ANNEX

ANNEX I EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS NOT SUBJECT TO PROCEEDINGS FOR RECOGNITION OR A DECLARATION OF ENFORCEABILITY (Articles 20 and 48 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance 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: … 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) (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: … 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) (4) (5) 4.1. Person A 4.1.1. Surname and given name(s): … 4.1.2. Date (dd/mm/yyyy) and place of birth: … 4.1.3. Identity number or social security number: … 4.1.4. Address: 4.1.4.1. Street and number/PO box: … 4.1.4.2. Place and postal code: … 4.1.4.3. Country: … 4.1.5. Has benefited from 4.1.5.1. legal aid:  Yes  No 4.1.5.2. exemption from costs and expenses:  Yes  No 4.1.5.3. free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:  Yes  No 4.2. Person B 4.2.1. Surname and given name(s): … 4.2.2. Date (dd/mm/yyyy) and place of birth: … 4.2.3. Identity number or social security number: … 4.2.4. Address: 4.2.4.1. Street and number/PO box: … 4.2.4.2. Place and postal code: … 4.2.4.3. Country: … 4.2.5. Has benefited from 4.2.5.1. legal aid:  Yes  No 4.2.5.2. exemption from costs and expenses:  Yes  No 4.2.5.3. free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:  Yes  No 4.3. Person C 4.3.1. Surname and given name(s): … 4.3.2. Date (dd/mm/yyyy) and place of birth: … 4.3.3. Identity number or social security number: … 4.3.4. Address: 4.3.4.1. Street and number/PO box: … 4.3.4.2. Place and postal code: … 4.3.4.3. Country: … 4.3.5. Has benefited from 4.3.5.1. legal aid:  Yes  No 4.3.5.2. exemption from costs and expenses:  Yes  No 4.3.5.3. free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:  Yes  No 5. TERMS OF THE DECISION/COURT SETTLEMENT 5.1. Currency  Euro (EUR)  Lev (BGN)  Czech koruna (CZK)  Kuna (HRK)  Forint (HUF)  Zloty (PLN)  Leu (RON)  Krona (SEK)  Other (please specify ISO code): … 5.2. Maintenance claim (6) 5.2.1. Maintenance claim A 5.2.1.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.1.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.1.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.1.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … … Indexation applicable as from: … (dd/mm/yyyy) 5.2.1.5.  Amount due retroactively Period covered: … ([dd/mm/yyyy] to [dd/mm/yyyy]) Amount: … Form of payment: … … … 5.2.1.6.  Interest (if specified in the decision/court settlement) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.1.7.  Payment in kind (please specify): … … … … 5.2.1.8.  Other form of payment (please specify): … … … … 5.2.2. Maintenance claim B 5.2.2.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.2.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.2.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.2.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.2.5.  Amount due retroactively Period covered: … ([dd/mm/yyyy] to [dd/mm/yyyy]) Amount: … Form of payment: … … … 5.2.2.6.  Interest (if specified in the decision/court settlement) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.2.7.  Payment in kind (please specify): … … … … 5.2.2.8.  Other form of payment (please specify): … … … … 5.2.3. Maintenance claim C 5.2.3.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.3.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.3.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.3.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.3.5.  Amount due retroactively Period covered: … ([dd/mm/yyyy] to [dd/mm/yyyy]) Amount: … Form of payment: … … … 5.2.3.6.  Interest (if specified in the decision/court settlement) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.3.7.  Payment in kind (please specify): … … … … 5.2.3.8.  Other form of payment (please specify): … … … … 5.3. Costs and expenses The decision/court settlement provides that … (surname and given name(s)) must pay the sum of … to: … [surname and given name(s)]. If additional pages have been attached, state the number of pages: … Done at: … on: … (dd/mm/yyyy) Signature and/or stamp of the court of origin: …

ANNEX II EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF ENFORCEABILITY (Articles 28 and 75(2) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (7)) 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) (8) (9) 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 (10):  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 (11):  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 (12):  Yes  No 4. DEFENDANT(S) (13) (14) 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 (15):  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 (16):  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 (17):  Yes  No 5. TERMS OF THE DECISION/COURT SETTLEMENT 5.1. Currency  Euro (EUR)  Lev (BGN)  Czech koruna (CZK)  Danish krone (DKK)  Pound sterling (GBP)  Kuna (HRK)  Forint (HUF)  Zloty (PLN)  Leu (RON)  Krona (SEK)  Other (please specify ISO code): … 5.2. Maintenance claim (18) 5.2.1. Maintenance claim A 5.2.1.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.1.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.1.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.1.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.1.5.  Amount due retroactively Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy)) Amount: … Form of payment: … … … 5.2.1.6.  Interest (if specified in the decision/court settlement) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.1.7.  Payment in kind (please specify): … … … … 5.2.1.8.  Other form of payment (please specify): … … … … 5.2.2. Maintenance claim B 5.2.2.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.2.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.2.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.2.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.2.5.  Amount due retroactively Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy)) Amount: … Form of payment: … … … 5.2.2.6.  Interest (if specified in the decision/court settlement) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.2.7.  Payment in kind (please specify): … … … … 5.2.2.8.  Other form of payment (please specify): … … … … 5.2.3. Maintenance claim C 5.2.3.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.3.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.3.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.3.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.3.5.  Amount due retroactively Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy)) Amount: … Form of payment: … … … 5.2.3.6.  Interest (if specified in the decision/court settlement) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.3.7.  Payment in kind (please specify): … … … … 5.2.3.8.  Other form of payment (please specify): … … … … 5.3. Costs and expenses The decision/court settlement provides that … (surname and given name(s)) must pay the sum of … to: … (surname and given name(s)). If additional pages have been attached, state the number of pages: … Done at: … on: … (dd/mm/yyyy) Signature and/or stamp of the court of origin: …

ANNEX III EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS NOT SUBJECT TO PROCEEDINGS FOR RECOGNITION OR A DECLARATION OF ENFORCEABILITY (Article 48 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (19)) 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  Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Croatia  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Finland  Sweden 2.2.3. Telephone/Fax/E-mail: … 3. CREDITOR(S) (20) 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) (21) 4.1. Person A 4.1.1. Surname and given name(s): … 4.1.2. Date (dd/mm/yyyy) and place of birth: … 4.1.3. Identity number or social security number: … 4.1.4. Address: 4.1.4.1. Street and number/PO box: … 4.1.4.2. Place and postal code: … 4.1.4.3. Country: … 4.2. Person B 4.2.1. Surname and given name(s): … 4.2.2. Date (dd/mm/yyyy) and place of birth: … 4.2.3. Identity number or social security number: … 4.2.4. Address: 4.2.4.1. Street and number/PO box: … 4.2.4.2. Place and postal code: … 4.2.4.3. Country: … 4.3. Person C 4.3.1. Surname and given name(s): … 4.3.2. Date (dd/mm/yyyy) and place of birth: … 4.3.3. Identity number or social security number: … 4.3.4. Address: 4.3.4.1. Street and number/PO box: … 4.3.4.2. Place and postal code: … 4.3.4.3. Country: … 5. CONTENTS OF THE AUTHENTIC INSTRUMENT 5.1. Currency  Euro (EUR)  Lev (BGN)  Czech koruna (CZK)  Kuna (HRK)  Forint (HUF)  Zloty (PLN)  Leu (RON)  Krona (SEK)  Other (please specify ISO code): … 5.2. Maintenance claim (22) 5.2.1. Maintenance claim A 5.2.1.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.1.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.1.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.1.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.1.5.  Amount due retroactively Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy)) Amount: … Form of payment: … … … 5.2.1.6.  Interest (if specified in the authentic instrument) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.1.7.  Payment in kind (please specify): … … … … 5.2.1.8.  Other form of payment (please specify): … … … … 5.2.2. Maintenance claim B 5.2.2.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.2.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.2.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.2.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.2.5.  Amount due retroactively Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy)) Amount: … Form of payment: … … … 5.2.2.6.  Interest (if specified in the authentic instrument) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.2.7.  Payment in kind (please specify): … … … … 5.2.2.8.  Other form of payment (please specify): … … … … 5.2.3. Maintenance claim C 5.2.3.1. The maintenance is to be paid by … (surname and given name(s)) to … (surname and given name(s) of the person to whom the sum must actually be paid) Person for whom maintenance is owed: … (surname and given name(s)) 5.2.3.2.  Amount to be paid in one sum Period covered, where applicable: … (from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event) Due date: … (dd/mm/yyyy) Amount: … 5.2.3.3.  Amount to be paid in instalments Maturity date (dd/mm/yyyy) Amount 5.2.3.4.  Sum to be paid regularly  Once a week  Once a month  Other (state frequency): … Amount: … From: … (dd/mm/yyyy) Due day/date: …  If applicable, until (date (dd/mm/yyyy) or event): … If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated: … Indexation applicable as from: … (dd/mm/yyyy) 5.2.3.5.  Amount due retroactively Period covered: … ((dd/mm/yyyy) to (dd/mm/yyyy)) Amount: … Form of payment: … … … 5.2.3.6.  Interest (if specified in the authentic instrument) If the maintenance claim is subject to interest, please indicate the rate: … Interest due as from: … (dd/mm/yyyy) 5.2.3.7.  Payment in kind (please specify): … … … … 5.2.3.8.  Other form of payment (please specify): … … … … 5.3. Costs The authentic instrument provides that … (surname and given name(s)) must pay the sum of … to: … (surname and given name(s)). If additional pages have been attached, state the number of pages: … Done at: … on: … (dd/mm/yyyy) Signature and/or stamp of the competent authority: …

ANNEX IV EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF ENFORCEABILITY (Articles 48 and 75(2) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (23)) 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) (24) 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) (25) 4.1. Person A 4.1.1. Surname and given name(s): … 4.1.2. Date (dd/mm/yyyy) and place of birth: … 4.1.3. Identity number or social security number: … 4.1.4. Address: 4.1.4.1. Street and number/PO box: … 4.1.4.2. Place and postal code: … 4.1.4.3. Country: … 4.2. Person B 4.2.1. Surname and given name(s): … 4.2.2. Date (dd/mm/yyyy) and place of birth: … 4.2.3. Identity number or social security number: … 4.2.4. Address: 4.2.4.1. Street and number/PO box: … 4.2.4.2. Place and postal code: … 4.2.4.3. Country: … 4.3. Person C 4.3.1. Surname and given name(s): … 4.3.2. Date (dd/mm/yyyy) and place of birth: … 4.3.3. Identity number or social security number: … 4.3.4. Address: 4.3.4.1. Street and number/PO box: … 4.3.4.2. Place and postal code: … 4.3.4.3. Country: … 5. CONTENTS OF THE AUTHENTIC INSTRUMENT 5.1. Currency  Euro (EUR)  Lev (BGN)  Czech koruna (CZK)  Danish krone (DKK)  Pound sterling (GBP)  Kuna (HRK)  Forint (HUF)  Zloty (PLN)  Leu (RON)  Krona (SEK)  Other (please specify ISO code): … 5.2. Maintenance claim (26) 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 obligations (27)) PART A To be completed by the requesting Central Authority 1. REQUESTING CENTRAL AUTHORITY 1.1. Name: … 1.2. Address: 1.2.1. Street and number/PO box: … 1.2.2. Place and postal code: … 1.2.3. Member State  Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Croatia  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden  United Kingdom 1.3. Telephone: … 1.4. Fax … 1.5. E-mail: … 1.6. Reference number: … 1.7. Person responsible for following up the request: 1.7.1. Surname and given name(s): … 1.7.2. Telephone: … 1.7.3. E-mail: … 2. REQUESTED CENTRAL AUTHORITY 2.1. Name: … 2.2. Address: 2.2.1. Street and number/PO box: … 2.2.2. Place and postal code: … 2.2.3. Member State  Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Croatia  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden  United Kingdom 3. REQUEST 3.1. The purpose of the specific measure requested is to: 3.1.1.  help locate the debtor or the creditor (see points 3.3. and 3.4.) 3.1.2.  facilitate the search for information on the income or assets of the debtor or the creditor (see points 3.3. and 3.4.) 3.1.3.  facilitate the obtaining of documentary or other evidence 3.1.4.  obtain assistance in establishing parentage 3.1.5.  initiate or facilitate the institution of proceedings to obtain a necessary provisional measure which is territorial in nature 3.1.6.  facilitate service of a document 3.2. Grounds for the request: … … … … … 3.3. The information requested relates to: 3.3.1.  the following debtor 3.3.1.1. Surname and given name(s): … 3.3.1.2. Date (dd/mm/yyyy) and place of birth (28): … 3.3.1.3. Last known address: … 3.3.1.4. Identity number or social security number (29): … 3.3.1.5. Any other information which may be useful (30): … … 3.3.2.  the following creditor 3.3.2.1. Surname and given name(s): … 3.3.2.2. Date (dd/mm/yyyy) and place of birth (31): … 3.3.2.3. Last known address: … 3.3.2.4. Identity number or social security number (32): … 3.3.2.5. Any other information which may be useful (33): … … 3.4. Information requested 3.4.1.  Current address of the debtor/creditor 3.4.2.  Income of the debtor/creditor 3.4.3.  Assets of the debtor/creditor, including the location of the assets of the debtor/creditor The creditor has produced a copy of the decision, court settlement or authentic instrument to be enforced, if appropriate accompanied by the relevant form.  Yes  No  There is a risk that notifying the person concerned by the collection of this information may prejudice the effective recovery of the maintenance claim (Article 63(2) of Regulation (EC) No 4/2009). Done at …, on … (dd/mm/yyyy) Name and signature of the authorised official of the requesting Central Authority: … PART B To be completed by the requested Central Authority 4. REFERENCE NUMBER OF THE REQUESTED CENTRAL AUTHORITY: 5. PERSON RESPONSIBLE FOR FOLLOWING UP THE REQUEST: … 5.1. Surname and given name(s): … 5.2. Telephone: … 5.3. Fax … 5.4. E-mail: … 6. MEASURES TAKEN AND RESULTS OBTAINED … … … … 7. INFORMATION COLLECTED: 7.1. Without recourse to Articles 61, 62 and 63 of Regulation (EC) No 4/2009: 7.1.1. Debtor’s/creditor’s address:  No  Yes (please specify): … … 7.1.2. Debtor’s/creditor’s revenue:  No  Yes (please specify): … … 7.1.3. Debtor’s/creditor’s assets:  No  Yes (please specify): … … 7.2. Pursuant to Articles 61, 62 and 63 of Regulation (EC) No 4/2009: 7.2.1. Debtor’s/creditor’s address:  No  Yes (please specify): … … … 7.2.2. Existence of debtor’s income:  No  Yes 7.2.3. Existence of debtor’s assets:  No  Yes IMPORTANT (In the event of the application of Articles 61, 62 and 63 of Regulation (EC) No 4/2009) Except for information merely indicating the existence of an address, income or assets in the requested Member State, the information referred to in Article 61(1) may not be disclosed to the person having applied to the requesting Central Authority, subject to the application of procedural rules before a court (Article 62(2), second subparagraph, of Regulation (EC) No 4/2009). 8. INABILITY TO COMMUNICATE THE REQUESTED INFORMATION The requested Central Authority is not able to provide the information requested, for the following reasons: … … … Done at …, on … (dd/mm/yyyy) Name and signature of the authorised official of the requested Central Authority: …

ANNEX VI APPLICATION FORM WITH A VIEW TO THE RECOGNITION, DECLARATION OF ENFORCEABILITY OR ENFORCEMENT OF A DECISION IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS (Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (34)) PART A To be completed by the requesting Central Authority 1. APPLICATION  Application for recognition or for recognition and declaration of enforceability of a decision (Article 56(1)(a))  Application for recognition of a decision (Article 56(2)(a))  Application for enforcement of a decision given or recognised in the requested Member State (Article 56(1)(b)) 2. REQUESTING CENTRAL AUTHORITY 2.1. Name: … 2.2. Address: 2.2.1. Street and number/PO box: … 2.2.2. Place and postal code: … 2.2.3. Member State  Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Croatia  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden  United Kingdom 2.3. Telephone: … 2.4. Fax … 2.5. E-mail: … 2.6. Reference number of the application: … Application to be handled with the application(s) bearing the following reference number(s): … 2.7. Person responsible for following up the application: 2.7.1. Surname and given name(s): … 2.7.2. Telephone: … 2.7.3. E-mail: … 3. REQUESTED CENTRAL AUTHORITY 3.1. Name: … 3.2. Address: 3.2.1. Street and number/PO box: … 3.2.2. Place and postal code: … 3.2.3. Member State  Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Croatia  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden  United Kingdom 4. DOCUMENTS ATTACHED (35) 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 (36) TO THE APPLICATION IN THE CASE OF A DECISION MADE IN A THIRD STATE  The complete text of the decision.  A summary of or extract from the decision drawn up by the competent authority of the State of origin.  A document stating that the decision is enforceable in the State of origin and, in the case of a decision by an administrative authority, a document stating that the requirements of Article 19(3) of the 2007 Hague Convention are met.  If the defendant did not appear and was not represented in the proceedings in the State of origin, a document or documents attesting, as appropriate, either that the defendant had proper notice of the proceedings and an opportunity to be heard, or that the defendant had proper notice of the decision and the opportunity to challenge it or appeal it in fact and law.  A document showing the amount of any arrears and the date such amount was calculated.  A document providing the information necessary to make appropriate calculations in the case of a decision providing for automatic adjustment by indexation.  A document showing the extent to which the applicant received free legal assistance in the State of origin.  Other (please specify): … … … … Total number of documents attached to the application form: … Done at: … on … (dd/mm/yyyy) Name and signature of the authorised official of the requesting Central Authority: … PART B To be completed by the applicant or, as appropriate, by the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf 6. APPLICATION 6.1.  Application for recognition or for recognition and declaration of enforceability of a decision The application is based on: 6.1.1.  Chapter IV, Section 2, of Regulation (EC) No 4/2009 6.1.2.  The 2007 Hague Convention 6.1.2.1. Indicate the basis for recognition and enforcement under Article 20 of the 2007 Hague Convention: 6.1.2.2. The defendant has appeared or been represented in the proceedings in the State of origin: Yes  No  6.1.3.  The national law of the requested Member State 6.1.4.  Other (please specify): … … … 6.2.  Application for enforcement of a decision given or recognised in the requested Member State 7. DECISION 7.1. Date and reference number: … 7.2. Name of the court of origin: … 8. APPLICANT 8.1. Natural person 8.1.1. Surname and given name(s): … 8.1.2. Date (dd/mm/yyyy) and place of birth: … 8.1.3. Identity number or social security number (37): … 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 violence (38). 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 proceedings (39): … 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 birth (40): … 9.3. Identity number or social security number (41): … 9.4. Nationality (42): … 9.5. Occupation (43): … 9.6. Civil status (44): … 9.7. Address (45): 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 OWED (46) 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 (47) 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 (48): … 11.3.1.4. Nationality (49): … 11.3.1.5. Occupation (50): … 11.3.1.6. Civil status (51): … 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 (52): … 11.3.2.4. Nationality (53): … 11.3.2.5. Occupation (54): … 11.3.2.6. Civil status (55): … 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 (56): … 11.3.3.4. Nationality (57): … 11.3.3.5. Occupation (58): … 11.3.3.6. Civil status (59): … 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 (60) 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 (61): … 12.3.4. Nationality (62): … 12.3.5. Occupation (63): … 12.3.6. Civil status (64): … 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: …