ANNEX I

ATTESTATION CONCERNING A DECISION IN A MATTER OF MATRIMONIAL PROPERTY REGIMES (Article 45(3)(b) of Council Regulation (EU) 2016/1103 implementing enhanced cooperation in thearea of jurisdiction, applicable law and the recognition and enforcement of decisions in matters of matrimonialproperty regimes (1)) 1. Member State of origin (*) Belgium Bulgaria Czech Republic Germany Greece Spain France Croatia Italy Cyprus Luxembourg Malta Netherlands Austria Portugal Slovenia Finland Sweden 2. Court or competent authority issuing the attestation 2.1. Name and designation of court or authority (*): 2.2. Address 2.2.1. Street and number/PO box (*): 2.2.2. Place and postcode (*): 2.3. Telephone (*): 2.4. Fax 2.5. Email: 2.6. Other relevant information (please specify): 3. Court (2) which gave the decision (to be completed ONLY if different from the authority referred to in section 2) 3.1. Name and designation of court (*): 3.2. Address (1) OJ L 183, 8.7.2016, p. 1. (*) Mandatory information. (2) In accordance with Article 3(2) of Council Regulation (EU) 2016/1103, the term ‘court’ includes under certain conditions, in addition to judicial authorities, other authorities and legal professionals with competence in matters of matrimonial property regimes which exercise judicial functions or act pursuant to a delegation of power by a judicial authority or act under the control of a judicial authority. The list of these other authorities and legal professionals is published in the Official Journal of the European Union.

3.2.1. Street and number/PO box (*): 3.2.2. Place and postcode (*): 3.3. Telephone (*): 3.4. Fax: 3.5. Email: 4. Decision 4.1. Date (dd/mm/yyyy) of the decision (*): 4.2. Reference number of the decision (*): 4.3. Parties to the decision 4.3.1. Party A 4.3.1.1. Surname and given name(s) (*): 4.3.1.2. Date (dd/mm/yyyy) and place of birth: 4.3.1.3. Identification number (1) 4.3.1.3.1. Identity number: 4.3.1.3.2. Social security number: 4.3.1.3.3. Other (please specify): 4.3.1.4. Address 4.3.1.4.1. Street and number/PO box: 4.3.1.4.2. Place and postcode: 4.3.1.4.3. Country Belgium Bulgaria Czech Republic Germany Greece Spain France Croatia Italy Cyprus Luxembourg Malta Netherlands Austria Portugal Slovenia Finland Sweden Other (please specify ISO-code): 4.3.1.5. Email: 4.3.1.6. Role in the proceedings (*) (*) Mandatory information. (1) Please indicate the most relevant number if applicable.

4.3.1.6.1. Claimant 4.3.1.6.2. Defendant 4.3.1.6.3. Other (please specify): 4.3.2. Party B 4.3.2.1. Surname and given name(s) (*): 4.3.2.2. Date (dd/mm/yyyy) and place of birth: 4.3.2.3. Identification number (1) 4.3.2.3.1. Identity number: 4.3.2.3.2. Social security number: 4.3.2.3.3. Other (please specify): 4.3.2.4. Address 4.3.2.4.1. Street and number/PO box: 4.3.2.4.2. Place and postcode: 4.3.2.4.3. Country Belgium Bulgaria Czech Republic Germany Greece Spain France Croatia Italy Cyprus Luxembourg Malta Netherlands Austria Portugal Slovenia Finland Sweden Other (please specify ISO-code): 4.3.2.5. Email: 4.3.2.6. Role in the proceedings (*) 4.3.2.6.1. Claimant 4.3.2.6.2. Defendant 4.3.2.6.3. Other (please specify): 4.4. The decision was given in default of appearance (*) 4.4.1. Yes (please indicate the date (dd/mm/yyyy) on which the document instituting the proceedings or the equivalent document was served on the person concerned): 4.4.2. No (*) Mandatory information. (1) Please indicate the most relevant number if applicable.

4.5. Is registration in a public register sought? 4.5.1. Yes 4.5.2. No 4.6. If YES under point 4.5.1, the decision is no longer subject to ordinary appeal, including any appeal to the Court of last instance: 4.6.1. Yes 4.6.2. No 5. Enforceability of the decision 5.1. Is attestation sought for the purpose of enforcement of the decision in another Member State? (*) 5.1.1. Yes 5.1.2. No 5.1.3. Don’t know 5.2. If YES under point 5.1.1, the decision is enforceable in the Member State of origin without any further conditions having to be met (*) 5.2.1. Yes (please specify the enforceable obligation(s)): 5.2.2. Yes, but limited to part(s) of the decision (please specify the enforceable obligation(s)): 5.2.3. The obligation(s) is (are) enforceable against the following person(s): 5.2.3.1. Party A (*) Mandatory information.

5.2.3.2. Party B 5.2.3.3. Other (please specify): 6. Interest 6.1. Is recovery of interest sought? (*) 6.1.1. Yes 6.1.2. No 6.2. If YES under point 6.1.1 (*) 6.2.1. Interest 6.2.1.1. Not specified in the decision 6.2.1.2. Yes, specified in the decision as follows 6.2.1.2.1. Interest due from: (date (dd/mm/yyyy) or event)to: (date (dd/mm/yyyy) or event) (1) 6.2.1.2.2. Final Amount: 6.2.1.2.3. Method to calculate the interest 6.2.1.2.3.1. Rate: % 6.2.1.2.3.2. Rate: % over reference rate (ECB/reference rate of national centralbank: ) in force on: (date (dd/mm/yyyy) or event) 6.2.2. Statutory interest to be calculated in accordance with (please specify relevant statute): 6.2.2.1. Interest due from: (date (dd/mm/yyyy) or event)to: (date (dd/mm/yyyy) or event) (1) 6.2.2.2. Method to calculate the interest 6.2.2.2.1. Rate: % 6.2.2.2.2. Rate: % over reference rate (ECB/reference rate of national central bank: ) in force on: (date (dd/mm/yyyy) or event) 6.2.2.2.2.1. First date of the respective semester in which the debtor is overdue 6.2.2.2.2.2. Other event (please specify): (*) Mandatory information. (1) Add the number of periods necessary if more than one period.

6.2.3. Capitalisation of interest (please specify): 6.2.4. Currency euro (EUR) lev (BGN) Czech koruna (CZK) kuna (HRK) krona (SEK) Other (please specify (ISO code)): 7. Costs or expenses 7.1. Parties having benefited from complete or partial legal aid 7.1.1. Party A 7.1.2. Party B 7.1.3. Other Party (please specify): 7.2. Parties having benefited from exemption from costs or expenses 7.2.1. Party A 7.2.2. Party B 7.2.3. Other Party (please specify): 7.3. Is recovery of costs or expenses sought? (*) 7.3.1. Yes (1) 7.3.2. No 7.4. If YES under point 7.3.1, the following person(s) against whom enforcement is sought has/have been ordered to bear the costs or expenses (*) 7.4.1. Party A 7.4.2. Party B 7.4.3. Other Party (please specify): 7.4.4. If more than one person has to bear the costs or expenses, may the whole amount be collected from any of them? (*) Mandatory information. (1) This point also covers situations where the costs or expenses are awarded in a separate decision.

7.4.4.1. Yes 7.4.4.2. No 7.5. If YES under point 7.3.1, the costs or expenses for which recovery is sought are as follows (in the event that the costs or expenses may be recovered from several persons, insert the breakdown for each person separately) (*) 7.5.1. The costs or expenses have been fixed in the decision by way of a total amount (please specify the amount): 7.5.2. The costs or expenses have been fixed in the decision by way of a percentage of total costs (please specify percentage of total): %. 7.5.3. Liability for the costs or expenses has been determined in the decision and the exact amounts are as follows: 7.5.3.1. Court fees: 7.5.3.2. Lawyers’ fees: 7.5.3.3. Cost of service of documents: 7.5.3.4. Other (please specify): 7.5.4. Other (please specify): 7.6. If YES under point 7.3.1 (*) 7.6.1. Interest on costs or expenses 7.6.1.1. Not specified in the decision 7.6.1.2. Yes, specified in the decision as follows 7.6.1.2.1. Interest due from: (date (dd/mm/yyyy) or event) to: (date (dd/mm/yyyy) or event) (1) 7.6.1.2.2. Final amount: 7.6.1.2.3. Method to calculate the interest 7.6.1.2.3.1. Rate: % 7.6.1.2.3.2. Rate: % over reference rate (ECB/reference rate of national central bank: ) in force on: (date (dd/mm/yyyy) or event) 7.6.2. Statutory interest to be calculated in accordance with (please specify relevant statute): (*) Mandatory information. (1) Add the number of periods necessary if more than one period.