in Italic are optional. It is suggested to remove subsections that are not selected.
f2: Where this form is transmitted by electronic means, its structure and lay-out may be adapted to the requirements and possibilities of the electronic communication system, provided that the set of data and information contained therein is not substantially altered.