Annexes to COM(2005)649 - Jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations - Main contents
Please note
This page contains a limited version of this dossier in the EU Monitor.
| dossier | COM(2005)649 - Jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance ... |
|---|---|
| document | COM(2005)649  |
| date | December 18, 2008 |
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 obligations (1))
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
2.3. Telephone/Fax/E-mail: …
3. Claimant(s) (2) (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: …
Address:
3.1.4.1. Street and number/PO box: …
3.1.4.2. Place and postal code: …
3.1.4.3. Country: …
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 of 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: …
Address:
3.2.4.1. Street and number/PO box: …
3.2.4.2. Place and postal code: …
3.2.4.3. Country: …
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 of 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: …
Address:
3.3.4.1. Street and number/PO box: …
3.3.4.2. Place and postal code: …
3.3.4.3. Country: …
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 of Regulation (EC) No 4/2009:
| | Yes | | No |
4. Defendant(s) (2) (3)
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: …
Address:
4.1.4.1. Street and number/PO box: …
4.1.4.2. Place and postal code: …
4.1.4.3. Country: …
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 of 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: …
Address:
4.2.4.1. Street and number/PO box: …
4.2.4.2. Place and postal code: …
4.2.4.3. Country: …
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 of 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: …
Address:
4.3.4.1. Street and number/PO box: …
4.3.4.2. Place and postal code: …
4.3.4.3. Country: …
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 of Regulation (EC) No 4/2009:
| | Yes | | No |
5. Terms of the decision/court settlement
5.1. Currency
Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Estonian kroon (EEK) Hungarian forint (HUF) Lithuanian litas (LTL) Latvian lats (LVL) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) Other (please specify ISO code): …
5.2. Maintenance claim (4)
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.1.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.2.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.3.4. | | Sum to be paid regularly
|
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:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.
(3) If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.
(4) If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet.
ANNEX II
EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF ENFORCEABILITY
(Article 28 and Article 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 obligations (1))
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
2.3. Telephone/Fax/E-mail: …
3. Claimant(s) (2) (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: …
Address:
3.1.4.1. Street and number/PO box: …
3.1.4.2. Place and postal code: …
3.1.4.3. Country: …
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 of 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: …
Address:
3.2.4.1. Street and number/PO box: …
3.2.4.2. Place and postal code: …
3.2.4.3. Country: …
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 of 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: …
Address:
3.3.4.1. Street and number/PO box: …
3.3.4.2. Place and postal code: …
3.3.4.3. Country: …
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 of Regulation (EC) No 4/2009:
| | Yes | | No |
4. Defendant(s) (2) (3)
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: …
Address:
4.1.4.1. Street and number/PO box: …
4.1.4.2. Place and postal code: …
4.1.4.3. Country: …
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 of 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: …
Address:
4.2.4.1. Street and number/PO box: …
4.2.4.2. Place and postal code: …
4.2.4.3. Country: …
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 of 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: …
Address:
4.3.4.1. Street and number/PO box: …
4.3.4.2. Place and postal code: …
4.3.4.3. Country: …
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 of Regulation (EC) No 4/2009:
| | Yes | | No |
5. Terms of the decision/court settlement
5.1. Currency
Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Estonian kroon (EEK) Hungarian forint (HUF) Lithuanian litas (LTL) Latvian lats (LVL) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) Other (please specify ISO code): …
5.2. Maintenance claim (4)
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.1.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.2.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.3.4. | | Sum to be paid regularly
|
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:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) If the parties are not the claimant or defendant in the decision/court settlement, they should be identified as either the claimant or the defendant without distinction.
(3) If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.
(4) If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet
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 obligations (1))
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
| | Instrument formally drawn up or registered on: … (dd/mm/yyyy) |
| | Agreement concluded or authenticated on: … (dd/mm/yyyy) |
Competent authority:
2.2.1. Name: …
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 Germany Estonia Ireland Greece Spain France 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) (2)
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: …
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: …
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: …
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) (2)
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: …
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: …
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: …
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) Bulgarian lev (BGN) Czech koruna (CZK) Estonian kroon (EEK) Hungarian forint (HUF) Lithuanian litas (LTL) Latvian lats (LVL) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) Other (please specify ISO code): …
5.2. Maintenance claim (3)
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.1.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.2.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.3.4. | | Sum to be paid regularly
|
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
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:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.
(3) If the authentic instrument concerns more than three maintenance claims, attach an additional sheet.
ANNEX IV
EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF ENFORCEABILITY
(Article 48 and Article 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 obligations (1))
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
| | Instrument formally drawn up or registered on: … (dd/mm/yyyy) |
| | Agreement concluded or authenticated on: … (dd/mm/yyyy) |
Competent authority:
2.2.1. Name: …
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 Germany Estonia Ireland Greece Spain France 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) (2)
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: …
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: …
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: …
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) (2)
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: …
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: …
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: …
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) Bulgarian lev (BGN) Czech koruna (CZK) Estonian kroon (EEK) Hungarian forint (HUF) Lithuanian litas (LTL) Latvian lats (LVL) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) Other (please specify ISO code): …
5.2. Maintenance claim (3)
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.1.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.2.4. | | Sum to be paid regularly
|
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 |
| Due date (dd/mm/yyyy) | Amount |
| 5.2.3.4. | | Sum to be paid regularly
|
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
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:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.
(3) If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet.
ANNEX V
(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 obligations (1))
1. Requesting Central Authority
1.1. Name: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
1.3. Telephone: …
1.4. Fax: …
1.5. E-mail: …
1.6. Reference number: …
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
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:
| | the following debtor |
3.3.1.1. Surname and given name(s): …
3.3.1.2. Date (dd/mm/yyyy) and place of birth (2): …
3.3.1.3. Last known address: …
3.3.1.4. Identity number or social security number (2): …
3.3.1.5. Any other information which may be useful (3):
…
…
| | the following creditor |
3.3.2.1. Surname and given name(s): …
3.3.2.2. Date (dd/mm/yyyy) and place of birth (2): …
3.3.2.3. Last known address: …
3.3.2.4. Identity number or social security number (2): …
3.3.2.5. Any other information which may be useful (3):
…
…
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:
…
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 |
(in the case 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:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) If this information is available.
(3) 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.
ANNEX VI
(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 obligations (1))
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
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): …
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
4. Documents attached (2) 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 attached (2) 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 on 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: …
6. Application
| | 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 |
| | 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 number (3): …
8.1.4. Nationality: …
8.1.5. Profession: …
8.1.6. Marital status: …
Address:
8.1.7.1. c/o … (surname and given name(s)) (4)
8.1.7.2. Street and number/PO box: …
8.1.7.3. Place and postal code: …
8.1.7.4. Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
8.1.8. Telephone/E-mail: …
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 IX to Regulation (EC) No 4/2009:
| | Yes | | No |
8.1.10. Where appropriate, surname, given name(s) and details of applicant’s representative (lawyer, etc.): …
…
8.2. Public body
8.2.1. Name: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
8.2.3. Telephone/Fax/E-mail: …
8.2.4. Name of the person representing the body in the proceedings (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 birth (6): …
9.3. Identity number or social security number (6): …
9.4. Nationality (6): …
9.5. Profession (6): …
9.6. Marital status (6): …
Address (6):
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
10. Any other information that may help locate the defendant:
…
…
…
11. Person(s) for whom maintenance is sought or owed (7)
| 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 |
| | The applicant | | The defendant |
is the representative (8) 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 number (9): …
11.3.1.4. Nationality (9): …
11.3.1.5. Profession (9): …
11.3.1.6. Marital status (9): …
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 number (9): …
11.3.2.4. Nationality (9): …
11.3.2.5. Profession (9): …
11.3.2.6. Marital status (9): …
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 number (9): …
11.3.3.4. Nationality (9): …
11.3.3.5. Profession (9): …
11.3.3.6. Marital status (9): …
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 |
| | The applicant | | The defendant |
is the representative (8) defending the interests of the following person:
12.3.1. Surname and given name(s): …
12.3.2. Date (dd/mm/yyyy) and place of birth: …
12.3.3. Identity number or social security number (6): …
12.3.4. Nationality (6): …
12.3.5. Profession (6): …
12.3.6. Marital status (6): …
13. Information regarding payment, if the application is made by the creditor
13.1. Payment by electronic means
13.1.1. Name of the 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: …
Cheque to be sent to
13.2.2.1. Surname and given name(s): …
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)
Signature of applicant: …
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:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) Please put a cross in the boxes which apply and number the documents in the order in which they are attached.
(3) If available.
(4) In cases of family violence (see Article 57(3) of Regulation (EC) No 4/2009).
(5) If relevant.
(6) If this information is available.
(7) If more than three persons, attach an additional sheet.
(8) For example the person with parental responsibility or the guardian of a protected adult.
(9) If this information is available and/or relevant.
ANNEX VII
(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 obligations (1))
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
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): …
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: …
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
4. Documents attached (2) 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:
…
5. Application
| | 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: … … … |
| | 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 marital 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 (please specify): … |
| | Reduction in the amount of maintenance (please specify): … |
| | 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): …
Address:
6.2.1. Care of: … (Surname and given name(s)) (3)
6.2.2. Street and number/PO box: …
6.2.3. Place and postal code: …
6.2.4. Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
6.3. Telephone/E-mail: …
6.4. Date (dd/mm/yyyy) and place of birth: …
6.5. Identity/social security number (4): …
6.6. Nationality: …
6.7. Profession: …
6.8. Current marital 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): …
Address (4):
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 Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
7.3. Date (dd/mm/yyyy) and place of birth (4): …
7.4. Identity/social security number (4): …
7.5. Nationality (4): …
7.6. Profession (4): …
7.7. Current marital status (4): …
8. Any other information that may help locate the defendant:
…
…
…
9. Person(s) for whom maintenance is sought or owed (5)
| 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 |
| | The applicant | | The defendant |
is the representative (6) 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/social security number (7): …
9.3.1.4. Nationality (7): …
9.3.1.5. Profession (7): …
9.3.1.6. Current marital status (7): …
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/social security number (7): …
9.3.2.4. Nationality (7): …
9.3.2.5. Profession (7): …
9.3.2.6. Current marital status (7): …
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/social security number (7): …
9.3.3.4. Nationality (7): …
9.3.3.5. Profession (7): …
9.3.3.6. Current marital status (7): …
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 |
| | The applicant | | The defendant |
is the representative (6) 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/social security number (4): …
10.3.4. Nationality (4): …
10.3.5. Profession (4): …
10.3.6. Current marital status (4): …
10.3.7. Maintenance is on the basis of the following relationship:
| | Parentage (please specify relationship): … |
| | Marriage |
| | Analogous relationship to marriage |
| | Affinity (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) Bulgarian lev (BGN) Czech koruna (CZK) Estonian kroon (EEK) Hungarian forint (HUF) Lithuanian litas (LTL) Latvian lats (LVL) Polish zloty (PLN) Romanian leu (RON) Swedish 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
| 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
| 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
| Debtor | Current spouse or partner of the debtor | ||||
| Salary (including payments in kind), pensions, disability pensions, alimonies, 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
| 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
Payment by electronic means
12.1.1. Name of the bank: …
12.1.2. BIC or other relevant bank code: …
12.1.3. Account holder: …
12.1.4. International Bank Account Number (IBAN): …
Payment by cheque
12.2.1. Cheque payable to: …
Cheque to be sent to
12.2.2.1. Surname and given name(s): …
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)
Signature of applicant: …
and/or, where applicable:
Name and signature of the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf:
…
(1) OJ L 7, 10.1.2009, p. 1.
(2) Please put a cross in the boxes which apply and number the documents in the order in which they are attached.
(3) In cases of domestic violence (see Article 57(3) of Regulation (EC) No 4/2009).
(4) If this information is available.
(5) If more than three persons, attach an additional sheet.
(6) For example, the person with parental responsibility or the guardian of a protected adult.
(7) If this information is available and/or relevant.
ANNEX VIII
ACKNOWLEDGEMENT OF RECEIPT OF AN APPLICATION
(Article 58(3) 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 obligations (1))
This acknowledgement of receipt must be sent within 30 days from the date of receipt of the application.
1. Requesting Central Authority
1.1. Reference number of the requesting Central Authority: …
1.2. Surname and given name(s) of the person responsible for following up the application:
…
2. Requested Central Authority
2.1. Reference number of the requested Central Authority: …
Person responsible for following up the application:
2.2.1. Surname and given name(s): …
2.2.2. Telephone: …
2.2.3. Fax: …
2.2.4. E-mail: …
3. Date received: … (dd/mm/yyyy)
4. Initial steps which have been or will be taken to deal with the application
…
…
…
…
| 5. | | Further necessary documents or information (please specify) |
…
…
…
A status report will be sent within 60 days.
Done at: … on: … (dd/mm/yyyy)
Name and signature of the authorised official of the requested Central Authority:
…
(1) OJ L 7, 10.1.2009, p. 1.
ANNEX IX
(Article 58(8) and (9) 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 obligations (1))
1. Requesting Central Authority
1.1. Reference number of the requesting Central Authority: …
1.2. Surname and given name(s) of the person responsible for following up the application:
…
2. Requested Central Authority
2.1. Reference number of the requested Central Authority: …
Person responsible for following up the application:
2.2.1. Surname and given name(s): …
2.2.2. Telephone: …
2.2.3. Fax: …
2.2.4. E-mail: …
| 3. | | The requested Central Authority refuses to process the application because it is manifest that the required conditions have not been met Reasons (please specify): … … … … … … … |
| 4. | | The requested Central Authority is no longer processing the application because the requesting Central Authority has not supplied the additional information sought by the requested Central Authority within 90 days or a longer period specified by the latter |
Done at: … on: … (dd/mm/yyyy)
Name and signature of the authorised official of the requested Central Authority:
…
(1) OJ L 7, 10.1.2009, p. 1.
ANNEX X
The administrative authorities referred to in Article 2(2) of Regulation (EC) No 4/2009 are as follows:
ANNEX XI
The competent authorities referred to in Article 47(3) of Regulation (EC) No 4/2009 are as follows: