P7_TA(2014)0054

Promoting free movement by simplifying the acceptance of certain public documents ***I

European Parliament legislative resolution of 4 February 2014 on the proposal for a regulation of the European Parliament and of the Council on promoting the free movement of citizens and businesses by simplifying the acceptance of certain public documents in the European Union and amending Regulation (EU) No 1024/2012 (COM(2013)0228 — C7-0111/2013 — 2013/0119(COD))

(Ordinary legislative procedure: first reading)

(2017/C 093/35)

The European Parliament,

having regard to the Commission proposal to Parliament and the Council (COM(2013)0228),

having regard to Article 294(2) and Articles 21(2) and 114(1) of the Treaty on the Functioning of the European Union, pursuant to which the Commission submitted the proposal to Parliament (C7-0111/2013),

having regard to Article 294(3) of the Treaty on the Functioning of the European Union,

having regard to the reasoned opinion submitted, within the framework of Protocol No 2 on the application of the principles of subsidiarity and proportionality, by the Romanian Senate, asserting that the draft legislative act does not comply with the principle of subsidiarity,

having regard to the opinion of the European Economic and Social Committee of 11 July 2013 (1) ,

having regard to Rule 55 of its Rules of Procedure,

having regard to the report of the Committee on Legal Affairs (A7-0017/2014),

Calls on the Commission to refer the matter to Parliament again if it intends to amend its proposal substantially or replace it with another text;

Instructs its President to forward its position to the Council, the Commission and the national parliaments.

(1) OJ C 327, 12.11.2013, p. 52.

P7_TC1-COD(2013)0119

Position of the European Parliament adopted at first reading on 4 February 2014 with a view to the adoption of Regulation (EU) No …/2014 of the European Parliament and of the Council on promoting the free movement of citizens and businesses by simplifying the acceptance of certain public documents in the European Union and amending Regulation (EU) No 1024/2012

THE EUROPEAN PARLIAMENT AND THE COUNCIL OF THE EUROPEAN UNION,

Having regard to the Treaty on the Functioning of the European Union, and in particular Article 21(2) and Article 114(1) thereof,

Having regard to the proposal from the European Commission,

After transmission of the draft legislative act to the national parliaments,

Having regard to the opinion of the Economic and Social Committee (1),

Acting in accordance with the ordinary legislative procedure (2),

Whereas:

(1) The Union has set itself the objective of maintaining and developing an area of freedom, security and justice without internal frontiers, in which the free movement of persons is ensured. The Union has also set itself the objective of establishing and ensuring the functioning of the internal market. In order for Union citizens and companies or other undertakings to enjoy their right to free movement within the internal market, the Union should adopt concrete measures simplifying the existing administrative formalities related to the cross-border acceptance of certain public documents.

(2) Legalisation and Apostille are administrative formalities which must currently be fulfilled in order for a public document issued in one Member State to be used for official purposes in another Member State.

(3) They are outdated and disproportionate mechanisms to establish the authenticity of public documents. A simpler framework should be put in place. At the same time, a more effective mechanism for administrative cooperation between the Member States should be available where there is reasonable doubt as to the authenticity of a public document. That mechanism should strengthen mutual trust between the Member States within the internal market.

(4) The authentication verification of the veracity of public documents between the Member States is governed by various international conventions and agreements. Those conventions and agreements predate the establishment of administrative and judicial cooperation at Union level, including the adoption of sectorial Union law instruments addressing the issue of cross-border acceptance of specific public documents. In any case, the requirements imposed by those instruments can be burdensome for citizens and companies or other undertakings and do not provide for satisfactory solutions for an easier acceptance of public documents between the Member States. [Am. 1]

(5) The scope of this Regulation should cover certain public documents drawn up by authorities of the Member States and having formal evidentiary value relating to birth, death, name, marriage or registered partnership, parenthood, adoption, residence, citizenship, nationality, real estate, legal status and representation of a company or other undertaking, intellectual property rights and absence of a criminal record. Simplification of the acceptance of these categories of public documents between the Member States should bring tangible benefits to Union citizens and companies or other undertakings. Because of their different legal nature, documents drawn up by private persons should be excluded from its scope. Documents drawn up by authorities of third countries should likewise fall outside the scope of this Regulation. The scope of this Regulation should not cover documents that contain an agreement between two or more parties. [Am. 2]

(6) The aim of this This Regulation does not change the substantive law of the Member States relating to birth, death, name, marriage, registered partnership, parenthood, adoption, residence, citizenship or nationality, real estate, various legal facts and the legal status of a company or other undertaking, intellectual property rights or absence of a criminal record natural or legal persons . Documents that contain an agreement between two or more parties should be excluded. [Am. 3]

(7) In order to promote the free movement of citizens and companies or other undertakings in the Union, the identified categories of public documents should be exempted from all forms of legalisation or similar formality apostille .

(8) Other formalities related to the cross-border circulation of public documents, namely the requirement to provide certified copies and certified translations should also be simplified to further facilitate the acceptance of public documents between the Member States.

(9) Appropriate safeguards for the prevention of fraud and forgery of public documents circulating between the Member States should be established in order to ensure legal certainty in the Union . [Am. 4]

(10) In order to allow for fast and secure cross-border information exchanges and to facilitate mutual assistance, this Regulation should establish administrative cooperation between the authorities designated by the Member States. That administrative cooperation should be based on the Internal Market Information System (‘the IMI’), established by Regulation (EU) No 1024/2012 of the European Parliament and of the Council (3).

(11) Regulation (EU) No 1024/2012 should therefore be amended in order to add this Regulation to the list of provisions that are implemented by means of the Internal Market Information System.

(12) The authorities of a Member State in which a public document or its certified copy is presented should have the possibility to submit requests for information to the relevant authorities of the Member State where these documents were issued, either by using the Internal Market Information System directly, or by contacting the central authority of their Member State, when they have reasonable doubt about the authenticity of these documents. The same possibility should be given to entities authorised by virtue of an act or an administrative decision to carry out public duties. The requested authorities should reply to such requests within the shortest possible period of time and in any case not exceeding one month. If the reply of the requested authorities does not confirm the authenticity of the public document or of its certified copy, the requesting authority should not be obliged to accept them.

(13) The authorities should benefit from the available IMI functionalities, including the provision of a multilingual system for communications, the use of pre-translated and standard questions and answers as well as from a repository of templates of public documents used within the internal market.

(14) The central authorities of the Member States should provide assistance in relation to requests for information, in particular to transmit and receive such requests and to supply all the information needed in respect of those requests.

(15) The central authorities should take any other measures necessary to facilitate the application of this Regulation, in particular to exchange best practices concerning the acceptance of public documents between the Member States, to provide and regularly update best practices on the prevention of fraud of public documents and on the promotion of the use of electronic versions of public documents. They should also establish templates of national public documents through the repository in the Internal Market Information System. For this purpose, the European Judicial Network in civil and commercial matters established by Council Decision 2001/470/EC (4) should be used.

(15a) The Commission should, as soon as possible, commence with the translation of the standard wording of public documents in common use in the Member States in order to further facilitate their cross-border circulation. Such translations could then be made available both to the public and to authorities in order to avoid misunderstandings and facilitate communication, in the manner of the PRADO database already in use for identity documents. They will also in many cases speed up the use of the IMI system for communication between central authorities in cases of doubt. [Am. 5]

(16) Union multilingual standard forms should be established in all official languages of the Union for public documents relating to birth, death, marriage, registered partnership and various legal facts and the legal status and representation of a company or other undertaking of natural or legal persons in order to avoid the need for Union citizens and companies or other undertakings to produce translations in cases where they would otherwise be required. [Am. 6]

(17) Union multilingual standard forms should be issued upon request to citizens and companies or other undertakings entitled to receive the equivalent a public documents existing in document issued by the issuing Member State by way of evidence of the particular legal facts and transactions referred to therein, and under the same conditions. The standard forms should have the same formal evidentiary value as the equivalent public documents drawn up by the authorities of the issuing Member State, leaving the choice to Union citizens and companies or other undertakings in each individual case to use them or the equivalent national documents. Union multilingual standard forms should not produce legal effects as regards the recognition of their content in the Member States where they are presented. The Commission should develop detailed guidance on their use, by associating central authorities for that purpose. [Am. 7]

(18) In order to allow for the use of modern communication technologies, the Commission should develop electronic versions of Union multilingual standard forms or other formats suitable for electronic exchanges.

(19) The relation between this Regulation and existing Union law should be clarified. In that regard, this Regulation should not prejudice the application of Union law which contains provisions on legalisation, similar formality apostille or other formalities, but it should complement it. This Regulation should also not prejudice the application of Union law on electronic signatures and electronic identification. Finally, this Regulation should not prejudice the use of other systems of administrative cooperation established by Union law which provide for exchange of information between the Member States in specific areas. This Regulation can be applied in synergy with such specific systems.

(20) Consistency with the general objectives of this Regulation requires that, as between the Member States, it should take precedence over bilateral or multilateral conventions to which the Member States are party and which concern matters covered by it.

(21) To facilitate the application of this Regulation, Member States should provide the Commission with the contact details of their central authorities. That information should be made available to the public in particular through the European Judicial Network in civil and commercial matters.

(21a) As the institutions, bodies, offices and agencies of the Union and the European Schools increasingly also have a direct administrative role to play, they should be equated with the authorities of the Member States for the purpose of issuing and accepting public documents. [Am. 8]

(22) This Regulation respects the fundamental rights and observes the principles recognised by the Charter of Fundamental Rights of the European Union, in particular the right to respect for private and family life (Article 7), the right to the protection of personal data (Article 8), the right to marry and found a family (Article 9), the freedom to choose an occupation and engage in work (Article 15), the freedom to conduct a business (Article 16) and the freedom of movement and of residence (Article 45). This Regulation should be applied in accordance with those rights and principles.

(23) Directive 95/46/EC of the European Parliament and of the Council (5) governs the processing of personal data carried out in the Member States in the context of this Regulation and under the supervision of the public independent authorities designated by the Member States. Any exchange or transmission of information and documents by the Member States authorities should be in accordance with Directive 95/46/EC. Furthermore, such exchanges and transmissions should serve the specific purpose of verifying the authenticity of public documents by authorities through the Internal Market Information System and only within the sphere of their competences in each individual case.

(24) Since the objectives of this Regulation cannot be sufficiently achieved by the Member States and can be better achieved at Union level, the Union may adopt measures in accordance with the principle of subsidiarity as set out in Article 5 of the Treaty on European Union. In accordance with the principle of proportionality, as set out in that Article, this Regulation does not go beyond what is necessary in order to achieve those objectives,

HAVE ADOPTED THIS REGULATION:

Chapter I

Subject matter, scope and definitions

Article 1

Subject matter

This Regulation provides for a dispensation from legalisation or similar formality apostille and for a simplification of other formalities related to the acceptance of certain public documents issued by authorities of the Member States.

It also establishes Union multilingual standard forms concerning birth, death, marriage, registered partnership and legal facts and the legal status and representation of a company or other undertaking of natural or legal persons . [Am. 9]

Article 2

Scope

1. This Regulation applies to the acceptance of public documents which have that are to be presented to the authorities of another Member State. [Am. not concerning all languages]

2. This Regulation does not apply to the recognition of the content of public documents issued by the authorities of other Member States.

Article 3

Definitions

For the purposes of this Regulation:

(1) ‘public documents’ means documents issued by authorities of a Member State or by Union authorities, including Union multilingual standard forms as referred to in Article 11, and having formal evidentiary value relating to: (a) birth the identity of a natural person; (b) death the signature of a natural person; (c) name the civil status and family relationships of a natural person; (d) marriage and registered partnership; (e) parenthood; (f) adoption; (g) residence; (ga) civil rights and electoral rights; (gb) immigration status; (gc) qualifications and records of schooling and further education; (gd) health, including officially recognised disability; (ge) the licence to drive or operate terrestrial, airborne and maritime vehicles; (h) citizenship and nationality; (i) real estate; (j) legal status and representation of a company or other undertaking; (ja) the legal form and representation of other legal persons; (jb) the tax obligations and status of a natural or legal person; (jc) the tax and customs status of assets; (jd) social insurance entitlements of all kinds; (k) intellectual property rights; (l) absence of a criminal record and/or entries in criminal records ; [Am. 11]

(2) ‘authority’ means a public authority of a Member State or an entity authorised by virtue of an act or an administrative decision to carry out public duties , including courts or notaries issuing public documents as referred to in point 1, or a Union authority ; [Am. 12]

(2a) ‘Union authorities’ means institutions, bodies, offices and agencies of the Union and the European Schools; [Am. 13]

(3) ‘legalisation’ means the formal procedure for certifying the authenticity of a public office holder's signature, the capacity in which the person signing the document has acted and, where appropriate, the identity of the seal or stamp which it bears;

(4) ‘similar formality apostille ’ means the addition of the certificate foreseen provided for by the Hague Convention of 1961 abolishing the requirement of legalisation for foreign public documents; [Am. 14. This amendment applies throughout the text]

(5) ‘other formality’ means the issuance of certified copies and certified translations of public documents;

(6) ‘central authority’ means the authority which has been designated in accordance with Article 9 by the Member States to fulfil functions relating to the application of this Regulation.

Chapter II

Exemption from legalisation, simplification of other formalities and requests for information

Article 4

Exemption from legalisation and similar formality apostille

Authorities shall accept public documents shall be exempted from all forms of submitted to them which have been issued by authorities of another Member State or by Union authorities without legalisation and similar formality or an apostille. [Am. 15]

Article 5

Certified copies and originals of public documents

1. Authorities shall not require parallel presentation accept, instead of the original of a public document and of its certified copy issued by the authorities of other Member States or by Union authorities, a certified or uncertified copy thereof . [Am. 16]

2. Where the original If, in an individual case, an authority has reasonable doubts concerning the authenticity of an uncertified copy of a public document issued by the authorities of one another Member State is presented together with its copy, the authorities of the other Member States shall accept such copy without certification or by Union authorities, it may require the original or a certified copy of that document to be submitted, the choice being at the discretion of the person submitting it.

If an uncertified copy of such a public document is submitted with a view to the entry of a legal fact or legal transaction in a public register, for the correctness of which public financial liability exists, the authority concerned may also require the original or a certified copy of that document to be submitted, the choice being at the discretion of the person submitting it, in cases where there is no reasonable doubt concerning the authenticity of the copy. [Am. 17]

3. Authorities shall accept certified copies which were issued in other Member States.

Article 6

Non-certified translations

1. Authorities shall accept non-certified translations of public documents issued by the authorities of other Member States or by Union authorities .

1a. By way of derogation from paragraph 1, authorities may require that specific public documents covered by points (i), (j) and (ja) of point 1 of Article 3, other than Union multilingual standard forms, be submitted together with a certified translation thereof.

2. Where an authority has reasonable doubt as to the correctness or quality of the translation of a public document presented to it in an individual case, it may require commission a certified or official translation of that public document. In such a case, the authority shall accept certified translations established in other Member States. If there are substantial differences between the translation and the certified or official translation commissioned by the authority, i.e. if the translation is incomplete, incomprehensible or misleading, the authority may require the person submitting the document to reimburse the costs of the translation.

2a. Authorities shall accept certified translations produced in other Member States. [Am. 18]

Article 7

Request for information in case of reasonable doubt

1. Where the authorities of a Member State in which a public document or its certified or uncertified copy is presented have , on the basis of a thorough and objective examination, reasonable doubt as to their the authenticity, which cannot be otherwise resolved, of the public document , they may submit a request for information to the relevant authorities of the Member State where these documents were the document was issued, either by using the Internal Market Information System referred to in Article 8 directly, or by contacting the central authority of their Member State. [Am. 19]

2. The reasonable doubt on the basis of a thorough and objective examination referred to in paragraph 1 may relate, in particular, to: [Am. 20]

(a) the authenticity of the signature,

(b) the capacity in which the person signing the document has acted,

(c) the identity of the seal or stamp.

3. Requests for information shall set out the grounds on which they are based in each individual case. Those grounds shall be directly related to the circumstances of the case and shall not rely on general considerations.

4. Requests for information shall be accompanied by a scanned copy of the public document concerned or of its certified copy. The requests and any replies to those requests shall not be subject to any tax, duty or charge. [Am. 21]

5. The authorities shall reply to such requests within the shortest possible period of time and in any case within not exceeding more than one month. The absence of a reply shall be deemed to be confirmation of the authenticity of the public document or of the certified copy thereof. [Am. 22]

6. If the reply of the authorities to the requests for information does not confirm the authenticity of the public document or of its certified copy, the requesting authority shall not be obliged to accept them it or a copy of it . [Am. 23]

Chapter III

Administrative cooperation

Article 8

Internal Market Information System

The Internal Market Information System established by Regulation (EU) No 1024/2012 shall be used for the purposes of Article 7.

The Commission shall ensure that the Internal Market Information System fulfils the technical and personal requirements for the exchange of information referred to in Article 7. [Am. 24]

Article 9

Designation of central authorities

1. Each Member State shall designate at least one central authority.

2. Where a Member State has appointed more than one central authority, it shall designate the central authority to which any communication may be addressed for transmission to the appropriate central authority within that Member State.

3. The designation of the one or more central authorities and their contact details shall be communicated by each Member State to the Commission in accordance with Article 20. [Am. 25]

Article 10

Functions of central authorities

1. The central authorities shall provide assistance in relation to requests for information pursuant to Article 7, and shall in particular:

(a) transmit and receive such requests;

(b) supply all the information needed in respect of those requests.

2. The central authorities shall take any other measures necessary to facilitate the application of this Regulation, and shall in particular:

(a) exchange best practices concerning the acceptance of public documents between the Member States;

(b) provide and regularly update best practices on the prevention of fraud of public documents, certified copies and certified translations;

(c) provide and regularly update best practices on the promotion of the use of electronic versions of public documents;

(d) establish templates of public documents through the repository in the Internal Market Information System.

3. For the purpose of paragraph 2, the European Judicial Network in civil and commercial matters established by Decision 2001/470/EC shall be used.

Chapter IV

Union multilingual standard forms

Article 11

Union multilingual standard forms concerning birth, death, marriage, registered partnership and legal facts and the legal status and representation of a company or other undertaking of natural or legal persons

Union multilingual standard forms concerning birth, death, marriage, registered partnership and legal facts and the legal status and representation of a company or other undertaking of natural or legal persons are hereby established. [Am. 26]

Those Union multilingual standard forms shall be as set out in the Annexes.

Article 12

Issuance of Union multilingual standard forms

1. Union multilingual standard forms shall be made available by the authorities of a Member State to citizens and companies or other undertakings as an alternative to equivalent public documents existing in that Member State.

2. Union multilingual standard forms shall be issued upon request to citizens and companies or other undertakings entitled to receive the equivalent public documents existing in the issuing Member State and under the same conditions. The fee for issuing a Union form must not exceed the fee charged for issuing the corresponding customary public document in the Member State concerned. [Am. 27]

3. The authorities of a Member State shall issue a Union multilingual standard form if an equivalent public document authority exists in that Member State which is in a position to confirm the correctness of the information in question . Union multilingual standard forms shall be issued regardless of the denomination of equivalent public documents in that Member State. [Am. 28]

3a. The Member States shall inform the Commission, with reference to each Union multilingual standard form, which authority is responsible for issuing it. They shall, if appropriate, inform the Commission what forms cannot be issued pursuant to paragraph 3. They shall inform the Commission as soon as any subsequent changes to that information occur.

The Commission shall make the information communicated available to the public in an appropriate manner. [Am. 29]

4. Union multilingual standard forms shall bear their date of issue as well as the signature and seal of the issuing authority.

Article 13

Guidance on the use of Union multilingual standard forms

The Commission shall develop detailed guidance on the use of Union multilingual standard forms and shall associate central authorities for that purpose by the means referred to in Article 10.

Article 14

Electronic versions of Union multilingual standard forms

The Commission shall develop electronic versions of Union multilingual standard forms or other formats suitable for electronic exchanges.

Article 15

Use and acceptance of Union multilingual standard forms

1. Union multilingual standard forms shall have the same formal evidentiary value as the equivalent public documents issued by the authorities of the issuing Member State.

2. Notwithstanding paragraph 1, Union multilingual standard forms shall not produce legal effects as regards the recognition of their content when they are presented in another Member State than the Member State where they were issued. [Am. 30]

3. Union multilingual standard forms shall be accepted by the authorities of the Member States where they are presented without legalisation or similar formality a translation of their contents . [Am. 31]

4. The use of Union multilingual standard forms shall not be mandatory and shall not prejudice the use of equivalent public documents issued by authorities of the issuing Member State, or of other public documents or means of evidence.

Chapter V

Relations with other instruments

Article 16

Relations with other provisions of Union law

1. This Regulation shall not prejudice the application of Union law which contains specific provisions on legalisation, similar formality apostille or other formalities, but shall complement it with reference to individual fields . [Am. 32]

2. This Regulation shall also not prejudice the application of Union law on electronic signatures and electronic identification.

3. This Regulation shall not prejudice the use of other systems of administrative cooperation established by Union law which provide for exchange of information between the Member States in specific areas.

Article 17

Amendment to Regulation (EU) No 1024/2012

In the Annex to Regulation (EU) No 1024/2012, the following point 6 is added:

‘6. Regulation (EU) No …/2014 (*1) of the European Parliament and of the Council of … (+) on promoting the free movement of citizens and businesses by simplifying the acceptance of certain public documents in the European Union and amending Regulation (EU) No 1024/2012: Article 7."

Article 18

Relations with existing international conventions

1. This Regulation shall not affect the application of international conventions to which one or more Member States are party at the time of adoption of this Regulation and which concern matters covered by this Regulation.

2. Notwithstanding paragraph 1, this Regulation shall, as between the Member States, take precedence over conventions concluded by them in so far as such conventions concern matters governed by this Regulation.

Chapter VI

General and final provisions

Article 19

Data protection

The exchange and transmission of information and documents by the Member States pursuant to this Regulation shall serve the specific purpose of making it possible to verify the authenticity of public documents by the authorities through the Internal Market Information System and only within the sphere of their competences in each individual case.

Article 20

Information on central authorities and contact details

1. By … (*2), the Member States shall communicate to the Commission the designation of one or more central authorities and their contact details referred to in Article 9(3). The Member States shall inform the Commission of any subsequent changes to that information. [Am. 33]

2. The Commission shall make all information referred to in paragraph 1 publicly available through any appropriate means, in particular through the European Judicial Network in civil and commercial matters.

Article 21

Review

1. By … (*3), and at the latest every three years thereafter, the Commission shall submit to the European Parliament, the Council and the Economic and Social Committee a report on the application of this Regulation, including an evaluation of any practical experiences relating to the cooperation between central authorities. That report shall also contain an assessment of needs for

(a) extension of the scope of this Regulation to public further documents relating to other categories than defined in Article 3 paragraph 1 points (a) — (l); [Am. 34]

(b) establishment of further Union multilingual standard forms relating to parenthood, adoption, residence, citizenship and nationality, real estate, intellectual property rights and absence of a criminal record; [Am. 35]

(c) in case of extension of the scope referred in point (a), establishment of Union multilingual standard forms relating to other categories of public documents removal of the derogation provided for in Article 6(1a) . [Am. 36]

2. The report shall be accompanied, where appropriate, by proposals for adaptations, in particular as regards the extension of the scope of this Regulation to public documents relating to new categories as referred in paragraph 1 point (a) or the establishment of new Union multilingual standard forms or modification of existing ones, as referred in paragraph 1 points (b) and (c).

Article 22

Entry into force

This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

It shall apply from … (*4), with the exception of Article 20, which shall apply from … (*5).

This Regulation shall be binding in its entirety and directly applicable in all Member States.

Done at For the European Parliament The President For the Council The President

(1) OJ C 327, 12.11.2013, p. 52.

(2) Position of the European Parliament of 4 February 2014.

(3) Regulation (EU) No 1024/2012 of the European Parliament and of the Council of 25 October 2012 on administrative cooperation through the Internal Market Information System and repealing Commission Decision 2008/49/EC (OJ L 316, 14.11.2012, p. 1).

(4) Council Decision 2001/470/EC of 28 May 2001 establishing a European Judicial Network in civil and commercial matters (OJ L 174, 27.6.2001, p. 25).

(5) Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data (OJ L 281, 23.11.1995, p. 319).

(++) OJ reference of the Regulation in procedure 2013/0119(COD).

(+) Number and date of adoption of the Regulation in procedure 2013/0119(COD).

(*2) Six months before the date of application of this Regulation.

(*3) Three years after the date of application of this Regulation.

(*4) One year after the entry into force of this Regulation.

(*5) Six months before the date of application of this Regulation.

Annex I Article 11 of Regulation (EU) [Add number and title of this Regulation]

1 MEMBER STATE 2 ISSUING AUTHORITY 3 EU UNION MULTILINGUAL STANDARD FORM CONCERNING BIRTH 4 DATE AND PLACE OF BIRTH Da Mo Ye 5 NAME 6 FORENAME(S) 7 SEX 8 FATHER 9 MOTHER 5 NAME 6 FORENAME(S) 10 OTHER PARTICULARS OF THE REGISTRATION 11 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, and it shall be used without prejudice to the substantive law of the Member States relating to birth. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann/Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Ženska/Nainen/Kvinnligt — Mar: Marriage/Mariage/Eheschlieβung/брак/Matrimonio/Manželství/Gift/Abielu/Γάμος/Pósadh/Brak/Matrimonio/Laulība/Santuoka/Házasság/Żwieġ/huwelijk/związek małżeński/Casamento/Căsătorie/Manželstvo/Zakonska zveza/Avioliitto/Giftermål — Reg: Registered Partnership/Partenariat enregistré/Eingetragene Partnerschaft/регистрирано партньорство/Unión registrada/Registrované partnerství/Registreret partnerskab/Registreeritud partnerlus/Καταχωρισμένη συμβίωση/Páirtnéireacht Chláraithe/Registrirano partnerstvo/Unione registrata/Reģistrētas partnerattiecības/Registruota partnerystė/Bejegyzett élettársi kapcsolat/Unjoni Rreġistrata/geregistreerd partnerschap/zarejestrowany związek partnerski/Parceria registada/Parteneriat înregistrat/Registrované partnerstvo/Registrirana partnerska skupnost/Rekisteröity parisuhde/Registrerat partnerskap — Ls: Legal separation/Séparation de corps/Trennung ohne Auflösung des Ehebandes/законна раздяла/Separación judicial/Rozluka/Separeret/Lahuselu/Δικαστικός χωρισμός/Scaradh Dlíthiúil/Zakonska rastava/Separazione personale/Laulāto atšķiršana/Gyvenimas skyrium (separacija)/Különválás/Separazzjoni legali/scheiding van tafel en bed/separacja prawna/Separação legal/Separare de drept/Súdna rozluka/Prenehanje življenjske skupnosti/Asumusero/Hemskillnad — Div: Divorce/Divorce/Scheidung/развод/Divorcio/Rozvod/Skilt/Lahutus/Διαζύγιο/Colscaradh/Razvod/Divorzio/Laulības šķiršana/Santuokos nutraukimas/Házasság felbontása/Divorzju/echtscheiding/rozwód/Divórcio/Divorț/Rozvod/Razveza zakonske zveze/Avioero/Skilsmässa — A: Annulment/Annulation/Nichtigerklärung/унищожаване/Anulación/Zrušení/Ophævelse af ægteskab/Tühistamine/Ακύρωση/Neamhniú pósta/Poništenje/Annullamento/Laulības atzīšana par neesošu/Pripažinimas negaliojančia/Érvénytelenítés/Annullament/nietigverklaring/anulowanie/Anulação/Anulare/Anulovanie/Razveljavitev zakonske zveze/Mitätöinti/Annullering — D: Death/Décès/Tod/смърт/Defunción/Úmrtí/Død/Surm/Θάνατος/Bás/Smrt/Decesso/Nāve/Mirtis/Halál/Mewt/overlijden/zgon/Óbito/Deces/Úmrtie/Smrt/Kuolema/Dödsfall — Dh: Death of the husband/Décès du mari/Tod des Ehemanns/смърт на съпруга/Defunción del esposo/Úmrtí manžela/Ægtefælles (mand) død/Abikaasa surm (M)/Θάνατος του συζύγου/Bás an fhir chéile/Smrt supruga/Decesso del marito/Vīra nāve/Vyro mirtis/Férj halála/: Mewt tar-raġel/overlijden van echtgenoot/zgon współmałżonka/Óbito do cônjuge masculino/Decesul soțului/Úmrtie manžela/Smrt moža/Aviomiehen kuolema/Makes dödsfall — Dw: Death of the Wife/Décès de la femme/Tod der Ehefrau/смърт на съпругата/Defunción de la esposa/Úmrtí manželky/Ægtefælles (kone) død/Abikaasa surm (F)/Θάνατος της συζύγου/Bás na mná céile/Smrt supruge/Decesso della moglie/Sievas nāve/Žmonos mirtis/Feleség halála/Mewt tal-mara/overlijden van echtgenote/zgon współmałżonki/Óbito do cônjuge feminino/Decesul soției/Úmrtie manželky/Smrt žene/Vaimon kuolema/Makas dödsfall 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁ/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE CONCERNANT LA NAISSANCE/MEHRSPRACHIGES EU-FORMULAR — GEBURT/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕС ЗА РАЖДАНЕ/FOIRM CHAIGHDEÁNACH ILTEANGACH AN AE MAIDIR LE BREITH/IMPRESO ESTÁNDAR MULTILINGÜE DE LA UE RELATIVO AL NACIMIENTO/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU PRO NAROZENÍ/FLERSPROGET EU-STANDARDFØDSELSATTEST/ELi MITMEKEELNE STANDARDVORM SÜNNI KOHTA/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΤΗΣ ΕΕ ΓΙΑ ΤΗ ΓΕΝΝΗΣΗ/VIŠEJEZIČNI STANDARDNI OBRAZAC EU-a — RODNI LIST/MODULO STANDARD MULTILINGUE DELL'UE RELATIVO ALLA NASCITA/ES DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ DZIMŠANAS FAKTU/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL GIMIMO/TÖBBNYELVŰ UNIÓS FORMANYOMTATVÁNY SZÜLETÉS TEKINTETÉBEN/FORMOLA MULTILINGWA STANDARD TAL-UE DWAR IT-TWELID/MEERTALIG EU-MODELFORMULIER BETREFFENDE GEBOORTE/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY NARODZIN/FORMULÁRIO MULTILINGUE DA UE RELATIVO AO NASCIMENTO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND NAŞTEREA/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA NARODENIA/STANDARDNI VEČJEZIČNI OBRAZEC EU V ZVEZI Z ROJSTVOM/EU:N MONIKIELINEN VAKIOLOMAKE — SYNTYMÄ/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE FÖDELSE 4 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 5 NOM/NAME/ФАМИЛНО ИМЕ/APELLIDO(S)/PŘÍJMENÍ/EFTERNAVN/PEREKONNANIMI/ΕΠΩΝΥΜΟ/SLOINNE/PREZIME/COGNOME/UZVĀRDS/PAVARDĖ/CSALÁDI NÉV/KUNJOM/NAAM/NAZWISKO/APELIDO/NUME/PRIEZVISKO/PRIIMEK/SUKUNIMI/EFTERNAMN 6 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 7 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 8 PÈRE/VATER/БАЩА/PADRE/OTEC/FAR/ISA/ΠΑΤΕΡΑΣ/ATHAIR/OTAC/PADRE/TĒVS/TĖVAS/APA/MISSIER/VADER/OJCIEC/PAI/TATĂL/OTEC/OČE/ISÄ/FADER 9 MÈRE/MUTTER/МАЙКА/MADRE/MATKA/MOR/EMA/ΜΗΤΕΡΑ/MÁTHAIR/MAJKA/MADRE/MĀTE/MOTINA/ANYA/OMM/MOEDER/MATKA/MÃE/MAMA/MATKA/MATI/ÄITI/MODER 10 AUTRES INFORMATIONS FIGURANT DANS L'ACTE/ANDERE ANGABEN AUS DEM EINTRAG/ДРУГИ БЕЛЕЖКИ ВЪВ ВРЪЗКА С РЕГИСТРАЦИЯТА/OTROS DATOS DEL REGISTRO/DALŠÍ ÚDAJE O ZÁPISU/ANDRE BEMÆRKNINGER TIL REGISTRERINGEN/MUU TEAVE/ΑΛΛΑ ΣΤΟΙΧΕΙΑ ΤΗΣ ΚΑΤΑΧΩΡΙΣΗΣ/SONRAÍ EILE A BHAINEANN LEIS AN gCLÁRÚCHÁN/OSTALE INFORMACIJE ZA PRIJAVU/ALTRI ELEMENTI PARTICOLARI DELLA REGISTRAZIONE/CITAS ZIŅAS PAR REĢISTRĀCIJU/KITI REGISTRACIJOS DUOMENYS/EGYÉB ANYAKÖNYVI ADATOK/PARTIKOLARITAJIET OĦRA TAR-REĠISTRAZZJONI/ANDERE BIJZONDERHEDEN VAN DE REGISTRATIE/INNE OKOLICZNOŚCI SZCZEGÓLNE ZWIĄZANE Z REJESTRACJĄ/OUTROS ELEMENTOS PARTICULARES DO REGISTO/ALTE CARACTERISTICI PRIVIND ÎNREGISTRAREA/INÉ OSOBITNÉ ÚDAJE V SÚVISLOSTI S REGISTRÁCIOU/DRUGE POSEBNOSTI PRIJAVE/MUITA REKISTERÖINTIIN LIITTYVIÄ SEIKKOJA/ANDRA UPPGIFTER I REGISTRERINGEN 11 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL

Annex Ia Article 11 of Regulation (EU) No [Add number and title of this Regulation]

1 MEMBER STATE 2 ISSUING AUTHORITY 3 EUROPEAN UNION MULTILINGUAL STANDARD FORM — NAME 4 NAME 5 FORENAME(S) 6 DATE AND PLACE OF BIRTH Da Mo Ye 7 SEX 8 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, but shall be without prejudice to the relevant substantive law of the Member State. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann/Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Ženska/Nainen/Kvinnligt 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁT/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE RELATIF AU NOM/MEHRSPRACHIGES EU-FORMULAR — NAME/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕВРОПЕЙСКИЯ СЪЮЗ ЗА ИМЕ/UE FORMULARIO NORMALIZADO MULTILINGÜE RELATIVO AL NOMBRE/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU TÝKAJÍCÍ SE JMÉNA/FLERSPROGET EU-STANDARDFORMULAR VEDRØRENDE NAVN/NIME PUUDUTAV MITMEKEELNE ELI STANDARDVORM/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΕΕ ΣΧΕΤΙΚΑ ΜΕ ΤΟ ΟΝΟΜΑ/FOIRM CHAIGHDEÁNACH ILTEANGACH AE MAIDIR LE HAINM/VIŠEJEZIČNI STANDARDNI OBRAZAC EUROPSKE UNIJE — IME/MODULO STANDARD MULTILINGUE DELL'UNIONE EUROPEA RELATIVO AL NOME/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL VARDO/PAVARDĖS/EIROPAS SAVIENĪBAS DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ VĀRDU/TÖBBNYELVŰ EURÓPAI UNIÓS FORMANYOMTATVÁNY NÉV TEKINTETÉBEN/FORMOLA STANDARD MULTILINGWALI TAL-UE DWAR L-ISEM/MEERTALIG MODELFORMULIER VAN DE EUROPESE UNIE BETREFFENDE NAAM/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY NAZWISKA/FORMULÁRIO MULTILINGUE NORMALIZADO DA UE RELATIVO AO NOME/FORMULAR STANDARD MULTILINGV AL UE PRIVIND NUMELE/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA MENA/VEČJEZIČNI STANDARDNI OBRAZEC EU O IMENU/EU:N MONIKIELINEN VAKIOLOMAKE — NIMI/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE NAMN 4 NOM/NAME/ФАМИЛНО ИМЕ/APELLIDO(S)/PŘÍJMENÍ/EFTERNAVN/PEREKONNANIMI/ΕΠΩΝΥΜΟ/SLOINNE/PREZIME/COGNOME/UZVĀRDS/PAVARDĖ/CSALÁDI NÉV/KUNJOM/NAAM/NAZWISKO/APELIDO/NUME/PRIEZVISKO/PRIIMEK/SUKUNIMI/EFTERNAMN 5 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 6 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 7 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 8 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL [Am. 37]

Annex Ib Article 11 of Regulation (EU) No [Add number and title of this Regulation]

1 MEMBER STATE 2 ISSUING AUTHORITY 3 EUROPEAN UNION MULTILINGUAL STANDARD FORM — DESCENT 4 NAME 5 FORENAME(S) 6 DATE AND PLACE OF BIRTH Da Mo Ye 7 SEX 8 PARENT 1 9 PARENT 2 4 SURNAME 5 FORENAME(S) 10 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, but shall be without prejudice to the relevant substantive law of the Member State. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann/Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Ženska/Nainen/Kvinnligt 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁT/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/NADLEŽNO TIJELO ZA IZDAVANJE/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE RELATIF À LA FILIATION/MEHRSPRACHIGES EU-FORMULAR — ABSTAMMUNG/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕВРОПЕЙСКИЯ СЪЮЗ ЗА РОДСТВО/UE FORMULARIO NORMALIZADO MULTILINGÜE RELATIVO A LA FILIACIÓN/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU TÝKAJÍCÍ SE PŮVODU/FLERSPROGET EU-STANDARDFORMULAR VEDRØRENDE AFSTAMNING/PÕLVNEMIST PUUDUTAV MITMEKEELNE ELI STANDARDVORM/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΕΕ ΣΧΕΤΙΚΑ ΜΕ ΤΟΥΣ ΑΠΟΓΟΝΟΥΣ/FOIRM CHAIGHDEÁNACH ILTEANGACH AE MAIDIR LE GINEALACH/VIŠEJEZIČNI STANDARDNI OBRAZAC EUROPSKE UNIJE — PODRIJETLO/MODULO STANDARD MULTILINGUE DELL'UNIONE EUROPEA RELATIVO ALLA FILIAZIONE/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL PAVELDĖJIMO/EIROPAS SAVIENĪBAS DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ IZCELSMI/TÖBBNYELVŰ EURÓPAI UNIÓS FORMANYOMTATVÁNY SZÁRMAZÁS TEKINTETÉBEN/FORMOLA STANDARD MULTILINGWALI TAL-UE DWAR ID-DIXXENDENZA/MEERTALIG MODELFORMULIER VAN DE EUROPESE UNIE BETREFFENDE AFSTAMMING/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY RODZICÓW/FORMULÁRIO MULTILINGUE NORMALIZADO DA UE RELATIVO À FILIAÇÃO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND FILIAŢIA/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA RODOVÉHO PÔVODU/VEČJEZIČNI STANDARDNI OBRAZEC EU O POREKLU/EU:N MONIKIELINEN VAKIOLOMAKE — SYNTYPERÄ/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE SLÄKTSKAP 4 NOM/NAME/ФАМИЛНО ИМЕ/APELLIDO(S)/PŘÍJMENÍ/EFTERNAVN/PEREKONNANIMI/ΕΠΩΝΥΜΟ/SLOINNE/PREZIME/COGNOME/UZVĀRDS/PAVARDĖ/CSALÁDI NÉV/KUNJOM/NAAM/NAZWISKO/APELIDO/NUME/PRIEZVISKO/PRIIMEK/SUKUNIMI/EFTERNAMN 5 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 6 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 7 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 8 PARENT 1/ELTERNTEIL 1/РОДИТЕЛ 1/PADRE 1/RODIČ 1/FORÆLDER 1/1. VANEM/ΓΟΝΕΑΣ 1/TUISMITHEOIR 1/RODITELJ 1/GENITORE 1/TĖVAS/MOTINA 1/1. VECĀKS/1. SZÜLŐ/ĠENITUR 1/OUDER 1/PRZYSPOSABIAJĄCY 1/PROGENITOR 1/PĂRINTE 1/RODIČ 1/STARŠ 1/VANHEMPI 1/FÖRÄLDER 1 9 PARENT 2/ELTERNTEIL 2/РОДИТЕЛ 2/PADRE 2/RODIČ 2/FORÆLDER 2/2. VANEM/ΓΟΝΕΑΣ 2/TUISMITHEOIR 2/RODITELJ 2/GENITORE 2/TĖVAS/MOTINA 2/2. VECĀKS/2. SZÜLŐ/ĠENITUR 2/OUDER 2/PRZYSPOSABIAJĄCY 2/PROGENITOR 2/PĂRINTE 2/RODIČ 2/STARŠ 2/VANHEMPI 2/FÖRÄLDER 2 10 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL [Am. 38]

Annex Ic Article 11 of Regulation (EU) No [Add number and title of this Regulation]

1 MEMBER STATE 2 ISSUING AUTHORITY 3 EUROPEAN UNION MULTILINGUAL STANDARD FORM — ADOPTION 4 DATE AND PLACE OF ADOPTION Da Mo Ye 5 NAME 6 FORENAME(S) 7 DATE AND PLACE OF BIRTH Da Mo Ye 8 SEX 9 PARENT 1 10 PARENT 2 5 SURNAME 6 FORENAME(S) 11 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, but shall be without prejudice to the relevant substantive law of the Member State. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann/Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Žensa/Nainen/Kvinnligt 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁT/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE RELATIF À L'ADOPTION/MEHRSPRACHIGES EU-FORMULAR — ADOPTION/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕВРОПЕЙСКИЯ СЪЮЗ ЗА ОСИНОВЯВАНЕ/UE FORMULARIO NORMALIZADO MULTILINGÜE RELATIVO A LA ADOPCIÓN/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU TÝKAJÍCÍ SE ADOPCE/FLERSPROGET EU-STANDARDFORMULAR VEDRØRENDE ADOPTION/LAPSENDAMIST PUUDUTAV MITMEKEELNE EL STANDARDVORM/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΕΕ ΣΧΕΤΙΚΑ ΜΕ ΤΗΝ ΥΙΟΘΕΣΙΑ/FOIRM CHAIGHDEÁNACH ILTEANGACH AE MAIDIR LE HUCHTÚ/VIŠEJEZIČNI STANDARDNI OBRAZAC EUROPSKE UNIJE — POSVOJENJE/MODULO STANDARD MULTILINGUE DELL'UNIONE EUROPEA RELATIVO ALL'ADOZIONE/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL ĮVAIKINIMO/EIROPAS SAVIENĪBAS DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ ADOPCIJU/TÖBBNYELVŰ EURÓPAI UNIÓS FORMANYOMTATVÁNY ÖRÖKBEFOGADÁS TEKINTETÉBEN/FORMOLA STANDARD MULTILINGWALI TAL-UE DWAR L-ADOZZJONI/MEERTALIG MODELFORMULIER VAN DE EUROPESE UNIE BETREFFENDE ADOPTIE/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY PRZYSPOSOBIENIA/FORMULÁRIO MULTILINGUE NORMALIZADO DA UE RELATIVO À ADOÇÃO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND ADOPŢIA/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA ADOPCIE/VEČJEZIČNI STANDARDNI OBRAZEC EU O POSVOJITVI/EU:N MONIKIELINEN VAKIOLOMAKE — LAPSEKSI OTTAMINEN/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE ADOPTION 4 DATE ET LIEU DE L'ADOPTION/TAG UND ORT DER ADOPTION/ДАТА И МЯСТО ДА ОСИНОВЯВАНЕ/FECHA Y LUGAR DE LA ADOPCIÓN/DATUM A MÍSTO ADOPCE/DATO OG STED FOR ADOPTIONEN/LAPSENDAMISE KUUPÄEV JA KOHT/HΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΥΙΟΘΕΣΙΑΣ/DÁTA AGUS ÁIT AN UCHTAITHE/DATUM I MJESTO POSVOJENJA/DATA E LUOGO DELL'ADOZIONE/ĮVAIKINIMO DATA IR VIETA/ADOPCIJAS DATUMS UN VIETA/ÖRÖKBEFOGADÁS IDEJE ÉS HELYE/DATA U POST TAL-ADOZZJONI/DATUM EN PLAATS VAN ADOPTIE/DATA I MIEJSCE PRZYSPOSOBIENIA/DATA E LOCAL DA ADOÇÃO/DATA ŞI LOCUL ADOPŢIEI/DÁTUM A MIESTO ADOPCIE/DATUM IN KRAJ POSVOJITVE/LAPSEKSI OTTAMISEN AIKA JA PAIKKA/DATUM OCH ORT FÖR ADOPTION 5 NOM/NAME/ФАМИЛНО ИМЕ/APELLIDO(S)/PŘÍJMENÍ/EFTERNAVN/PEREKONNANIMI/ΕΠΩΝΥΜΟ/SLOINNE/PREZIME/COGNOME/UZVĀRDS/PAVARDĖ/CSALÁDI NÉV/KUNJOM/NAAM/NAZWISKO/APELIDO/NUME/PRIEZVISKO/PRIIMEK/SUKUNIMI/EFTERNAMN 6 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 7 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 8 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 9 PARENT 1/ELTERNTEIL 1/РОДИТЕЛ 1/PADRE 1/RODIČ 1/FORÆLDER 1/1. VANEM/ΓΟΝΕΑΣ 1/TUISMITHEOIR 1/ RODITELJ 1 /GENITORE 1/TĖVAS/MOTINA 1/1. VECĀKS/1. SZÜLŐ/ĠENITUR 1/OUDER 1/PRZYSPOSABIAJĄCY 1/PROGENITOR 1/PĂRINTE 1/RODIČ 1/STARŠ 1/VANHEMPI 1/FÖRÄLDER 1 10 PARENT 2/ELTERNTEIL 2/РОДИТЕЛ 2/PADRE 2/RODIČ 2/FORÆLDER 2/2. VANEM/ΓΟΝΕΑΣ 2/TUISMITHEOIR 2/RODITELJ 2/GENITORE 2/TĖVAS/MOTINA 2/2. VECĀKS/2. SZÜLŐ/ĠENITUR 2/OUDER 2/PRZYSPOSABIAJĄCY 2/PROGENITOR 2/PĂRINTE 2/RODIČ 2/STARŠ 2/VANHEMPI 2/FÖRÄLDER 2 11 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL [Am. 39]

Annex II Article 11 of Regulation (EU) [Add number and title of this Regulation]

1 MEMBER STATE 2 ISSUING AUTHORITY 3 EU MULTILINGUAL STANDARD FORM CONCERNING DEATH 4 DATE AND PLACE OF DEATH Da Mo Ye 5 NAME 6 FORENAME(S) 7 SEX 8 DATE AND PLACE OF BIRTH Da Mo Ye 9 NAME OF THE LAST SPOUSE 10 FORENAME(S) OF THE LAST SPOUSE 12 FATHER 13 MOTHER 5 SURNAME 6 FORENAME(S) 11 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State. and it shall be used without prejudice to the substantive law of the Member States relating to death. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann/Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Ženska/Nainen/Kvinnligt 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁ/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE CONCERNANT LE DÉCÈS/MEHRSPRACHIGES EU-FORMULAR — TOD/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕС ЗА СМЪРТ/IMPRESO ESTÁNDAR MULTILINGÜE DE LA UE RELATIVO A LA DEFUNCIÓN/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU PRO ÚMRTÍ/FLERSPROGET EU-STANDARDDØDSATTEST/ELi MITMEKEELNE STANDARDVORM SURMA KOHTA/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΤΗΣ ΕΕ ΓΙΑ ΤΟΝ ΘΑΝΑΤΟ/FOIRM CHAIGHDEÁNACH ILTEANGACH AN AE MAIDIR LE BÁS/VIŠEJEZIČNI STANDARDNI OBRAZAC EU-a KOJI SE ODNOSI NA SMRT/MODULO STANDARD MULTILINGUE DELL'UE RELATIVO AL DECESSO/ES DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ MIRŠANAS FAKTU/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL MIRTIES/TÖBBNYELVŰ UNIÓS FORMANYOMTATVÁNY HALÁLESET TEKINTETÉBEN/FORMOLA MULTILINGWA STANDARD TAL-UE DWAR MEWT/MEERTALIG EU-MODELFORMULIER BETREFFENDE OVERLIJDEN/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY ZGONU/FORMULÁRIO MULTILINGUE DA UE RELATIVO AO ÓBITO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND DECESUL/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA ÚMRTIA/STANDARDNI VEČJEZIČNI OBRAZEC EU V ZVEZI S SMRTJO/EU:N MONIKIELINEN VAKIOLOMAKE — KUOLEMA/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE DÖDSFALL 4 DATE ET LIEU DU DÉCÈS/TAG UND ORT DES TODES/ДАТА И МЯСТО НА СМЪРТТА/FECHA Y LUGAR DE DEFUNCIÓN/DATUM A MÍSTO ÚMRTÍ/DØDSDATO OG DØDSSTED/SURMAAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΘΑΝΑΤΟΥ/DÁTA AGUS IONAD AN BHÁIS/DATUM I MJESTO SMRTI/DATA E LUOGO DEL DECESSO/MIRŠANAS DATUMS UN VIETA/MIRTIES DATA IR VIETA/HALÁL BEKÖVETKEZÉSÉNEK IDEJE ÉS HELYE/POST U DATA TAL-MEWT/DATUM EN PLAATS VAN OVERLIJDEN/DATA I MIEJSCE ZGONU/DATA E LOCAL DO ÓBITO/DATA ŞI LOCUL DECESULUI/DÁTUM A MIESTO ÚMRTIA/DATUM IN KRAJ SMRTI/KUOLINAIKA JA –PAIKKA/DÖDSDATUM OCH DÖDSORT 5 NOM/NAME/ФАМИЛНО ИМЕ/APELLIDO(S)/PŘÍJMENÍ/EFTERNAVN/PEREKONNANIMI/ΕΠΩΝΥΜΟ/SLOINNE/PREZIME/COGNOME/UZVĀRDS/PAVARDĖ/CSALÁDI NÉV/KUNJOM/NAAM/NAZWISKO/APELIDO/NUME/PRIEZVISKO/PRIIMEK/SUKUNIMI/EFTERNAMN 6 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 7 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 8 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 9 NOM DU DERNIER CONJOINT/NAME DES LETZTEN EHEPARTNERS/ФАМИЛНО ИМЕ НА ПОСЛЕДНИЯ СЪПРУГ/APELLIDO(S) DEL ÚLTIMO CÓNYUGE/PŘÍJMENÍ POSLEDNÍHO MANŽELA/MANŽELKY/SIDSTE ÆGTEFÆLLES EFTERNAVN/VIIMASE ABIKAASA PEREKONNANIMI/ΕΠΩΝΥΜΟ ΤΟΥ/ΤΗΣ ΤΕΛΕΥΤΑΙΟΥ/ΑΣ ΣΥΖΥΓΟΥ/SLOINNE AN CHÉILE DHEIREANAIGH/PREZIME POSLJEDNJEG BRAČNOG DRUGA/COGNOME DELL'ULTIMO CONIUGE/PĒDĒJĀ(-S) LAULĀTĀ(-S) UZVĀRDS/PASKUTINIO SUTUOKTINIO PAVARDĖ/UTOLSÓ HÁZASTÁRS CSALÁDI NEVE/KUNJOM L-AĦĦAR KONJUGI/NAAM VAN LAATSTE ECHTGENOOT/-GENOTE/NAZWISKO OSTATNIEGO MAŁŻONKA/APELIDO DO ÚLTIMO CÔNJUGE/NUMELE ULTIMULUI SOŢ/ULTIMEI SOŢII/PRIEZVISKO POSLEDNÉHO MANŽELA/POSLEDNEJ MANŽELKY/PRIIMEK ZADNJEGA ZAKONCA/VIIMEISIMMÄN PUOLISON SUKUNIMI/SISTA MAKENS/MAKANS EFTERNAMN 10 PRÉNOM(S) DU DERNIER CONJOINT/VORNAME(N) DES LETZTEN EHEPARTNERS/СОБСТВЕНО ИМЕ НА ПОСЛЕДНИЯ СЪПРУГ/NOMBRE(S) DEL ÚLTIMO CÓNYUGE/JMÉNO (JMÉNA) POSLEDNÍHO MANŽELA/MANŽELKY/SIDSTE ÆGTEFÆLLES FORNAVN/-E/VIIMASE ABIKAASA EESNIMED/ΟΝΟΜΑ/ΟΝΟΜΑΤΑ ΤΟΥ/ΤΗΣ ΤΕΛΕΥΤΑΙΟΥ/ΑΣ ΣΥΖΥΓΟΥ/CÉADAINM(NEACHA) AN CHÉILE DHEIREANAIGH/IME(NA) POSLJEDNJEG BRAČNOG DRUGA/NOME/I DELL'ULTIMO CONIUGE/PĒDĒJĀ(-S) LAULĀTĀ(-S) VĀRDS(-I)/PASKUTINIO SUTUOKTINIO VARDAS (-AI)/UTOLSÓ HÁZASTÁRS UTÓNEVE(I)/ISEM (ISMIJIET) L-AĦĦAR KONJUĠI/VOORNAMEN VAN LAATSTE ECHTGENOOT/-GENOTE/IMIĘ (IMIONA) OSTATNIEGO MAŁŻONKA/NOME PRÓPRIO DO ÚLTIMO CÕNJUGE/PRENUMELE ULTIMULUI SOŢ/ULTIMEI SOŢII/MENO POSLEDNÉHO MANŽELA/POSLEDNEJ MANŽELKY/(IME)NA ZADNJEGA ZAKONCA/VIIMEISIMMÄN PUOLISON ETUNIMET/SISTA MAKENS/MAKANS FÖRNAMN 11 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL 12 PÈRE/VATER/БАЩА/PADRE/OTEC/FAR/ISA/ΠΑΤΕΡΑΣ/ATHAIR/OTAC/PADRE/TĒVS/TĖVAS/APA/MISSIER/VADER/OJCIEC/PAI/TATĂL/OTEC/OČE/ISÄ/FADER 13 MÈRE/MUTTER/МАЙКА/MADRE/MATKA/MOR/EMA/ΜΗΤΕΡΑ/MÁTHAIR/MAJKA/MADRE/MĀTE/MOTINA/ANYA/OMM/MOEDER/MATKA/MÃE/MAMA/MATKA/MATI/ÄITI/MODER

Annex IIa Article 11 of Regulation (EU) [Add number and title of this Regulation]

1 MEMBER STATE: 2 ISSUING AUTHORITY 3 EUROPEAN UNION MULTILINGUAL STANDARD FORM CONFIRMING NON-MARRIED STATUS 4 NAME 5 FORENAME(S) 6 SEX 7 DATE AND PLACE OF BIRTH Da Mo Ye 8 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, and it shall be used without prejudice to the substantive law of the Member States. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann / Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Ženska/Nainen/Kvinnligt 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁT/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE CONFIRMANT LE STATUT NON MARIÉ/MEHRSPRACHIGES EU-FORMULAR ZUR BESTÄTIGUNG DER LEDIGKEITSBESCHEINIGUNG/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕВРОПЕЙСКИЯ СЪЮЗ ЗА ЛИПСА НА СКЛЮЧЕН БРАК/IMPRESO ESTÁNDAR MULTILINGÜE DE LA UNIÓN EUROPEA QUE ACREDITA EL ESTADO DE SOLTERÍA/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EVROPSKÉ UNIE PRO RODINNÝ STAV ‘SVOBODNÝ/Á’/FLERSPROGET EU-STANDARDFORMULAR TIL BEKRÆFTELSE AF STATUS SOM UGIFT//ELi MITMEKEELNE STANDARDVORM VALLALISE STAATUSE KOHTA/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΤΗΣ ΕΥΡΩΠΑΪΚΗΣ ΕΝΩΣΗΣ ΓΙΑ ΤΗ ΒΕΒΑΙΩΣΗ ΑΓΑΜΙΑΣ/FOIRM CHAIGHDEÁNACH ILTEANGACH DE CHUID AN AONTAIS EORPAIGH LENA NDAINGNÍTEAR STÁDAS NEAMHPHÓSTA/ VIŠEJEZIČNI STANDARDNI OBRAZAC EUROPSKE UNIJE KOJIM SE POTVRĐUJE SLOBODNO BRAČNO STANJE /MODULO STANDARD MULTILINGUE DELL'UE PER LA CONFERMA DELLO STATUS DI NON CONIUGATO/A/EIROPAS SAVIENĪBAS DAUDZVALODU STANDARTA VEIDLAPA (APLIECINA NEPRECĒTAS PERSONAS ĢIMENES STĀVOKLI)/EUROPOS SĄJUNGOS DAUGIAKALBĖ STANDARTINĖ FORMA, KURIA PATVIRTINAMAS NESUSITUOKUSIO ASMENS SATUSAS/TÖBBNYELVŰ EURÓPAI UNIÓS FORMANYOMTATVÁNY NŐTLEN/HAJADON CSALÁDI ÁLLAPOT TEKINTETÉBEN/FORMOLA STANDARD MULTILINGWI TAL-UNJONI EWROPEA LI TIKKONFERMA STATUS MHUX MIŻŻEWWEĠ/MEERTALIG EU-MODELFORMULIER TER STAVING VAN ONGEHUWDE STAAT/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UNII EUROPEJSKIEJ POTWIERDZAJĄCY STAN WOLNY/FORMULÁRIO MULTILINGUE DA UNIÃO EUROPEIA RELATIVO AO ESTADO DE SOLTEIRO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND STAREA CIVILĂ A UNEI PERSOANE NECĂSĂTORITE/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA NEUZAVRETIA MANŽELSTVA/VEČJEZIČNI STANDARDNI OBRAZEC EU O SAMSKEM STANU/EU:N MONIKIELINEN VAKIOLOMAKE, JOLLA VAHVISTETAAN SIVIILISÄÄDYKSI NAIMATON/FLERSPRÅKIGT EU STANDARDFORMULÄR FÖR INTYGANDE AV ATT EN PERSON ÄR OGIFT 4 NOM/NAME/ФАМИЛНО ИМЕ/APELLIDO(S)/PŘÍJMENÍ/EFTERNAVN/PEREKONNANIMI/ΕΠΩΝΥΜΟ/SLOINNE/PREZIME/COGNOME/UZVĀRDS/PAVARDĖ/CSALÁDI NÉV/KUNJOM/NAAM/NAZWISKO/APELIDO/NUME/PRIEZVISKO/PRIIMEK/SUKUNIMI/EFTERNAMN 5 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 6 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 7 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 8 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL [Am. 40]

Annex III Article 11 of Regulation (EU) [Add number and title of this Regulation]

1 MEMBER STATE: 2 ISSUING AUTHORITY 3 EU MULTILINGUAL STANDARD FORM CONCERNING MARRIAGE 4 DATE AND PLACE OF THE MARRIAGE Da Mo Ye 5 SPOUSE A /HUSBAND [Am. 41] 6 SPOUSE B /WIFE [Am. 42] 7 NAME BEFORE THE MARRIAGE 8 FORENAME(S) 9 SEX 10 DATE AND PLACE OF BIRTH Da Mo Ye Da Mo Ye 11 NAME FOLLOWING THE MARRIAGE 12 HABITUAL RESIDENCE 13 OTHER PARTICULARS OF THE REGISTRATION 14 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, and it shall be used without prejudice to the substantive law of the Member States relating to marriage. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — Mar: Marriage/Mariage/Eheschlieβung/брак/Matrimonio/Manželství/Gift/Abielu/Γάμος/Pósadh/Brak/Matrimonio/Laulība/Santuoka/Házasság/Żwieġ/huwelijk/związek małżeński/Casamento/Căsătorie/Manželstvo/Zakonska zveza/Avioliitto/Giftermål — Reg: Registered Partnership/Partenariat enregistré/Eingetragene Partnerschaft/регистрирано партньорство/Unión registrada/Registrované partnerství/Registreret partnerskab/Registreeritud partnerlus/Καταχωρισμένη συμβίωση/Páirtnéireacht Chláraithe/Registrirano partnerstvo/Unione registrata/Reģistrētas partnerattiecības/Registruota partnerystė/Bejegyzett élettársi kapcsolat/Unjoni Rreġistrata/geregistreerd partnerschap/zarejestrowany związek partnerski/Parceria registada/Parteneriat înregistrat/Registrované partnerstvo/Registrirana partnerska skupnost/Rekisteröity parisuhde/Registrerat partnerskap — Ls: Legal separation/Séparation de corps/Trennung ohne Auflösung des Ehebandes/законна раздяла/Separación judicial/Rozluka/Separeret/Lahuselu/Δικαστικός χωρισμός/Scaradh Dlíthiúil/Zakonska rastava/Separazione personale/Laulāto atšķiršana/Gyvenimas skyrium (separacija)/Különválás/Separazzjoni legali/scheiding van tafel en bed/separacja prawna/Separação legal/Separare de drept/Súdna rozluka/Prenehanje življenjske skupnosti/Asumusero/Hemskillnad — Div: Divorce/Divorce/Scheidung/развод/Divorcio/Rozvod/Skilt/Lahutus/Διαζύγιο/Colscaradh/Razvod/Divorzio/Laulības šķiršana/Santuokos nutraukimas/Házasság felbontása/Divorzju/echtscheiding/rozwód/Divórcio/Divorț/Rozvod/Razveza zakonske zveze/Avioero/Skilsmässa — A: Annulment/Annulation/Nichtigerklärung/унищожаване/Anulación/Zrušení/Ophævelse af ægteskab/Tühistamine/Ακύρωση/Neamhniú pósta/Poništenje/Annullamento/Laulības atzīšana par neesošu/Pripažinimas negaliojančia/Érvénytelenítés/Annullament/nietigverklaring/anulowanie/Anulação/Anulare/Anulovanie/Razveljavitev zakonske zveze/Mitätöinti/Annullering — D: Death/Décès/Tod/смърт/Defunción/Úmrtí/Død/Surm/Θάνατος/Bás/Smrt/Decesso/Nāve/Mirtis/Halál/Mewt/overlijden/zgon/Óbito/Deces/Úmrtie/Smrt/Kuolema/Dödsfall — Dh: Death of the husband/Décès du mari/Tod des Ehemanns/смърт на съпруга/Defunción del esposo/Úmrtí manžela/Ægtefælles (mand) død/Abikaasa surm (M)/Θάνατος του συζύγου/Bás an fhir chéile/Smrt supruga/Decesso del marito/Vīra nāve/Vyro mirtis/Férj halála/: Mewt tar-raġel/overlijden van echtgenoot/zgon współmałżonka/Óbito do cônjuge masculino/Decesul soțului/Úmrtie manžela/Smrt moža/Aviomiehen kuolema/Makes dödsfall — Dw: Death of the Wife/Décès de la femme/Tod der Ehefrau/смърт на съпругата/Defunción de la esposa/Úmrtí manželky/Ægtefælles (kone) død/Abikaasa surm (F)/Θάνατος της συζύγου/Bás na mná céile/Smrt supruge/Decesso della moglie/Sievas nāve/Žmonos mirtis/Feleség halála/Mewt tal-mara/overlijden van echtgenote/zgon współmałżonki/Óbito do cônjuge feminino/Decesul soției/Úmrtie manželky/Smrt žene/Vaimon kuolema/Makas dödsfall 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁT/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE CONCERNANT LE MARIAGE/MEHRSPRACHIGES EU-FORMULAR — EHESCHLIEßUNG/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕС ЗА БРАК/IMPRESO ESTÁNDAR MULTILINGÜE DE LA UE RELATIVO AL MATRIMONIO/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU PRO MANŽELSTVÍ/FLERSPROGET EU-STANDARDVIELSESATTEST/ELi MITMEKEELNE STANDARDVORM ABIELU KOHTA/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΤΗΣ ΕΕ ΓΙΑ ΤΟΝ ΓΑΜΟ/FOIRM CHAIGHDEÁNACH ILTEANGACH AN AE MAIDIR LE PÓSADH/MODULO STANDARD MULTILINGUE DELL'UE RELATIVO AL MATRIMONIO/ES DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ LAULĪBU/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL SANTUOKOS/TÖBBNYELVŰ UNIÓS FORMANYOMTATVÁNY HÁZASSÁG TEKINTETÉBEN/FORMOLA MULTILINGWA STANDARD TAL-UE DWAR ŻWIEĠ/MEERTALIG EU-MODELFORMULIER BETREFFENDE HUWELIJK/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY ZAWARCIA ZWIĄZKU MAŁŻEŃSKIEGO/VIŠEJEZIČNI STANDARDNI FORMULAR EU-a KOJI SE ODNOSI NA BRAK/FORMULÁRIO MULTILINGUE DA UE RELATIVO AO CASAMENTO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND CĂSĂTORIA/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA UZAVRETIA MANŽELSTVA/STANDARDNI VEČJEZIČNI OBRAZEC EU V ZVEZI S SKLENITVIJO ZAKONSKE ZVEZE/EU:N MONIKIELINEN VAKIOLOMAKE — AVIOLIITTO/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE GIFTERMÅL 4 DATE ET LIEU DU MARIAGE/TAG UND ORT DES EINTRAGS/ДАТА И МЯСТО НА СКЛЮЧВАНЕ НА БРАКА/FECHA Y LUGAR DE MATRIMONIO/DATUM A MÍSTO UZAVŘENÍ MANŽELSTVÍ/VIELSESDATO- OG STED/ABIELLUMISE KUUPÄEV JA KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΤΟΥ ΓΑΜΟΥ/DÁTA AGUS IONAD AN PHÓSTA/DAN I MJESTO SKLAPANJA BRAKA/DATA E LUOGO DI MATRIMONIO/LAULĪBAS NOSLĒGŠANAS DATUMS UN VIETA/SANTUOKOS DATA IR VIETA/HÁZASSÁGKÖTÉS IDEJE ÉS HELYE/DATA U POST TAŻ-ŻWIEĠ/DATUM EN PLAATS VAN HUWELIJK/DATA I MIEJSCE ZAWARCIA ZWIĄZKU MAŁŻEŃSKIEGO/DATA E LOCAL DO CASAMENTO/DATA ŞI LOCUL CĂSĂTORIEI/DÁTUM A MIESTO UZAVRETIA MANŽELSTVA/DATUM IN KRAJ SKLENITVE ZAKONSKE ZVEZE/AVIOLIITON SOLMIMISAIKA JA –PAIKKA/GIFTERMÅLSDATUM OCH GIFTERMÅLSORT 5 ÉPOUX A/EHEPARTNER A/СЪПРУГ A/CÓNYUGE A/MANŽEL/KA A/ÆGTEFÆLLE A/ABIKAASA A/ΣΥΖΥΓΟΣ Α/CÉILE A/BRAČNI DRUG A/CONIUGE A/LAULĀTAIS A/SUTUOKTINIS A/‘A’ HÁZASTÁRS/KONJUĠI A/ECHTGENOOT/-GENOTE A/MAŁŻONEK A/COÕNJUGE A/SOŢUL/SOŢIA A/MANŽEL A/ZAKONEC A/PUOLISO A/MAKE A 6 ÉPOUX B/EHEPARTNER B//СЪПРУГ В/CÓNYUGE B/MANŽEL/KA B/ÆGTEFÆLLE B/ABIKAASA B/ΣΥΖΥΓΟΣ Β/CÉILE B/BRAČNI DRUG B/CONIUGE B/LAULĀTAIS B/SUTUOKTINIS B/‘B’ HÁZASTÁRS/KONJUĠI B/ECHTGENOOT/-GENOTE B/MAŁŻONEK B/CÕNJUGE B/SOŢUL/SOŢIA B/MANŽEL B/ZAKONEC B/PUOLISO B/MAKE B 7 NOM ANTÉRIEUR AU MARIAGE/NAME VOR DER EHESCHLIEßUNG/ФАМИЛНО ИМЕ ПРЕДИ БРАКА/APELLIDO(S) ANTES DEL MATRIMONIO/PŘÍJMENÍ PŘED UZAVŘENÍM MANŽELSTVÍ/EFTERNAVN FØR INDGÅELSE AF ÆGTESKAB/PEREKONNANIMI ENNE ABIELLUMIST/ΕΠΩΝΥΜΟ ΠΡΙΝ ΑΠΟ ΤΟ ΓΑΜΟ/SLOINNE ROIMH PHÓSADH/DJEVOJAČKO PREZIME/COGNOME PRIMA DEL MATRIMONIO/UZVĀRDS PIRMS LAULĪBAS NOSLĒGŠANAS/PAVARDĖ IKI SANTUOKOS SUDARYMO/HÁZASSÁGKÖTÉS ELŐTTI CSALÁDI NÉV/KUNJOM QABEL IŻ-ŻWIEĠ/NAAM VÓÓR HET HUWELIJK/NAZWISKO PRZED ZAWARCIEM ZWIĄZKU MAŁŻEŃSKIEGO/APELIDO ANTERIOR AO CASAMENTO/NUMELE DINAINTEA CĂSĂTORIEI/PRIEZVISKO ZA SLOBODNA/PRIIMEK PRED SKLENITVIJO ZAKONSKE ZVEZE/SUKUNIMI ENNEN AVIOLIITTOA/EFTERNAMN FÖRE GIFTERMÅLET 8 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/ΟΝΟΜΑΤΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOMÉPRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 9 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SPOL/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 10 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG –STED/KUUPÄEV JA KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉSI HELY ÉS IDŐ/DATA U POST TAT-TWELID/GEBOORTEDATUM EN –PLAATS/DATA I MIEJSCE URODZIN/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 11 NOM POSTÉRIEUR AU MARIAGE/NAME NACH DER EHESCHLIEßUNG/ФАМИЛНО ИМЕ СЛЕД СКЛЮЧВАНЕ НА БРАКА/APELLIDO(S) TRAS EL MATRIMONIO/PŘÍJMENÍ PO UZAVŘENÍ MANŽELSTVÍ/EFTERNAVN EFTER INDGÅELSE AF ÆGTESKAB/PEREKONNANIMI PÄRAST ABIELLUMIST/ΕΠΩΝΥΜΟ ΜΕΤΑ ΤΟΝ ΓΑΜΟ/SLOINNE TAR ÉIS AN PHÓSTA/PREZIME NAKON SKLAPANJA BRAKA/COGNOME DOPO IL MATRIMONIO/UZVĀRDS PĒC LAULĪBAS NOSLĒGŠANAS/PAVARDĖ PO SANTUOKOS SUDARYMO/HÁZASSÁGKÖTÉS UTÁNI NÉV/KUNJOM WARA Ż-ŻWIEĠ/NAAM NA HET HUWELIJK/NAZWISKO PO ZAWARCIU ZWIĄZKU MAŁŻEŃSKIEGO/APELIDO POSTERIOR AO CASAMENTO/NUMELE DUPĂ CĂSĂTORIE/PRIEZVISKO PO UZAVRETÍ MANŽELSTVA/PRIIMEK PO SKLENITVI ZAKONSKE ZVEZE/SUKUNIMI AVIOLIITON SOLMIMISEN JÄLKEEN/EFTERNAMN EFTER GIFTERMÅLET 12 RÉSIDENCE HABITUELLE/ORT DES GEWÖHNLICHEN AUFENTHALTS/ОБИЧАЙНО МЕСТОПРЕБИВАВАНЕ/DOMICILIO HABITUAL/OBVYKLÉ BYDLIŠTĚ/SÆDVANLIG BOPÆLSADRESSE/ALALINE ELUKOHT/ΣΥΝΗΘΗΣ ΔΙΑΜΟΝΗ/GNÁTHÁIT CHÓNAITHE/MJESTO PREBIVALIŠTA/RESIDENZA ABITUALE/PASTĀVĪGĀ DZĪVESVIETA/NUOLATINĖ GYVENAMOJI VIETA/SZOKÁSOS TARTÓZKODÁSI HELY/RESIDENZA NORMALI/WOONPLAATS/MIEJSCE ZWYKŁEGO POBYTU/RESIDÊNCIA HABITUAL/REŞEDINŢA OBIŞNUITĂ/MIESTO OBVYKLÉHO POBYTU/OBIČAJNO PREBIVALIŠČE/ASUINPAIKKA/HEMVIST 13 AUTRES INFORMATIONS FIGURANT DANS L'ACTE/ANDERE ANGABEN AUS DEM EINTRAG/ДРУГИ БЕЛЕЖКИ ВЪВ ВРЪЗКА С РЕГИСТРАЦИЯТА/OTROS DATOS DEL REGISTRO/DALŠÍ ÚDAJE O ZÁPISU/ANDRE BEMÆRKNINGER TIL REGISTRERINGEN/MUU TEAVE/ΑΛΛΑ ΣΤΟΙΧΕΙΑ ΤΗΣ ΚΑΤΑΧΩΡΙΣΗΣ/SONRAÍ EILE A BHAINEANN LEIS AN gCLÁRÚCHÁN/OSTALE INFORMACIJE ZA PRIJAVU/ALTRI ELEMENTI PARTICOLARI DELLA REGISTRAZIONE/CITAS ZIŅAS PAR REĢISTRĀCIJU/KITI REGISTRACIJOS DUOMENYS/EGYÉB ANYAKÖNYVI ADATOK/PARTIKOLARITAJIET OĦRA TAR-REĠISTRAZZJONI/ANDERE BIJZONDERHEDEN VAN DE REGISTRATIE/INNE OKOLICZNOŚCI SZCZEGÓLNE ZWIĄZANE Z REJESTRACJĄ/OUTROS ELEMENTOS PARTICULARES DO REGISTO/ALTE CARACTERISTICI PRIVIND ÎNREGISTRAREA/INÉ OSOBITNÉ ÚDAJE V SÚVISLOSTI S REGISTRÁCIOU/DRUGE POSEBNOSTI PRIJAVE/MUITA REKISTERÖINTIIN LIITTYVIÄ SEIKKOJA/ANDRA UPPGIFTER I REGISTRERINGEN 14 DATE DE DÉLIVRANCE, SIGNATURE, SCEAU/TAG DER AUSSTELLUNG, UNTERSCHRIFT, SIEGEL/ДАТА НА ИЗДАВАНЕ, ПОДПИС, ПЕЧАТ/FECHA DE EXPEDICIÓN, FIRMA Y SELLO/DATUM VYDÁNÍ, PODPIS, RAZÍTKO/UDSTEDELSESDATO, UNDERSKRIFT, STEMPEL/VÄLJAANDMISE KUUPÄEV, ALLKIRI, PITSER/ΗΜΕΡΟΜΗΝΙΑ ΕΚΔΟΣΗΣ, ΥΠΟΓΡΑΦΗ, ΣΦΡΑΓΙΔΑ/DÁTA EISIÚNA, SÍNIÚ, SÉALA/DATUM IZDAVANJA, POTPIS, PEČAT/DATA DI RILASCIO, FIRMA, TIMBRO/IZSNIEGŠANAS DATUMS, PARAKSTS, ZĪMOGS/IŠDAVIMO DATA, PARAŠAS, ANTSPAUDAS/KIÁLLÍTÁS DÁTUMA, ALÁÍRÁS, PECSÉT/DATA TAL-ĦRUĠ, FIRMA, TIMBRU/DATUM VAN AFGIFTE, HANDTEKENING, STEMPEL/DATA WYDANIA, PODPIS, PIECZĘĆ/DATA DE EMISSÃO, ASSINATURA, SELO/DATA ELIBERĂRII, SEMNĂTURA, ŞTAMPILA/DÁTUM VYDANIA, PODPIS, PEČIATKA/DATUM IZDAJE, PODPIS, ŽIG/ANTAMISPÄIVÄ, ALLEKIRJOITUS, SINETTI/UTFÄRDANDEDATUM, UNDERSKRIFT, STÄMPEL

Annex IIIa Article 11 of Regulation (EU) No [Add number and title of this Regulation]

1 MEMBER STATE 2 ISSUING AUTHORITY 3 EUROPEAN UNION MULTILINGUAL STANDARD FORM — DIVORCE 4 DATE AND PLACE OF DIVORCE Da Mo Ye 5 SPOUSE A 6 SPOUSE B 7 NAME BEFORE DIVORCE 8 FORENAME(S) 9 SEX 10 DATE AND PLACE OF BIRTH Da Mo Ye Da Mo Ye 11 NAME AFTER DIVORCE 12 HABITUAL RESIDENCE 13 OTHER PARTICULARS OF THE ACT 14 DATE OF ISSUE Da Mo Ye SIGNATURE, SEAL Legal note: This EU multilingual standard form is made available by the authorities of the issuing Member State and may be requested alternatively to the equivalent public document existing in that Member State. It shall not prejudice the use of an equivalent national public document drawn up by the authorities of the issuing Member State. It shall have the same formal evidentiary value as the national equivalent of the issuing Member State, but shall be without prejudice to the relevant substantive law of the Member State. SYMBOLS/SYMBOLES/ZEICHEN/СИМВОЛИ/SÍMBOLOS/SYMBOLY/SYMBOLER/SÜMBOLID/ΣΥΜΒΟΛΑ/NODA/SIMBOLI/SIMBOLI/APZĪMĒJUMI/SIMBOLIAI/JELMAGYARÁZAT/SIMBOLI/AFKORTINGEN/SKRÓT/SÍMBOLOS/SIMBOLURI/SYMBOLY/KRATICE/SYMBOLIT/FÖRKLARINGAR — Da: Day/Jour/Tag/ден/Día/Den/Dag/Päev/Ημέρα/Lá/Dan/Giorno/diena/diena/Nap/Jum/dag/dzień/Dia/Ziua/Deň/Dan/Päivä/Dag — Mo: Month/Mois/Monat/месец/Mes/Měsíc/Måned/Kuu/Μήνας/Mí/Mjesec/Mese/mēnesis/mėnuo/Hónap/Xahar/maand/miesiąc/Mês/Luna/Mesiac/Mesec/Kuukausi/Månad — Ye: Year/Année/Jahr/година/Año/Rok/År/Aasta/Έτος/Bliain/Godina/Anno/gads/metai/Év/Sena/jaar/rok/Ano/Anul/Rok/Leto/Vuosi/År — M: Masculine/Masculin/Männlich/мъжки/Masculino/Mužské/Mand/Mees/Άρρεν/Fireann/Muško/Maschile/Vīrietis/Vyras/Férfi/Maskil/man/mężczyzna/Masculino/Masculin/Muž/Moški/Mies/Manligt — F: Feminine/Féminin/Weiblich/женски/Femenino/Ženské/Kvinde/Naine/Θήλυ/Baineann/Žensko/Femminile/Sieviete/Moteris/Nő/Femminil/vrouw/kobieta/Feminino/Feminin/Žena/Ženska/Nainen/Kvinnligt — Mar: Marriage/Mariage/Eheschlieβung/брак/Matrimonio/Manželství/Gift/Abielu/Γάμος/Pósadh/Brak/Matrimonio/Laulība/Santuoka/Házasság/Żwieġ/huwelijk/związek małżeński/Casamento/Căsătorie/Manželstvo/Zakonska zveza/Avioliitto/Giftermål — Reg: Registered Partnership/Partenariat enregistré/Eingetragene Partnerschaft/регистрирано партньорство/Unión registrada/Registrované partnerství/Registreret partnerskab/Registreeritud partnerlus/Καταχωρισμένη συμβίωση/Páirtnéireacht Chláraithe/Registrirano partnerstvo/Unione registrata/Reģistrētas partnerattiecības/Registruota partnerystė/Bejegyzett élettársi kapcsolat/Unjoni Rreġistrata/geregistreerd partnerschap/zarejestrowany związek partnerski/Parceria registada/Parteneriat înregistrat/Registrované partnerstvo/Registrirana partnerska skupnost/Rekisteröity parisuhde/Registrerat partnerskap — Ls: Legal separation/Séparation de corps/Trennung ohne Auflösung des Ehebandes/законна раздяла/Separación judicial/Rozluka/Separeret/Lahuselu/Δικαστικός χωρισμός/Scaradh Dlíthiúil/Zakonska rastava/Separazione personale/Laulāto atšķiršana/Gyvenimas skyrium (separacija)/Különválás/Separazzjoni legali/scheiding van tafel en bed/separacja prawna/Separação legal/Separare de drept/Súdna rozluka/Prenehanje življenjske skupnosti/Asumusero/Hemskillnad — Div: Divorce/Divorce/Scheidung/развод/Divorcio/Rozvod/Skilt/Lahutus/Διαζύγιο/Colscaradh/Razvod/Divorzio/Laulības šķiršana/Santuokos nutraukimas/Házasság felbontása/Divorzju/echtscheiding/rozwód/Divórcio/Divorț/Rozvod/Razveza zakonske zveze/Avioero/Skilsmässa — A: Annulment/Annulation/Nichtigerklärung/унищожаване/Anulación/Zrušení/Ophævelse af ægteskab/Tühistamine/Ακύρωση/Neamhniú pósta/Poništenje/Annullamento/Laulības atzīšana par neesošu/Pripažinimas negaliojančia/Érvénytelenítés/Annullament/nietigverklaring/anulowanie/Anulação/Anulare/Anulovanie/Razveljavitev zakonske zveze/Mitätöinti/Annullering — D: Death/Décès/Tod/смърт/Defunción/Úmrtí/Død/Surm/Θάνατος/Bás/Smrt/Decesso/Nāve/Mirtis/Halál/Mewt/overlijden/zgon/Óbito/Deces/Úmrtie/Smrt/Kuolema/Dödsfall — Dh: Death of the husband/Décès du mari/Tod des Ehemanns/смърт на съпруга/Defunción del esposo/Úmrtí manžela/Ægtefælles (mand) død/Abikaasa surm (M)/Θάνατος του συζύγου/Bás an fhir chéile/Smrt supruga/Decesso del marito/Vīra nāve/Vyro mirtis/Férj halála/: Mewt tar-raġel/overlijden van echtgenoot/zgon współmałżonka/Óbito do cônjuge masculino/Decesul soțului/Úmrtie manžela/Smrt moža/Aviomiehen kuolema/Makes dödsfall — Dw: Death of the Wife/Décès de la femme/Tod der Ehefrau/смърт на съпругата/Defunción de la esposa/Úmrtí manželky/Ægtefælles (kone) død/Abikaasa surm (F)/Θάνατος της συζύγου/Bás na mná céile/Smrt supruge/Decesso della moglie/Sievas nāve/Žmonos mirtis/Feleség halála/Mewt tal-mara/overlijden van echtgenote/zgon współmałżonki/Óbito do cônjuge feminino/Decesul soției/Úmrtie manželky/Smrt žene/Vaimon kuolema/Makas dödsfall 1 ÉTAT MEMBRE/MITGLIEDSTAAT/ДЪРЖАВА ЧЛЕНКА/ESTADO MIEMBRO/ČLENSKÝ STÁT/MEDLEMSSTAT/LIIKMESRIIK/ΚΡΑΤΟΣ ΜΕΛΟΣ/BALLSTÁT/DRŽAVA ČLANICA/STATO MEMBRO/DALĪBVALSTS/VALSTYBĖ NARĖ/TAGÁLLAM/STAT MEMBRU/LIDSTAAT/PAŃSTWO CZŁONKOWSKIE/ESTADO-MEMBRO/STATUL MEMBRU/ČLENSKÝ ŠTÁT/DRŽAVA ČLANICA/JÄSENVALTIO/MEDLEMSSTAT 2 AUTORITÉ DE DÉLIVRANCE/AUSSTELLUNGSBEHÖRDE/ИЗДАВАЩ ОРГАН/AUTORIDAD EXPEDIDORA/VYDÁVAJÍCÍ ORGÁN/UDSTEDENDE MYNDIGHED/VÄLJAANDJA ASUTUS/ΑΡΧΗ ΕΚΔΟΣΗΣ/ÚDARÁS EISIÚNA/NADLEŽNO TIJELO ZA IZDAVANJE/AUTORITÀ DI RILASCIO/IZSNIEDZĒJA IESTĀDE/IŠDUODANTI INSTITUCIJA/KIÁLLÍTÓ HATÓSÁG/AWTORITÀ KOMPETENTI/AUTORITEIT VAN AFGIFTE/ORGAN WYDAJĄCY/AUTORIDADE DE EMISSÃO/AUTORITATEA EMITENTĂ/VYDÁVAJÚCI ORGÁN/ORGAN IZDAJATELJ/ANTAVA VIRANOMAINEN/UTFÄRDANDE MYNDIGHET 3 FORMULAIRE TYPE MULTILINGUE DE L'UE RELATIF AU DIVORCE/MEHRSPRACHIGES EU-FORMULAR — SCHEIDUNG/МНОГОЕЗИЧНО СТАНДАРТНО УДОСТОВЕРЕНИЕ НА ЕВРОПЕЙСКИЯ СЪЮЗ ЗА РАЗВОД/UE FORMULARIO NORMALIZADO MULTILINGÜE RELATIVO AL DIVORCIO/VÍCEJAZYČNÝ STANDARDNÍ FORMULÁŘ EU TÝKAJÍCÍ SE ROZVODU/FLERSPROGET EU-STANDARDFORMULAR VEDRØRENDE SKILSMISSE/LAHUTUST PUUDUTAV MITMEKEELNE ELI STANDARDVORM/ΠΟΛΥΓΛΩΣΣΟ ΤΥΠΟΠΟΙΗΜΕΝΟ ΕΝΤΥΠΟ ΕΕ ΣΧΕΤΙΚΑ ΜΕ ΤΟ ΔΙΑΖΥΓΙΟ/FOIRM CHAIGHDEÁNACH ILTEANGACH AE MAIDIR LE COLSCARADH/VIŠEJEZIČNI STANDARDNI OBRAZAC EUROPSKE UNIJE — RAZVOD/MODULO STANDARD MULTILINGUE DELL'UNIONE EUROPEA RELATIVO AL DIVORZIO/ES DAUGIAKALBĖ STANDARTINĖ FORMA DĖL SKYRYBŲ/EIROPAS SAVIENĪBAS DAUDZVALODU STANDARTA VEIDLAPA ATTIECĪBĀ UZ LAULĪBAS ŠĶIRŠANU/TÖBBNYELVŰ EURÓPAI UNIÓS FORMANYOMTATVÁNY VÁLÁS TEKINTETÉBEN/FORMOLA STANDARD MULTILINGWALI TAL-UE DWAR ID-DIVORZJU/MEERTALIG MODELFORMULIER VAN DE EUROPESE UNIE BETREFFENDE ECHTSCHEIDING/WIELOJĘZYCZNY FORMULARZ STANDARDOWY UE DOTYCZĄCY ROZWODU/FORMULÁRIO MULTILINGUE NORMALIZADO DA UE RELATIVO AO DIVÓRCIO/FORMULAR STANDARD MULTILINGV AL UE PRIVIND DIVORŢUL/ŠTANDARDNÝ VIACJAZYČNÝ FORMULÁR EÚ TÝKAJÚCI SA ROZVODU/VEČJEZIČNI STANDARDNI OBRAZEC EU O RAZVEZI ZAKONSKE ZVEZE/EU:N MONIKIELINEN VAKIOLOMAKE — AVIOERO/FLERSPRÅKIGT EU-STANDARDFORMULÄR RÖRANDE SKILSMÄSSA 4 DATE ET LIEU DU DIVORCE/TAG UND ORT DER SCHEIDUNG/ДАТА И МЯСТО НА РАЗВОДА/FECHA Y LUGAR DEL DIVORCIO/DATUM A MÍSTO ROZVODU/DATO OG STED FOR SKILSMISSEN/LAHUTUSE KUUPÄEV JA KOHT/HΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΔΙΑΖΥΓΙΟΥ/DÁTA AGUS ÁIT AN CHOLSCARTHA/DATUM I MJESTO RAZVODA/DATA E LUOGO DEL DIVORZIO/SKYRYBŲ DATA IR VIETA/LAULĪBAS ŠĶIRŠANAS DATUMS UN VIETA/VÁLÁS IDEJE ÉS HELYE/DATA U POST TAD-DIVORZJU/DATUM EN PLAATS VAN DE ECHTSCHEIDING/DATA I MIEJSCE ROZWODU/DATA E LOCAL DO DIVÓRCIO/DATA ŞI LOCUL DIVORŢULUI/DÁTUM A MIESTO ROZVODU/DATUM IN KRAJ RAZVEZE/AVIOERON VOIMAANTULOPÄIVÄ JA PAIKKA/DATUM OCH ORT FÖR SKILSMÄSSA 5 CONJOINT A/EHEPARTNER A/СЪПРУГ A/CÓNYUGE A/MANŽEL/ÆGTEFÆLLE A/ABIKAASA A/ΣΥΖΥΓΟΣ Α/CÉILE A/ BRAČNI PARTNER A /CONIUGE A/LAULĀTAIS A/SUTUOKTINIS A/‘A’ HÁZASTÁRS/KONJUĠI A/ECHTGENOOT/-GENOTE A/MAŁŻONEK A/COÕNJUGE A/SOŢUL/SOŢIA A/MANŽEL A/ZAKONEC A/PUOLISO A/MAKE A 6 CONJOINT B/EHEPARTNER B/СЪПРУГ В/CÓNYUGE B/MANŽELKA/ÆGTEFÆLLE B/ABIKAASA B/ΣΥΖΥΓΟΣ Β/CÉILE B/BRAČNI PARTNER B/CONIUGE B/LAULĀTAIS B/SUTUOKTINIS B/‘B’ HÁZASTÁRS/KONJUĠI B/ECHTGENOOT/-GENOTE B/MAŁŻONEK B/CÕNJUGE B/SOŢUL/SOŢIA B/MANŽEL B/ZAKONEC B/PUOLISO B/MAKE B 7 NOM ANTÉRIEUR AU DIVORCE/NAME VOR DER SCHEIDUNG/ИМЕ ПРЕДИ РАЗВОДА/NOMBRE ANTES DEL DIVORCIO/JMÉNO PŘED ROZVODEM/NAVN FØR SKILSMISSEN/LAHUTUSE-EELNE NIMI/ΌΝΟΜΑ ΠΡΙΝ ΤΟ ΔΙΑΖΥΓΙΟ/SLOINNE ROIMH AN GCOLSCARADH/ PREZIME PRIJE RAZVODA /NOME ANTERIORMENTE AL DIVORZIO/PAVARDĖ PRIEŠ SKYRYBAS/VĀRDS PIRMS LAULĪBAS ŠĶIRŠANAS/VÁLÁS ELŐTTI NÉV/ISEM QABEL ID-DIVORZJU/NAAM VOOR DE ECHTSCHEIDING/NAZWISKO PRZED ROZWODEM/APELIDO ANTERIOR AO DIVÓRCIO/NUMELE ÎNAINTE DE DIVORŢ/MENO PRED ROZVODOM/IME PRED RAZVEZO/SUKUNIMI ENNEN AVIOEROA/EFTERNAMN FÖRE SKILSMÄSSA 8 PRÉNOM(S)/VORNAME(N)/СОБСТВЕНО ИМЕ/NOMBRE(S)/JMÉNO (JMÉNA)/FORNAVN/-E/EESNIMED/ΟΝΟΜΑ/CÉADAINM(NEACHA)/IME(NA)/NOME/I/VĀRDS(-I)/VARDAS (-AI)/UTÓNÉV (UTÓNEVEK)/ISEM (ISMIJIET)/VOORNAMEN/IMIĘ (IMIONA)/NOME PRÓPRIO/PRENUME/MENO(Á)/IME(NA)/ETUNIMET/FÖRNAMN 9 SEXE/GESCHLECHT/ПОЛ/SEXO/POHLAVÍ/KØN/SUGU/ΦΥΛΟ/GNÉAS/SESSO/DZIMUMS/LYTIS/NEM/SESS/GESLACHT/PŁEĆ/SPOL/SEXO/SEX/POHLAVIE/SPOL/SUKUPUOLI/KÖN 10 DATE ET LIEU DE NAISSANCE/TAG UND ORT DER GEBURT/ДАТА И МЯСТО НА РАЖДАНЕ/FECHA Y LUGAR DE NACIMIENTO/DATUM A MÍSTO NAROZENÍ/FØDSELSDATO OG -STED/SÜNNIAEG JA –KOHT/ΗΜΕΡΟΜΗΝΙΑ ΚΑΙ ΤΟΠΟΣ ΓΕΝΝΗΣΗΣ/DÁTA AGUS IONAD BREITHE/DATUM I MJESTO ROĐENJA/DATA E LUOGO DI NASCITA/DZIMŠANAS DATUMS UN VIETA/GIMIMO DATA IR VIETA/SZÜLETÉS IDEJE ÉS HELYE/POST U DATA TAT-TWELID/GEBOORTEPLAATS EN –DATUM/DATA I MIEJSCE URODZENIA/DATA E LOCAL DE NASCIMENTO/DATA ŞI LOCUL NAŞTERII/DÁTUM A MIESTO NARODENIA/DATUM IN KRAJ ROJSTVA/SYNTYMÄAIKA JA –PAIKKA/FÖDELSEDATUM OCH FÖDELSEORT 11 NOM POSTÉRIEUR AU DIVORCE/NAME NACH DER SCHEIDUNG/ИМЕ СЛЕД РАЗВОДА/NOMBRE DESPUÉS DEL DIVORCIO/JMÉNO PO ROZVODU/NAVN EFTER SKILSMISSEN/LAHUTUSEJÄRGNE NIMI/ΌΝΟΜΑ ΜΕΤΑ ΤΟ ΔΙΑΖΥΓΙΟ/SLOINNE I NDIAIDH AN CHOLSCARTHA/PREZIME NAKON RAZVODA/NOME SUCCESSIVAMENTE AL DIVORZIO/PAVARDĖ PO SKYRYBŲ/VĀRDS PĒC LAULĪBAS ŠĶIRŠANAS/VÁLÁS UTÁNI NÉV/ISEM WARA D-DIVORZJU/NAAM NA DE ECHTSCHEIDING/NAZWISKO PO ROZWODZIE/APELIDO POSTERIOR AO DIVÓRCIO/NUMELE DUPĂ DIVORŢ/MENO PO ROZVODE/IME PO RAZVEZI/SUKUNIMI AVIOERON JÄLKEEN/EFTERNAMN EFTER SKILSMÄSSA 12 RÉSIDENCE HABITUELLE/ORT DES GEWÖHNLICHEN AUFENTHALTS/ОБИЧАЙНО МЕСТОПРЕБИВАВАНЕ/DOMICILIO HABITUAL/OBVYKLÉ BYDLIŠTĚ/SÆDVANLIG BOPÆLSADRE