Commission Implementing Regulation (EU) 2015/228
of 17 February 2015
replacing Annexes I to VII to Council Regulation (EC) No 4/2009 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations
THE EUROPEAN COMMISSION,
Having regard to the Treaty on the Functioning of the European Union,
Whereas:
Latvia and Lithuania changed currency on 1 January 2014 and 1 January 2015 respectively. Annexes I to IV and VII should be amended accordingly.
In accordance with Article 4 of Protocol No 21 on the position of the United Kingdom and Ireland in respect of the Area of Freedom, Security and Justice, annexed to the Treaty on European Union and the Treaty on the Functioning of the European Union, the United Kingdom has informed the Commission of its wish to take part in the application of Regulation (EC) No 4/2009. References to the United Kingdom must therefore be included in Annexes II and IV to VII.
In accordance with Articles 1 and 2 of Protocol No 22 on the position of Denmark, annexed to the Treaty on European Union and the Treaty on the Functioning of the European Union, Denmark did not take part in the adoption of Regulation (EC) No 4/2009 and is not taking part in the adoption of this Regulation; it is not bound by Regulation (EC) No 4/2009 or by this Regulation, nor is it subject to their application.
Lastly, it is necessary to amend certain sections of Annexes VI and VII to facilitate their application.
For reasons of clarity, therefore, Annexes I to VII of Regulation (EC) No 4/2009 must be replaced,
HAS ADOPTED THIS REGULATION:
Article 1
Annexes I to VII to Regulation (EC) No 4/2009 are replaced by the text in the annex to this Regulation.
Article 2
This Regulation shall enter into force on the twentieth day following its publication in the Official Journal of the European Union.
This Regulation shall be binding in its entirety and directly applicable in the Member States in accordance with the Treaties.
ANNEX
‘ANNEX IEXTRACT 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 obligations7)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.CLAIMANT(S)89
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.DEFENDANT(S)1011
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 claim12
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 IIEXTRACT 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 obligations13)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.CLAIMANT(S)1415
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 4/200916:
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 4/200917:
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 4/200918:
Yes
No
4.DEFENDANT(S)1920
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 4/200921:
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 4/200922:
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 4/200923:
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 claim24
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 IIIEXTRACT 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 obligations25)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)26
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)27
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 claim28
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 IVEXTRACT 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 obligations29)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)30
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)31
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 claim32
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 obligations33)PART ATo 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:
3.4.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 BTo 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 VIAPPLICATION 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 obligations40)PART ATo 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 ATTACHED41 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 ATTACHED42 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 BTo 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 number43: …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 violence44. 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 proceedings45:…
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 birth46: …9.3.
Identity number or social security number47: …9.4.
Nationality48: …9.5.
Occupation49: …9.6.
Civil status50: …9.7.
Address51:9.7.1.
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 OWED52
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 representative53 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 number54: …11.3.1.4.
Nationality55: …11.3.1.5.
Occupation56: …11.3.1.6.
Civil status57: …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 representative66 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 VIIAPPLICATION 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 obligations71)PART ATo 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 ATTACHED72 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 BTo 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 violence73. 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 number74: …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.
Address75:
- 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 birth76: …7.4.
Identity number or social security number77: …7.5.
Nationality78: …7.6.
Occupation79: …7.7.
Civil status80: …8.ANY OTHER INFORMATION THAT MAY HELP LOCATE THE DEFENDANT:
…
…
…
9.PERSON(S) FOR WHOM MAINTENANCE IS SOUGHT OR OWED81
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 representative82 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 number83: …9.3.1.4.
Nationality84: …9.3.1.5.
Occupation85: …9.3.1.6.
Civil status86: …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 number87: …9.3.2.4.
Nationality88: …9.3.2.5.
Occupation89: …9.3.2.6.
Civil status90: …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 number91: …9.3.3.4.
Nationality92: …9.3.3.5.
Occupation93: …9.3.3.6.
Civil status94: …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 representative95 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 number96: …- 10.3.4.
Nationality97: …- 10.3.5.
Occupation98: …- 10.3.6.
Civil status99: …- 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:
…’