Division 1 COMPLETION OF SERVICE (Article 14)

Date and address of service

The document was

1. 1.2.1.

   served in accordance with the law of the Member State addressed, namely

   1. 1.2.1.1.

      handed to ☐

      1. 1.2.1.1.1.

         the addressee in person ☐

      2. 1.2.1.1.2.

         another person ☐

         1. 1.2.1.1.2.1.

            Name:

         2. 1.2.1.1.2.2.

            Address:

            1. 1.2.1.1.2.2.1.

               Street and number/PO box:

            2. 1.2.1.1.2.2.2.

               Place and postcode:

            3. 1.2.1.1.2.2.3.

               Country:

         3. 1.2.1.1.2.3.

            Nature of relationship with the addressee:

            family ☐ employee ☐ other ☐

      3. 1.2.1.1.3.

         the addressee’s address ☐

      4. 1.2.1.1.4.

         another address (please specify) ☐^f1

   2. 1.2.1.2.

      served by postal services ☐

      1. 1.2.1.2.1.

         without acknowledgement of receipt ☐

      2. 1.2.1.2.2.

         with the enclosed acknowledgement of receipt ☐

         1. 1.2.1.2.2.1.

            from the addressee ☐

         2. 1.2.1.2.2.2.

            from another person ☐

         3. 1.2.1.2.2.2.1.

            Name:

         4. 1.2.1.2.2.2.2.

            Address:

            1. 1.2.1.2.2.2.2.1.

               Street and number/PO box:

            2. 1.2.1.2.2.2.2.2.

               Place and postcode:

            3. 1.2.1.2.2.2.2.3.

               Country:

         5. 1.2.1.2.2.2.3.

            Nature of relationship with the addressee:

            family ☐ employee ☐ other ☐

   3. 1.2.1.3.

      served electronically (please state how): ☐

   4. 1.2.1.4.

      served by another method (please state how): ☐

2. 1.2.2.

   served by the following particular method (please state how): ☐

The addressee of the document was informed, in accordance with Article 12(2) of Regulation (EU) 2020/1784, in writing that the addressee may refuse to accept the document if it is not written in or accompanied by a translation into either a language which he or she understands or the official language or one of the official languages of the place of service.