Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations
Date: 2008-12-18
Institutions: Council of the European Union
Subjects: divorce, judicial cooperation in civil matters in the EU, jurisdiction, maintenance obligation, parental responsibility

10.1.2009

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I

(Acts adopted under the EC Treaty/Euratom Treaty whose publication is obligatory)

REGULATIONS

COUNCIL REGULATION (EC) No 4/2009

of 18 December 2008

on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters
relating to maintenance obligations

THE COUNCIL OF THE EUROPEAN UNION,

(2)

In accordance with Article 65(b) of the Treaty, these mea-
sures must aim, inter alia, to promote the compatibility of
the rules applicable in the Member States concerning the
conflict of laws and of jurisdiction.

Having regard to the Treaty establishing the European Commu-
nity, and in particular Article 61(c) and Article 67(2) thereof,

Having regard to the proposal from the Commission,

(3)

Having regard to the opinion of the European Parliament (1),

Having regard to the opinion of the European Economic and
Social Committee (2),

Whereas:

(1)

The Community has set itself the objective of maintaining
and developing an area of freedom, security and justice, in
which the free movement of persons is ensured. For the
gradual establishment of such an area, the Community is
to adopt, among others, measures relating to judicial coop-
eration in civil matters having cross-border implications, in
so far as necessary for the proper functioning of the inter-
nal market.

(1) Opinion given on 13 December 2007 (not yet published in the Offi-
cial Journal) and opinion given on 4 December 2008 following
re-consultation (not yet published in the Official Journal).

(2) Opinion given following non-obligatory consultation (OJ C 185,

8.8.2006, p. 35).

In this respect, the Community has among other measures
already adopted Council Regulation (EC) No 44/2001 of
22 December 2000 on jurisdiction and the recognition
and enforcement of judgments in civil and commercial
matters (3), Council Decision 2001/470/EC of 28 May
2001 establishing a European Judicial Network in civil
and commercial matters (4), Council Regulation (EC)
No 1206/2001 of 28 May 2001 on cooperation between
the courts of the Member States in the taking of evidence
in civil or commercial matters (5), Council Directive
2003/8/EC of 27 January 2003 to improve access to jus-
tice in cross-border disputes by establishing minimum
common rules relating to legal aid for such disputes (6),
Council Regulation (EC) No 2201/2003 of 27 November
2003 on jurisdiction and the recognition and enforcement
of judgments in matrimonial matters and in matters of
parental responsibility (7), Regulation (EC) No 805/2004 of
the European Parliament and of the Council of 21 April
2004 creating a European Enforcement Order for uncon-
tested claims (8), and Regulation (EC) No 1393/2007 of the
European Parliament and of the Council of 13 November
2007 on the service in the Member States of judicial and
extrajudicial documents in civil or commercial matters
(service of documents) (9).

(3) OJ L 12, 16.1.2001, p. 1.
(4) OJ L 174, 27.6.2001, p. 25.
(5) OJ L 174, 27.6.2001, p. 1.
(6) OJ L 26, 31.1.2003, p. 41.
(7) OJ L 338, 23.12.2003, p. 1.
(8) OJ L 143, 30.4.2004, p. 15.
(9) OJ L 324, 10.12.2007, p. 79.

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(4)

(5)

(6)

(7)

(8)

(9)

(10)

The European Council in Tampere on 15 and 16 October
1999 invited the Council and the Commission to establish
special common procedural rules to simplify and acceler-
ate the settlement of cross-border disputes concerning,
inter alia, maintenance claims. It also called for the aboli-
tion of intermediate measures required for the recognition
and enforcement in the requested State of a decision given
in another Member State, particularly a decision relating to
a maintenance claim.

A programme of measures for the enforcement of the prin-
ciple of mutual recognition of decisions in civil and com-
mercial matters (1), common to the Commission and to the
Council, was adopted on 30 November 2000. That pro-
gramme provides for the abolition of the exequatur proce-
dure for maintenance claims in order to boost
the
effectiveness of the means by which maintenance creditors
safeguard their rights.

The European Council meeting in Brussels on 4
and 5 November 2004 adopted a new programme called
‘The Hague Programme: strengthening freedom, security
and justice in the European Union’ (hereinafter referred to
as The Hague Programme) (2).

At its meeting on 2 and 3 June 2005, the Council adopted
a Council and Commission Action Plan (3) which imple-
ments The Hague Programme in concrete actions and
which mentions the necessity of adopting proposals on
maintenance obligations.

In the framework of The Hague Conference on Private
International Law, the Community and its Member States
took part in negotiations which led to the adoption on
23 November 2007 of the Convention on the Interna-
tional Recovery of Child Support and other Forms of Fam-
ily Maintenance (hereinafter referred to as the 2007 Hague
Convention) and the Protocol on the Law Applicable to
Maintenance Obligations (hereinafter referred to as the
2007 Hague Protocol). Both those instruments should
therefore be taken into account in this Regulation.

A maintenance creditor should be able to obtain easily, in
a Member State, a decision which will be automatically
enforceable in another Member State without further
formalities.

In order to achieve this goal, it is advisable to create a Com-
munity instrument in matters relating to maintenance obli-
gations bringing together provisions on jurisdiction,
conflict of laws, recognition and enforceability, enforce-
ment,
legal aid and cooperation between Central
Authorities.

(11)

The scope of this Regulation should cover all maintenance
obligations arising from a family relationship, parentage,

(1) OJ C 12, 15.1.2001, p. 1.
(2) OJ C 53, 3.3.2005, p. 1.
(3) OJ C 198, 12.8.2005, p. 1.

(12)

(13)

(14)

(15)

(16)

marriage or affinity, in order to guarantee equal treatment
of all maintenance creditors. For the purposes of this Regu-
lation, the term ‘maintenance obligation’ should be inter-
preted autonomously.

In order to take account of the various ways of resolving
maintenance obligation issues in the Member States, this
Regulation should apply both to court decisions and to
decisions given by administrative authorities, provided that
the latter offer guarantees with regard to, in particular,
their impartiality and the right of all parties to be heard.
Those authorities should therefore apply all the rules of
this Regulation.

For the reasons set out above, this Regulation should also
ensure the recognition and enforcement of court settle-
ments and authentic instruments without affecting the
right of either party to such a settlement or instrument to
challenge the settlement or instrument before the courts of
the Member State of origin.

It should be provided in this Regulation that for the pur-
poses of an application for the recognition and enforce-
ment of a decision relating to maintenance obligations the
term ‘creditor’ includes public bodies which are entitled to
act in place of a person to whom maintenance is owed or
to claim reimbursement of benefits provided to the credi-
tor in place of maintenance. Where a public body acts in
this capacity, it should be entitled to the same services and
the same legal aid as a creditor.

In order to preserve the interests of maintenance creditors
and to promote the proper administration of justice within
the European Union, the rules on jurisdiction as they result
from Regulation (EC) No 44/2001 should be adapted. The
circumstance that the defendant is habitually resident in a
third State should no longer entail the non-application of
Community rules on jurisdiction, and there should no
longer be any referral to national law. This Regulation
should therefore determine the cases in which a court in a
Member State may exercise subsidiary jurisdiction.

In order to remedy, in particular, situations of denial of jus-
tice this Regulation should provide a forum necessitatis
allowing a court of a Member State, on an exceptional
basis, to hear a case which is closely connected with a third
State. Such an exceptional basis may be deemed to exist
when proceedings prove impossible in the third State in
question, for example because of civil war, or when an
applicant cannot reasonably be expected to initiate or con-
duct proceedings in that State. Jurisdiction based on the
forum necessitatis should, however, be exercised only if the
dispute has a sufficient connection with the Member State
of the court seised, for instance the nationality of one of
the parties.

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(17) An additional rule of jurisdiction should provide that,
except under specific conditions, proceedings to modify an
existing maintenance decision or to have a new decision
given can be brought by the debtor only in the State in
which the creditor was habitually resident at the time the
decision was given and in which he remains habitually resi-
dent. To ensure proper symmetry between the 2007 Hague
Convention and this Regulation, this rule should also apply
as regards decisions given in a third State which is party to
the said Convention in so far as that Convention is in force
between that State and the Community and covers the
same maintenance obligations in that State and in the
Community.

(18)

(19)

(20)

For the purposes of this Regulation, it should be provided
that in Ireland the concept of ‘domicile’ replaces the con-
cept of ‘nationality’ which is also the case in the United
Kingdom, subject to this Regulation being applicable in the
latter Member State in accordance with Article 4 of the
Protocol on the position of the United Kingdom and Ire-
land annexed to the Treaty on European Union and the
Treaty establishing the European Community.

In order to increase legal certainty, predictability and the
autonomy of the parties, this Regulation should enable the
parties to choose the competent court by agreement on the
basis of specific connecting factors. To protect the weaker
party, such a choice of court should not be allowed in the
case of maintenance obligations towards a child under the
age of 18.

It should be provided in this Regulation that, for Member
States bound by the 2007 Hague Protocol, the rules on
conflict of laws in respect of maintenance obligations will
be those set out in that Protocol. To that end, a provision
referring to the said Protocol should be inserted. The 2007
Hague Protocol will be concluded by the Community in
time to enable this Regulation to apply. To take account of
a scenario in which the 2007 Hague Protocol does not
apply to all the Member States a distinction for the pur-
poses of recognition, enforceability and enforcement of
decisions needs to be made in this Regulation between the
Member States bound by the 2007 Hague Protocol and
those not bound by it.

(21)

It needs to be made clear in this Regulation that these rules
on conflict of laws determine only the law applicable to
maintenance obligations and do not determine the law
applicable to the establishment of the family relationships
on which the maintenance obligations are based. The
establishment of family relationships continues to be cov-
ered by the national law of the Member States, including
their rules of private international law.

(22)

In order to ensure swift and efficient recovery of a main-
tenance obligation and to prevent delaying actions, deci-
sions in matters relating to maintenance obligations given
in a Member State should in principle be provisionally
enforceable. This Regulation should therefore provide that
the court of origin should be able to declare the decision
provisionally enforceable even if the national law does not
provide for enforceability by operation of law and even if
an appeal has been or could still be lodged against the deci-
sion under national law.

(23)

To limit the costs of proceedings subject to this Regulation,
the greatest possible use of modern communications tech-
nologies, particularly for hearing parties, would be helpful.

(24)

(25)

(26)

(27)

The guarantees provided by the application of rules on
conflict of laws should provide the justification for having
decisions relating to maintenance obligations given in a
Member State bound by the 2007 Hague Protocol recog-
nised and regarded as enforceable in all the other Member
States without any procedure being necessary and without
any form of control on the substance in the Member State
of enforcement.

Recognition in a Member State of a decision relating to
maintenance obligations has as its only object to allow the
recovery of the maintenance claim determined in the deci-
sion. It does not imply the recognition by that Member
State of the family relationship, parentage, marriage or
affinity underlying the maintenance obligations which
gave rise to the decision.

For decisions on maintenance obligations given in a Mem-
ber State not bound by the 2007 Hague Protocol, there
should be provision in this Regulation for a procedure for
recognition and declaration of enforceability. That proce-
dure should be modelled on the procedure and the grounds
for
in Regulation (EC)
No 44/2001. To accelerate proceedings and enable the
creditor to recover his claim quickly, the court seised
should be required to give its decision within a set time,
unless there are exceptional circumstances.

refusing recognition set out

It would also be appropriate to limit as far as possible the
formal enforcement requirements likely to increase the
costs to be borne by the maintenance creditor. To that end,
this Regulation should provide that a maintenance credi-
tor ought not to be required to have a postal address or an
authorised representative in the Member State of enforce-
ment, without this otherwise affecting the internal organi-
sation of
the Member States in matters relating to
enforcement proceedings.

(28)

In order to limit the costs of enforcement proceedings, no
translation should be required unless enforcement is con-
tested, and without prejudice to the rules applicable to ser-
vice of documents.

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(29)

(30)

(31)

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In order to guarantee compliance with the requirements of
a fair trial, this Regulation should provide for the right of a
defendant who did not enter an appearance in the court of
origin of a Member State bound by the 2007 Hague Pro-
tocol to apply for a review of the decision given against
him at the stage of enforcement. However, the defendant
must apply for this review within a set period which should
start no later than the day on which, in the enforcement
proceedings, his property was first made non-disposable in
whole or in part. That right to apply for a review should
be an extraordinary remedy granted to the defendant in
default and not affecting the application of any extraordi-
nary remedies laid down in the law of the Member State of
origin provided that those remedies are not incompatible
with the right to a review under this Regulation.

In order to speed up the enforcement in another Member
State of a decision given in a Member State bound by the
2007 Hague Protocol it is necessary to limit the grounds
of refusal or of suspension of enforcement which may be
invoked by the debtor on account of the cross-border
nature of the maintenance claim. This limitation should
not affect the grounds of refusal or of suspension laid down
in national law which are not incompatible with those
listed in this Regulation, such as the debtor’s discharge of
his debt at the time of enforcement or the unattachable
nature of certain assets.

To facilitate cross-border recovery of maintenance claims,
provision should be made for a system of cooperation
between Central Authorities designated by the Member
States. These Authorities should assist maintenance credi-
tors and debtors in asserting their rights in another Mem-
ber State by submitting applications for recognition,
enforceability and enforcement of existing decisions, for
the modification of such decisions or for the establishment
of a decision. They should also exchange information in
order to locate debtors and creditors, and identify their
income and assets, as necessary. Lastly, they should coop-
erate with each other by exchanging general information
and promoting cooperation amongst
the competent
authorities in their Member States.

(33)

(34)

(35)

In order to provide full assistance to maintenance creditors
and debtors and to facilitate as much as possible cross-
border recovery of maintenance, the Central Authorities
should be able to obtain a certain amount of personal
information. This Regulation should therefore oblige the
Member States to ensure that their Central Authorities have
access to such information through the public authorities
or administrations which hold the information concerned
in the course of their ordinary activities. It should however
be left to each Member State to decide on the arrangements
for such access. Accordingly, a Member State should be
able to designate the public authorities or administrations
which will be required to supply the information to the
Central Authority in accordance with this Regulation,
including, if appropriate, public authorities or administra-
tions already designated in the context of other systems for
access to information. Where a Member State designates
public authorities or administrations, it should ensure that
its Central Authority is able to access the requisite infor-
mation held by those bodies as provided for in this Regu-
lation. A Member State should also be able to allow its
Central Authority to access requisite information from any
other legal person which holds it and controls its
processing.

In the context of access to personal data and the use and
transmission thereof,
the requirements of 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 (1), as transposed into the national
law of the Member States, should be complied with.

For the purposes of the application of this Regulation it is
however necessary to define the specific conditions of
access to personal data and of the use and transmission of
such data. In this context, the opinion of the European
Data Protection Supervisor (2) has been taken into consid-
eration. Notification of the data subject should take place
in accordance with national law. It should however be pos-
sible to defer the notification to prevent the debtor from
transferring his assets and thus jeopardising the recovery of
the maintenance claim.

(32) A Central Authority designated under this Regulation
should bear its own costs, except in specifically determined
cases, and should provide assistance for all applicants resid-
ing in its Member State. The criterion for determining a
person’s right to request assistance from a Central Author-
ity should be less strict than the connecting factor of
‘habitual residence’ used elsewhere in this Regulation.
However, the ‘residence’ criterion should exclude mere
presence.

(36) On account of the costs of proceedings it is appropriate to
provide for a very favourable legal aid scheme, that is, full
coverage of the costs relating to proceedings concerning
maintenance obligations in respect of children under the
age of 21 initiated via the Central Authorities. Specific rules
should therefore be added to the current rules on legal aid
in the European Union which exist by virtue of Directive

(1) OJ L 281, 23.11.1995, p. 31.
(2) OJ C 242, 7.10.2006, p. 20.

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(37)

(38)

(39)

(40)

2003/8/EC thus setting up a special legal aid scheme for
maintenance obligations. In this context, the competent
authority of the requested Member State should be able,
exceptionally, to recover costs from an applicant having
received free legal aid and lost the case, provided that the
person’s financial situation so permits. This would apply,
in particular, where someone well-off had acted in bad
faith.

In addition, for maintenance obligations other than those
referred to in the preceding recital, all parties should be
guaranteed the same treatment in terms of legal aid at the
time of enforcement of a decision in another Member State.
Accordingly, the provisions of this Regulation on continu-
ity of legal aid should be understood as also granting such
aid to a party who, while not having received legal aid in
the proceedings to obtain or amend a decision in the Mem-
ber State of origin, did then benefit from such aid in that
State in the context of an application for enforcement of
the decision. Similarly, a party who benefited from free
proceedings before an administrative authority listed in
Annex X should, in the Member State of enforcement, ben-
efit from the most favourable legal aid or the most exten-
sive exemption from costs or expenses, provided that he
shows that he would have so benefited in the Member
State of origin.

In order to minimise the costs of translating supporting
documents the court seised should only require a transla-
tion of such documents when this is necessary, without
prejudice to the rights of the defence and the rules appli-
cable concerning service of documents.

To facilitate the application of this Regulation, Member
States should be obliged to provide the Commission with
the names and contact details of their Central Authorities
and with other information. That information should be
made available to practitioners and to the public through
publication in the Official Journal of the European Union or
through electronic access to the European Judicial Network
in civil and commercial matters established by Decision
2001/470/EC. Furthermore, the use of forms provided for
in this Regulation should facilitate and speed up commu-
nication between the Central Authorities and make it pos-
sible to submit applications electronically.

The relationship between this Regulation and the bilateral
or multilateral conventions and agreements on mainte-
nance obligations to which the Member States are party
should be specified. In this context it should be stipulated
that Member States which are party to the Convention of
23 March 1962 between Sweden, Denmark, Finland, Ice-
land and Norway on the recovery of maintenance by the
Member States may continue to apply that Convention
since it contains more favourable rules on recognition and
enforcement than those in this Regulation. As regards the
conclusion of future bilateral agreements on maintenance
obligations with third States, the procedures and condi-
tions under which Member States would be authorised to

(41)

(42)

(43)

(44)

(45)

negotiate and conclude such agreements on their own
behalf should be determined in the course of discussions
relating to a Commission proposal on the subject.

In calculating the periods and time limits provided for in
this Regulation, Regulation (EEC, Euratom) No 1182/71 of
the Council of 3 June 1971 determining the rules appli-
cable to periods, dates and time limits (1) should apply.

The measures necessary for the implementation of this
Regulation should be adopted in accordance with Council
Decision 1999/468/EC of 28 June 1999 laying down the
procedures for the exercise of implementing powers con-
ferred on the Commission (2).

In particular, the Commission should be empowered to
adopt any amendments to the forms provided for in this
Regulation in accordance with the advisory procedure pro-
vided for in Article 3 of Decision 1999/468/EC. For the
establishment of the list of the administrative authorities
falling within the scope of this Regulation, and the list of
authorities competent to certify the right to legal aid, the
Commission should be empowered to act in accordance
with the management procedure provided for in Article 4
of that Decision.

should

amend Regulation

This Regulation
(EC)
No 44/2001 by replacing the provisions of that Regulation
applicable to maintenance obligations. Subject to the tran-
sitional provisions of this Regulation, Member States
should, in matters relating to maintenance obligations,
apply the provisions of this Regulation on jurisdiction, rec-
ognition, enforceability and enforcement of decisions and
on legal aid instead of those of Regulation (EC) No 44/2001
as from the date on which this Regulation becomes
applicable.

Since the objectives of this Regulation, namely the intro-
duction of a series of measures to ensure the effective
recovery of maintenance claims in cross-border situations
and thus to facilitate the free movement of persons within
the European Union, cannot be sufficiently achieved by the
Member States and can therefore, by reason of the scale
and effects of this Regulation, be better achieved at Com-
munity level, the Community may adopt measures in
accordance with the principle of subsidiarity as set out in
Article 5 of the Treaty. In accordance with the principle of
proportionality as set out in that Article this Regulation
does not go beyond what is necessary to achieve those
objectives.

(46)

In accordance with Article 3 of the Protocol on the posi-
tion of the United Kingdom and Ireland, annexed to the
Treaty on European Union and to the Treaty establishing
the European Community, Ireland has given notice of its
wish to take part in the adoption and application of this
Regulation.

(1) OJ L 124, 8.6.1971, p. 1.
(2) OJ L 184, 17.7.1999, p. 23.

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(47)

(48)

In accordance with Articles 1 and 2 of the Protocol on the
position of the United Kingdom and Ireland, annexed to
the Treaty on European Union and to the Treaty establish-
ing the European Community, the United Kingdom is not
taking part in the adoption of this Regulation and is not
bound by it or subject to its application. This is, however,
without prejudice to the possibility for the United King-
dom of notifying its intention of accepting this Regulation
after its adoption in accordance with Article 4 of the said
Protocol.

In accordance with Articles 1 and 2 of the Protocol on the
position of Denmark annexed to the Treaty on European
Union and the Treaty establishing the European Commu-
nity, Denmark is not taking part in the adoption of this
Regulation and is not bound by it or subject to its appli-
cation, without prejudice to the possibility for Denmark of
applying the amendments made here to Regulation (EC)
No 44/2001 pursuant to Article 3 of the Agreement of
19 October 2005 between the European Community and
the Kingdom of Denmark on jurisdiction and the recogni-
tion and enforcement of judgments in civil and commer-
cial matters (1),

HAS ADOPTED THIS REGULATION:

CHAPTER I

SCOPE AND DEFINITIONS

Article 1

Scope of application

This Regulation shall apply to maintenance obligations aris-

1.
ing from a family relationship, parentage, marriage or affinity.

In this Regulation, the term ‘Member State’ shall mean

2.
Member States to which this Regulation applies.

Article 2

Definitions

1.

1.

For the purposes of this Regulation:

the term ‘decision’ shall mean a decision in matters relating
to maintenance obligations given by a court of a Member
State, whatever the decision may be called, including a decree,
order, judgment or writ of execution, as well as a decision by
an officer of the court determining the costs or expenses. For
the purposes of Chapters VII and VIII, the term ‘decision’ shall
also mean a decision in matters relating to maintenance obli-
gations given in a third State;

2.

the term ‘court settlement’ shall mean a settlement in mat-
ters relating to maintenance obligations which has been
approved by a court or concluded before a court in the course
of proceedings;

(1) OJ L 299, 16.11.2005, p. 62.

3.

the term ‘authentic instrument’ shall mean:

(a) a document in matters relating to maintenance obliga-
tions which has been formally drawn up or registered as
an authentic instrument in the Member State of origin
and the authenticity of which:

(i)

relates to the signature and the content of the instru-
ment, and

(ii) has been established by a public authority or other

authority empowered for that purpose; or,

4.

5.

6.

7.

8.

(b) an arrangement relating to maintenance obligations con-
cluded with administrative authorities of the Member
State of origin or authenticated by them;

the term ‘Member State of origin’ shall mean the Member
State in which, as the case may be, the decision has been
given, the court settlement has been approved or concluded,
or the authentic instrument has been established;

the term ‘Member State of enforcement’ shall mean the Mem-
ber State in which the enforcement of the decision, the court
settlement or the authentic instrument is sought;

the term ‘requesting Member State’ shall mean the Member
State whose Central Authority transmits an application pur-
suant to Chapter VII;

the term ‘requested Member State’ shall mean the Member
State whose Central Authority receives an application pursu-
ant to Chapter VII;

the term ‘2007 Hague Convention Contracting State’ shall
mean a State which is a contracting party to the Hague Con-
vention of 23 November 2007 on the International Recov-
ery of Child Support and other Forms of Family Maintenance
(hereinafter referred to as the 2007 Hague Convention) to the
extent that the said Convention applies between the Commu-
nity and that State;

9.

the term ‘court of origin’ shall mean the court which has
given the decision to be enforced;

10. the term ‘creditor’ shall mean any individual to whom main-

tenance is owed or is alleged to be owed;

11. the term ‘debtor’ shall mean any individual who owes or who

is alleged to owe maintenance.

2.
For the purposes of this Regulation, the term ‘court’ shall
include administrative authorities of the Member States with com-
petence in matters relating to maintenance obligations provided
that such authorities offer guarantees with regard to impartiality
and the right of all parties to be heard and provided that their
decisions under the law of the Member State where they are
established:

(i) may be made the subject of an appeal to or review by a judi-

cial authority; and

(ii) have a similar force and effect as a decision of a judicial

authority on the same matter.

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These administrative authorities shall be listed in Annex X. That
Annex shall be established and amended in accordance with the
management procedure referred to in Article 73(2) at the request
of the Member State in which the administrative authority con-
cerned is established.

(b) a court or the courts of a Member State of which one of the

parties has the nationality;

(c)

in the case of maintenance obligations between spouses or
former spouses:

3.
For the purposes of Articles 3, 4 and 6, the concept of
‘domicile’ shall replace that of ‘nationality’ in those Member States
which use this concept as a connecting factor in family matters.

(i)

the court which has jurisdiction to settle their dispute in
matrimonial matters; or

For the purposes of Article 6, parties which have their ‘domicile’
in different territorial units of the same Member State shall be
deemed to have their common ‘domicile’ in that Member State.

(ii) a court or the courts of the Member State which was the
Member State of the spouses’ last common habitual resi-
dence for a period of at least one year.

CHAPTER II

JURISDICTION

Article 3

General provisions

In matters relating to maintenance obligations in Member States,
jurisdiction shall lie with:

(a)

the court for the place where the defendant is habitually resi-
dent, or

(b)

the court for the place where the creditor is habitually resi-
dent, or

the court which, according to its own law, has jurisdiction to
entertain proceedings concerning the status of a person if the
matter relating to maintenance is ancillary to those proceed-
ings, unless that jurisdiction is based solely on the national-
ity of one of the parties, or

(c)

(d)

The conditions referred to in points (a), (b) or (c) have to be
met at the time the choice of court agreement is concluded
or at the time the court is seised.

The jurisdiction conferred by agreement shall be exclusive
unless the parties have agreed otherwise.

2.
A choice of court agreement shall be in writing. Any com-
munication by electronic means which provides a durable record
of the agreement shall be equivalent to ‘writing’.

This Article shall not apply to a dispute relating to a main-

3.
tenance obligation towards a child under the age of 18.

4.
If the parties have agreed to attribute exclusive jurisdiction
to a court or courts of a State party to the Convention on juris-
diction and the recognition and enforcement of judgments in civil
and commercial matters (1), signed on 30 October 2007 in
Lugano (hereinafter referred to as the Lugano Convention), where
that State is not a Member State, the said Convention shall apply
except in the case of the disputes referred to in paragraph 3.

Article 5

Jurisdiction based on the appearance of the defendant

the court which, according to its own law, has jurisdiction to
entertain proceedings concerning parental responsibility if
the matter relating to maintenance is ancillary to those pro-
ceedings, unless that jurisdiction is based solely on the nation-
ality of one of the parties.

Apart from jurisdiction derived from other provisions of this
Regulation, a court of a Member State before which a defendant
enters an appearance shall have jurisdiction. This rule shall not
apply where appearance was entered to contest the jurisdiction.

Article 4

Choice of court

Article 6

Subsidiary jurisdiction

1.
The parties may agree that the following court or courts of
a Member State shall have jurisdiction to settle any disputes in
matters relating to a maintenance obligation which have arisen or
may arise between them:

Where no court of a Member State has jurisdiction pursuant to
Articles 3, 4 and 5 and no court of a State party to the Lugano
Convention which is not a Member State has jurisdiction pursu-
ant to the provisions of that Convention, the courts of the Mem-
ber State of the common nationality of the parties shall have
jurisdiction.

(a) a court or the courts of a Member State in which one of the

parties is habitually resident;

(1) OJ L 339, 21.12.2007, p. 3.

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Article 7

Forum necessitatis

Where no court of a Member State has jurisdiction pursuant to
Articles 3, 4, 5 and 6, the courts of a Member State may, on an
exceptional basis, hear the case if proceedings cannot reasonably
be brought or conducted or would be impossible in a third State
with which the dispute is closely connected.

(b)

if the document has to be served before being lodged with the
court, at the time when it is received by the authority respon-
sible for service, provided that the claimant has not subse-
quently failed to take the steps he was required to take to
have the document lodged with the court.

Article 10

Examination as to jurisdiction

The dispute must have a sufficient connection with the Member
State of the court seised.

Where a court of a Member State is seised of a case over which it
has no jurisdiction under this Regulation it shall declare of its own
motion that it has no jurisdiction.

Article 8

Limit on proceedings

Article 11

Examination as to admissibility

1. Where a decision is given in a Member State or a 2007
Hague Convention Contracting State where the creditor is habitu-
ally resident, proceedings to modify the decision or to have a new
decision given cannot be brought by the debtor in any other
Member State as long as the creditor remains habitually resident
in the State in which the decision was given.

2.

Paragraph 1 shall not apply:

(a) where the parties have agreed in accordance with Article 4 to
the jurisdiction of the courts of that other Member State;

(b) where the creditor submits to the jurisdiction of the courts of

that other Member State pursuant to Article 5;

(c) where the competent authority in the 2007 Hague Conven-
tion Contracting State of origin cannot, or refuses to, exer-
cise jurisdiction to modify the decision or give a new decision;
or

(d) where the decision given in the 2007 Hague Convention
Contracting State of origin cannot be recognised or declared
enforceable in the Member State where proceedings to
modify the decision or to have a new decision given are
contemplated.

Article 9

Seising of a court

For the purposes of this Chapter, a court shall be deemed to be
seised:

(a) at the time when the document instituting the proceedings or
an equivalent document is lodged with the court, provided
that the claimant has not subsequently failed to take the steps
he was required to take to have service effected on the defen-
dant; or

1. Where a defendant habitually resident in a State other than
the Member State where the action was brought does not enter an
appearance, the court with jurisdiction shall stay the proceedings
so long as it is not shown that the defendant has been able to
receive the document instituting the proceedings or an equivalent
document in sufficient time to enable him to arrange for his
defence, or that all necessary steps have been taken to this end.

2.
Article 19 of Regulation (EC) No 1393/2007 shall apply
instead of the provisions of paragraph 1 of this Article if the docu-
ment instituting the proceedings or an equivalent document had
to be transmitted from one Member State to another pursuant to
that Regulation.

3. Where the provisions of Regulation (EC) No 1393/2007 are
not applicable, Article 15 of the Hague Convention of 15 Novem-
ber 1965 on the service abroad of judicial and extrajudicial docu-
ments in civil or commercial matters shall apply if the document
instituting the proceedings or an equivalent document had to be
transmitted abroad pursuant to that Convention.

Article 12

Lis pendens

1. Where proceedings involving the same cause of action and
between the same parties are brought in the courts of different
Member States, any court other than the court first seised shall of
its own motion stay its proceedings until such time as the juris-
diction of the court first seised is established.

2. Where the jurisdiction of the court first seised is established,
any court other than the court first seised shall decline jurisdic-
tion in favour of that court.

Article 13

Related actions

1. Where related actions are pending in the courts of different
Member States, any court other than the court first seised may
stay its proceedings.

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2. Where these actions are pending at first instance, any court
other than the court first seised may also, on the application of
one of the parties, decline jurisdiction if the court first seised has
jurisdiction over the actions in question and its law permits the
consolidation thereof.

3.
For the purposes of this Article, actions are deemed to be
related where they are so closely connected that it is expedient to
hear and determine them together to avoid the risk of irreconcil-
able judgments resulting from separate proceedings.

SECTION 1

Decisions given in a Member State bound by the 2007 Hague
Protocol

Article 17

Abolition of exequatur

Article 14

Provisional, including protective, measures

1.
A decision given in a Member State bound by the 2007
Hague Protocol shall be recognised in another Member State
without any special procedure being required and without any
possibility of opposing its recognition.

Application may be made to the courts of a Member State for
such provisional, including protective, measures as may be avail-
able under the law of that State, even if, under this Regulation, the
courts of another Member State have jurisdiction as to the sub-
stance of the matter.

A decision given in a Member State bound by the 2007
2.
Hague Protocol which is enforceable in that State shall be enforce-
able in another Member State without the need for a declaration
of enforceability.

CHAPTER III

APPLICABLE LAW

Article 15

Determination of the applicable law

The law applicable to maintenance obligations shall be deter-
mined in accordance with the Hague Protocol of 23 November
2007 on the law applicable to maintenance obligations (herein-
after referred to as the 2007 Hague Protocol) in the Member States
bound by that instrument.

Article 18

Protective measures

An enforceable decision shall carry with it by operation of law the
power to proceed to any protective measures which exist under
the law of the Member State of enforcement.

Article 19

Right to apply for a review

CHAPTER IV

1.
A defendant who did not enter an appearance in the Mem-
ber State of origin shall have the right to apply for a review of the
decision before the competent court of that Member State where:

RECOGNITION, ENFORCEABILITY AND ENFORCEMENT OF
DECISIONS

(a) he was not served with the document instituting the proceed-
ings or an equivalent document in sufficient time and in such
a way as to enable him to arrange for his defence; or

Article 16

Scope of application of this Chapter

1.
This Chapter shall govern the recognition, enforceability
and enforcement of decisions falling within the scope of this
Regulation.

Section 1 shall apply to decisions given in a Member State

2.
bound by the 2007 Hague Protocol.

Section 2 shall apply to decisions given in a Member State

3.
not bound by the 2007 Hague Protocol.

4.

Section 3 shall apply to all decisions.

(b) he was prevented from contesting the maintenance claim by
reason of force majeure or due to extraordinary circum-
stances without any fault on his part;

unless he failed to challenge the decision when it was possible for
him to do so.

The time limit for applying for a review shall run from the
2.
day the defendant was effectively acquainted with the contents of
the decision and was able to react, at the latest from the date of
the first enforcement measure having the effect of making his
property non-disposable in whole or in part. The defendant shall
react promptly, in any event within 45 days. No extension may
be granted on account of distance.

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If the court rejects the application for a review referred to in
3.
paragraph 1 on the basis that none of the grounds for a review
set out in that paragraph apply, the decision shall remain in force.

If the court decides that a review is justified for one of the reasons
laid down in paragraph 1, the decision shall be null and void.
However, the creditor shall not lose the benefits of the interrup-
tion of prescription or limitation periods, or the right to claim ret-
roactive maintenance acquired in the initial proceedings.

Article 20

Documents for the purposes of enforcement

1.
For the purposes of enforcement of a decision in another
Member State, the claimant shall provide the competent enforce-
ment authorities with:

(a) a copy of the decision which satisfies the conditions neces-

sary to establish its authenticity;

(b)

the extract from the decision issued by the court of origin
using the form set out in Annex I;

(c) where appropriate, a document showing the amount of any

arrears and the date such amount was calculated;

(d) where necessary, a transliteration or a translation of the con-
tent of the form referred to in point (b) into the official lan-
guage of the Member State of enforcement or, where there
are several official languages in that Member State, into the
official language or one of the official languages of court pro-
ceedings of the place where the application is made, in accor-
dance with the law of that Member State, or into another
language that the Member State concerned has indicated it
can accept. Each Member State may indicate the official lan-
guage or languages of the institutions of the European Union
other than its own which it can accept for the completion of
the form.

2.
The competent authorities of the Member State of enforce-
ment may not require the claimant to provide a translation of the
decision. However, a translation may be required if the enforce-
ment of the decision is challenged.

Any translation under this Article must be done by a per-

3.
son qualified to do translations in one of the Member States.

The competent authority in the Member State of enforce-
2.
ment shall, on application by the debtor, refuse, either wholly or
in part, the enforcement of the decision of the court of origin if
the right to enforce the decision of the court of origin is extin-
guished by the effect of prescription or the limitation of action,
either under the law of the Member State of origin or under the
law of the Member State of enforcement, whichever provides for
the longer limitation period.

Furthermore, the competent authority in the Member State of
enforcement may, on application by the debtor, refuse, either
wholly or in part, the enforcement of the decision of the court of
origin if it is irreconcilable with a decision given in the Member
State of enforcement or with a decision given in another Member
State or in a third State which fulfils the conditions necessary for
its recognition in the Member State of enforcement.

A decision which has the effect of modifying an earlier decision
on maintenance on the basis of changed circumstances shall not
be considered an irreconcilable decision within the meaning of
the second subparagraph.

3.
The competent authority in the Member State of enforce-
ment may, on application by the debtor, suspend, either wholly
or in part, the enforcement of the decision of the court of origin
if the competent court of the Member State of origin has been
seised of an application for a review of the decision of the court
of origin pursuant to Article 19.

Furthermore, the competent authority of the Member State of
enforcement shall, on application by the debtor, suspend the
enforcement of the decision of the court of origin where the
enforceability of that decision is suspended in the Member State
of origin.

Article 22

No effect on the existence of family relationships

The recognition and enforcement of a decision on maintenance
under this Regulation shall not in any way imply the recognition
of the family relationship, parentage, marriage or affinity under-
lying the maintenance obligation which gave rise to the decision.

SECTION 2

Decisions given in a Member State not bound by the 2007
Hague Protocol

Article 21

Refusal or suspension of enforcement

Article 23

Recognition

1.
The grounds of refusal or suspension of enforcement under
the law of the Member State of enforcement shall apply in so far
as they are not incompatible with the application of paragraphs 2
and 3.

1.
A decision given in a Member State not bound by the 2007
Hague Protocol shall be recognised in the other Member States
without any special procedure being required.

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Any interested party who raises the recognition of a deci-
2.
sion as the principal issue in a dispute may, in accordance with
the procedures provided for in this Section, apply for a decision
that the decision be recognised.

Article 26

Enforceability

3.
If the outcome of proceedings in a court of a Member State
depends on the determination of an incidental question of recog-
nition, that court shall have jurisdiction over that question.

A decision given in a Member State not bound by the 2007 Hague
Protocol and enforceable in that State shall be enforceable in
another Member State when, on the application of any interested
party, it has been declared enforceable there.

Article 24

Grounds of refusal of recognition

A decision shall not be recognised:

Article 27

Jurisdiction of local courts

1.
The application for a declaration of enforceability shall be
submitted to the court or competent authority of the Member
State of enforcement notified by that Member State to the Com-
mission in accordance with Article 71.

(a)

if such recognition is manifestly contrary to public policy in
the Member State in which recognition is sought. The test of
public policy may not be applied to the rules relating to
jurisdiction;

2.
The local jurisdiction shall be determined by reference to the
place of habitual residence of the party against whom enforce-
ment is sought, or to the place of enforcement.

(b) where it was given in default of appearance, if the defendant
was not served with the document which instituted the pro-
ceedings or with an equivalent document in sufficient time
and in such a way as to enable him to arrange for his defence,
unless the defendant failed to commence proceedings to
challenge the decision when it was possible for him to do so;

Article 28

Procedure

The application for a declaration of enforceability shall be

1.
accompanied by the following documents:

(c)

if it is irreconcilable with a decision given in a dispute
between the same parties in the Member State in which rec-
ognition is sought;

(a) a copy of the decision which satisfies the conditions neces-

sary to establish its authenticity;

(d)

if it is irreconcilable with an earlier decision given in another
Member State or in a third State in a dispute involving the
same cause of action and between the same parties, provided
that the earlier decision fulfils the conditions necessary for its
recognition in the Member State in which recognition is
sought.

A decision which has the effect of modifying an earlier decision
on maintenance on the basis of changed circumstances shall not
be considered an irreconcilable decision within the meaning of
points (c) or (d).

Article 25

Staying of recognition proceedings

A court of a Member State in which recognition is sought of a
decision given in a Member State not bound by the 2007 Hague
Protocol shall stay the proceedings if the enforceability of the
decision is suspended in the Member State of origin by reason of
an appeal.

(b) an extract from the decision issued by the court of origin
using the form set out in Annex II, without prejudice to
Article 29;

(c) where necessary, a transliteration or a translation of the con-
tent of the form referred to in point (b) into the official lan-
guage of the Member State of enforcement or, where there
are several official languages in that Member State, into the
official language or one of the official languages of court pro-
ceedings of the place where the application is made, in accor-
dance with the law of that Member State, or into another
language that the Member State concerned has indicated it
can accept. Each Member State may indicate the official lan-
guage or languages of the institutions of the European Union
other than its own which it can accept for the completion of
the form.

2.
The court or competent authority seised of the application
may not require the claimant to provide a translation of the deci-
sion. However, a translation may be required in connection with
an appeal under Articles 32 or 33.

Any translation under this Article must be done by a per-

3.
son qualified to do translations in one of the Member States.

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Article 29

Non-production of the extract

1.
If the extract referred to in Article 28(1)(b) is not produced,
the competent court or authority may specify a time for its pro-
duction or accept an equivalent document or, if it considers that
it has
information before it, dispense with its
production.

sufficient

2.
In the situation referred to in paragraph 1, if the competent
court or authority so requires, a translation of the documents shall
be produced. The translation shall be done by a person qualified
to do translations in one of the Member States.

Article 30

Declaration of enforceability

The decision shall be declared enforceable without any review
under Article 24 immediately on completion of the formalities in
Article 28 and at the latest within 30 days of the completion of
those formalities, except where exceptional circumstances make
this impossible. The party against whom enforcement is sought
shall not at this stage of the proceedings be entitled to make any
submissions on the application.

Article 31

Notice of the decision on the application for a declaration

1.
The decision on the application for a declaration of enforce-
ability shall forthwith be brought to the notice of the applicant in
accordance with the procedure laid down by the law of the Mem-
ber State of enforcement.

2.
The declaration of enforceability shall be served on the party
against whom enforcement is sought, accompanied by the deci-
sion, if not already served on that party.

Article 32

Appeal against the decision on the application for a
declaration

The decision on the application for a declaration of enforce-

1.
ability may be appealed against by either party.

2.
The appeal shall be lodged with the court notified by the
Member State concerned to the Commission in accordance with
Article 71.

The appeal shall be dealt with in accordance with the rules

3.
governing procedure in contradictory matters.

4.
If the party against whom enforcement is sought fails to
appear before the appellate court in proceedings concerning an
appeal brought by the applicant, Article 11 shall apply even where
the party against whom enforcement is sought is not habitually
resident in any of the Member States.

An appeal against the declaration of enforceability shall be
5.
lodged within 30 days of service thereof. If the party against
whom enforcement is sought has his habitual residence in a Mem-
ber State other than that in which the declaration of enforceabil-
ity was given, the time for appealing shall be 45 days and shall
run from the date of service, either on him in person or at his resi-
dence. No extension may be granted on account of distance.

Article 33

Proceedings to contest the decision given on appeal

The decision given on appeal may be contested only by the pro-
cedure notified by the Member State concerned to the Commis-
sion in accordance with Article 71.

Article 34

Refusal or revocation of a declaration of enforceability

1.
The court with which an appeal is lodged under Articles 32
or 33 shall refuse or revoke a declaration of enforceability only on
one of the grounds specified in Article 24.

2.
Subject to Article 32(4), the court seised of an appeal under
Article 32 shall give its decision within 90 days from the date it
was seised, except where exceptional circumstances make this
impossible.

The court seised of an appeal under Article 33 shall give its

3.
decision without delay.

Article 35

Staying of proceedings

The court with which an appeal is lodged under Articles 32 or 33
shall, on the application of the party against whom enforcement
is sought, stay the proceedings if the enforceability of the deci-
sion is suspended in the Member State of origin by reason of an
appeal.

Article 36

Provisional, including protective measures

1. When a decision must be recognised in accordance with this
Section, nothing shall prevent the applicant from availing himself
of provisional, including protective, measures in accordance with
the law of the Member State of enforcement without a declara-
tion of enforceability under Article 30 being required.

The declaration of enforceability shall carry with it by opera-

2.
tion of law the power to proceed to any protective measures.

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to
During the time specified for an appeal pursuant
3.
Article 32(5) against the declaration of enforceability and until
any such appeal has been determined, no measures of enforce-
ment may be taken other than protective measures against the
property of the party against whom enforcement is sought.

Article 37

Partial enforceability

1. Where a decision has been given in respect of several mat-
ters and the declaration of enforceability cannot be given for all
of them, the competent court or authority shall give it for one or
more of them.

An applicant may request a declaration of enforceability

2.
limited to parts of a decision.

Article 38

No charge, duty or fee

In proceedings for the issue of a declaration of enforceability, no
charge, duty or fee calculated by reference to the value of the mat-
ter at issue may be levied in the Member State of enforcement.

SECTION 3

Common provisions

Article 39

Provisional enforceability

The court of origin may declare the decision provisionally enforce-
able, notwithstanding any appeal, even if national law does not
provide for enforceability by operation of law.

Article 40

Invoking a recognised decision

1.
A party who wishes to invoke in another Member State a
decision recognised within the meaning of Article 17(1) or rec-
ognised pursuant to Section 2 shall produce a copy of the deci-
sion which satisfies the conditions necessary to establish its
authenticity.

If necessary, the court before which the recognised decision
2.
is invoked may ask the party invoking the recognised decision to
produce an extract issued by the court of origin using the form set
out in Annex I or in Annex II, as the case may be.

The court of origin shall also issue such an extract at the request
of any interested party.

3. Where necessary, the party invoking the recognised decision
shall provide a transliteration or a translation of the content of the
form referred to in paragraph 2 into the official language of the

Member State concerned or, where there are several official lan-
guages in that Member State, into the official language or one of
the official languages of court proceedings of the place where the
recognised decision is invoked, in accordance with the law of that
Member State, or into another language that the Member State
concerned has indicated it can accept. Each Member State may
indicate the official language or languages of the institutions of
the European Union other than its own which it can accept for
the completion of the form.

Any translation under this Article must be done by a per-

4.
son qualified to do translations in one of the Member States.

Article 41

Proceedings and conditions for enforcement

Subject to the provisions of this Regulation, the procedure
1.
for the enforcement of decisions given in another Member State
shall be governed by the law of the Member State of enforcement.
A decision given in a Member State which is enforceable in the
Member State of enforcement shall be enforced there under the
same conditions as a decision given in that Member State of
enforcement.

2.
The party seeking the enforcement of a decision given in
another Member State shall not be required to have a postal
address or an authorised representative in the Member State of
enforcement, without prejudice to persons with competence in
matters relating to enforcement proceedings.

Article 42

No review as to substance

Under no circumstances may a decision given in a Member State
be reviewed as to its substance in the Member State in which rec-
ognition, enforceability or enforcement is sought.

Article 43

No precedence for the recovery of costs

Recovery of any costs incurred in the application of this Regula-
tion shall not take precedence over the recovery of maintenance.

CHAPTER V

ACCESS TO JUSTICE

Article 44

Right to legal aid

1.
Parties who are involved in a dispute covered by this Regu-
lation shall have effective access to justice in another Member
State, including enforcement and appeal or review procedures, in
accordance with the conditions laid down in this Chapter.

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In cases covered by Chapter VII, effective access to justice shall be
provided by the requested Member State to any applicant who is
resident in the requesting Member State.

2.
To ensure such effective access, Member States shall provide
legal aid in accordance with this Chapter, unless paragraph 3
applies.

3.
In cases covered by Chapter VII, a Member State shall not
be obliged to provide legal aid if and to the extent that the pro-
cedures of that Member State enable the parties to make the case
without the need for legal aid, and the Central Authority provides
such services as are necessary free of charge.

Entitlements to legal aid shall not be less than those avail-

4.
able in equivalent domestic cases.

5.
No security, bond or deposit, however described, shall be
required to guarantee the payment of costs and expenses in pro-
ceedings concerning maintenance obligations.

Article 45

Content of legal aid

Legal aid granted under this Chapter shall mean the assistance
necessary to enable parties to know and assert their rights and to
ensure that
lodged through the Central
Authorities or directly with the competent authorities, are fully
and effectively dealt with. It shall cover as necessary the following:

their applications,

(a) pre-litigation advice with a view to reaching a settlement

prior to bringing judicial proceedings;

(b)

legal assistance in bringing a case before an authority or a
court and representation in court;

(c)

exemption from or assistance with the costs of proceedings
and the fees to persons mandated to perform acts during the
proceedings;

(d)

in Member States in which an unsuccessful party is liable for
the costs of the opposing party, if the recipient of legal aid
loses the case, the costs incurred by the opposing party, if
such costs would have been covered had the recipient been
habitually resident in the Member State of the court seised;

(e)

interpretation;

(g)

travel costs to be borne by the recipient of legal aid where the
physical presence of the persons concerned with the presen-
tation of the recipient’s case is required in court by the law
or by the court of the Member State concerned and the court
decides that the persons concerned cannot be heard to the
satisfaction of the court by any other means.

Article 46

Free legal aid for applications through Central Authorities
concerning maintenance to children

1.
The requested Member State shall provide free legal aid in
respect of all applications by a creditor under Article 56 concern-
ing maintenance obligations arising from a parent-child relation-
ship towards a person under the age of 21.

2.
Notwithstanding paragraph 1, the competent authority of
the requested Member State may, in relation to applications other
than those under Article 56(1)(a) and (b), refuse free legal aid if it
considers that, on the merits, the application or any appeal or
review is manifestly unfounded.

Article 47

Cases not covered by Article 46

1.
Subject to Articles 44 and 45, in cases not covered by
Article 46, legal aid may be granted in accordance with national
law, particularly as regards the conditions for the means test or
the merits test.

Notwithstanding paragraph 1, a party who, in the Member
2.
State of origin, has benefited from complete or partial legal aid or
exemption from costs or expenses, shall be entitled, in any pro-
ceedings for recognition, enforceability or enforcement, to ben-
efit from the most favourable legal aid or the most extensive
exemption from costs or expenses provided for by the law of the
Member State of enforcement.

Notwithstanding paragraph 1, a party who, in the Member
3.
State of origin, has benefited from free proceedings before an
administrative authority listed in Annex X, shall be entitled, in any
proceedings for recognition, enforceability or enforcement, to
benefit from legal aid in accordance with paragraph 2. To that
end, he shall present a statement from the competent authority in
the Member State of origin to the effect that he fulfils the finan-
cial requirements to qualify for the grant of complete or partial
legal aid or exemption from costs or expenses.

(f)

translation of the documents required by the court or by the
competent authority and presented by the recipient of legal
aid which are necessary for the resolution of the case;

Competent authorities for the purposes of this paragraph shall be
listed in Annex XI. That Annex shall be established and amended
in accordance with the management procedure referred to in
Article 73(2).

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CHAPTER VI

(b)

seek as far as possible solutions to difficulties which arise in
the application of this Regulation.

COURT SETTLEMENTS AND AUTHENTIC INSTRUMENTS

Article 48

Application of this Regulation to court settlements and
authentic instruments

1.
Court settlements and authentic instruments which are
enforceable in the Member State of origin shall be recognised in
another Member State and be enforceable there in the same way
as decisions, in accordance with Chapter IV.

2.
Central Authorities shall take measures to facilitate the
application of this Regulation and to strengthen their coopera-
tion. For this purpose the European Judicial Network in civil and
commercial matters established by Decision 2001/470/EC shall
be used.

Article 51

Specific functions of Central Authorities

The provisions of this Regulation shall apply as necessary to

2.
court settlements and authentic instruments.

Central Authorities shall provide assistance in relation to

1.
applications under Article 56 and shall in particular:

The competent authority of the Member State of origin shall
3.
issue, at the request of any interested party, an extract from the
court settlement or the authentic instrument using the forms set
out in Annexes I and II or in Annexes III and IV as the case may be.

(a)

transmit and receive such applications;

(b)

initiate or facilitate the institution of proceedings in respect
of such applications.

CHAPTER VII

In relation to such applications Central Authorities shall

2.
take all appropriate measures:

COOPERATION BETWEEN CENTRAL AUTHORITIES

Article 49

Designation of Central Authorities

1.
Each Member State shall designate a Central Authority to
discharge the duties which are imposed by this Regulation on
such an authority.

Federal Member States, Member States with more than one
2.
system of law or Member States having autonomous territorial
units shall be free to appoint more than one Central Authority
and shall specify the territorial or personal extent of their func-
tions. Where a Member State has appointed more than one Cen-
tral 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. If a com-
munication is sent to a Central Authority which is not competent,
the latter shall be responsible for forwarding it to the competent
Central Authority and for informing the sender accordingly.

3.
The designation of the Central Authority or Central Authori-
ties, their contact details, and where appropriate the extent of
their functions as specified in paragraph 2, shall be communi-
cated by each Member State to the Commission in accordance
with Article 71.

Article 50

General functions of Central Authorities

1.

Central Authorities shall:

(a)

cooperate with each other, including by exchanging informa-
tion, and promote cooperation amongst the competent
authorities in their Member States to achieve the purposes of
this Regulation;

(a) where the circumstances require, to provide or facilitate the

provision of legal aid;

(b)

to help locate the debtor or the creditor, in particular pursu-
ant to Articles 61, 62 and 63;

(c)

to help obtain relevant information concerning the income
and, if necessary, other financial circumstances of the debtor
or creditor, including the location of assets, in particular pur-
suant to Articles 61, 62 and 63;

(d)

to encourage amicable solutions with a view to obtaining
voluntary payment of maintenance, where suitable by use of
mediation, conciliation or similar processes;

(e)

to facilitate the ongoing enforcement of maintenance deci-
sions, including any arrears;

(f)

to facilitate the collection and expeditious transfer of main-
tenance payments;

(g)

to facilitate the obtaining of documentary or other evidence,
without prejudice to Regulation (EC) No 1206/2001;

(h)

to provide assistance in establishing parentage where neces-
sary for the recovery of maintenance;

(i)

to initiate or facilitate the institution of proceedings to obtain
any necessary provisional measures which are territorial in
nature and the purpose of which is to secure the outcome of
a pending maintenance application;

(j)

to facilitate the service of documents, without prejudice to
Regulation (EC) No 1393/2007.

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The functions of the Central Authority under this Article
3.
may, to the extent permitted under the law of the Member State
concerned, be performed by public bodies, or other bodies sub-
ject to the supervision of the competent authorities of that Mem-
ber State. The designation of any such public bodies or other
bodies, as well as their contact details and the extent of their func-
tions, shall be communicated by each Member State to the Com-
mission in accordance with Article 71.

A Central Authority may also take specific measures at the
3.
request of another Central Authority in relation to a case having
an international element concerning the recovery of maintenance
pending in the requesting Member State.

For requests under this Article, the Central Authorities shall

4.
use the form set out in Annex V.

4.
Nothing in this Article or in Article 53 shall impose an obli-
gation on a Central Authority to exercise powers that can be exer-
cised only by judicial authorities under the law of the requested
Member State.

Article 52

Power of attorney

The Central Authority of the requested Member State may require
a power of attorney from the applicant only if it acts on his behalf
in judicial proceedings or before other authorities, or in order to
designate a representative so to act.

Article 53

Requests for specific measures

1.
A Central Authority may make a request, supported by rea-
sons, to another Central Authority to take appropriate specific
measures under points (b), (c), (g), (h), (i) and (j) of Article 51(2)
when no application under Article 56 is pending. The requested
Central Authority shall take such measures as are appropriate if
satisfied that they are necessary to assist a potential applicant in
making an application under Article 56 or in determining whether
such an application should be initiated.

2. Where a request for measures under Article 51(2)(b) and (c)
is made, the requested Central Authority shall seek the informa-
tion requested, if necessary pursuant to Article 61. However, the
information referred to in points (b), (c) and (d) of Article 61(2)
may be sought only when the creditor produces a copy of the
decision, court settlement or authentic instrument to be enforced,
accompanied by the extract provided for in Articles 20, 28 or 48,
as appropriate.

The requested Central Authority shall communicate the informa-
tion obtained to the requesting Central Authority. Where that
information was obtained pursuant to Article 61, this communi-
cation shall specify only the address of the potential defendant in
the requested Member State. In the case of a request with a view
to recognition, declaration of enforceability or enforcement, the
communication shall, in addition, specify merely whether the
debtor has income or assets in that State.

Article 54

Central Authority costs

Each Central Authority shall bear its own costs in applying

1.
this Regulation.

2.
Central Authorities may not impose any charge on an appli-
cant for the provision of their services under this Regulation save
for exceptional costs arising from a request for a specific measure
under Article 53.

For the purposes of this paragraph, costs relating to locating the
debtor shall not be regarded as exceptional.

3.
The requested Central Authority may not recover the costs
of the services referred to in paragraph 2 without the prior con-
sent of the applicant to the provision of those services at such
cost.

Article 55

Application through Central Authorities

An application under this Chapter shall be made through the Cen-
tral Authority of the Member State in which the applicant resides
to the Central Authority of the requested Member State.

Article 56

Available applications

A creditor seeking to recover maintenance under this Regu-

1.
lation may make applications for the following:

(a)

recognition or recognition and declaration of enforceability
of a decision;

(b) enforcement of a decision given or recognised in the

requested Member State;

(c)

establishment of a decision in the requested Member State
where there is no existing decision, including where neces-
sary the establishment of parentage;

(d) establishment of a decision in the requested Member State
where the recognition and declaration of enforceability of a
decision given in a State other than the requested Member
State is not possible;

If the requested Central Authority is not able to provide the infor-
mation requested it shall inform the requesting Central Authority
without delay and specify the grounds for this impossibility.

(e) modification of a decision given in the requested Member

State;

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(f) modification of a decision given in a State other than the

requested Member State.

As appropriate, and to the extent known, the application

4.
shall in addition in particular include:

A debtor against whom there is an existing maintenance

2.
decision may make applications for the following:

(a)

the financial circumstances of the creditor;

(a)

recognition of a decision leading to the suspension, or limit-
ing the enforcement, of a previous decision in the requested
Member State;

(b)

the financial circumstances of the debtor, including the name
and address of the employer of the debtor and the nature and
location of the assets of the debtor;

(b) modification of a decision given in the requested Member

(c) any other information that may assist with the location of the

State;

defendant.

(c) modification of a decision given in a State other than the

requested Member State.

3.
For applications under this Article, the assistance and rep-
resentation referred to in Article 45(b) shall be provided by the
Central Authority of the requested Member State directly or
through public authorities or other bodies or persons.

Save as otherwise provided in this Regulation, the applica-
4.
tions referred to in paragraphs 1 and 2 shall be determined under
the law of the requested Member State and shall be subject to the
rules of jurisdiction applicable in that Member State.

Article 57

Application contents

An application under Article 56 shall be made using the

1.
form set out in Annex VI or in Annex VII.

2.

An application under Article 56 shall as a minimum include:

(a) a statement of the nature of the application or applications;

(b)

the name and contact details, including the address, and date
of birth of the applicant;

(c)

the name and, if known, address and date of birth of the
defendant;

(d)

the name and the date of birth of any person for whom
maintenance is sought;

(e)

the grounds upon which the application is based;

(f)

(g)

in an application by a creditor,
information concerning
where the maintenance payment should be sent or electroni-
cally transmitted;

the name and contact details of the person or unit from the
Central Authority of the requesting Member State responsible
for processing the application.

3.
For the purposes of paragraph 2(b), the applicant’s personal
address may be replaced by another address in cases of family vio-
lence, if the national law of the requested Member State does not
require the applicant to supply his or her personal address for the
purposes of proceedings to be brought.

5.
The application shall be accompanied by any necessary sup-
porting information or documentation including, where appro-
priate, documentation concerning the entitlement of the applicant
to legal aid. Applications under Article 56(1)(a) and (b) and under
Article 56(2)(a) shall be accompanied, as appropriate, only by the
documents listed in Articles 20, 28 and 48, or in Article 25 of the
2007 Hague Convention.

Article 58

Transmission, receipt and processing of applications and
cases through Central Authorities

1.
The Central Authority of the requesting Member State shall
assist the applicant in ensuring that the application is accompa-
nied by all the information and documents known by it to be nec-
essary for consideration of the application.

2.
The Central Authority of the requesting Member State shall,
when satisfied that the application complies with the require-
ments of this Regulation, transmit the application to the Central
Authority of the requested Member State.

3.
The requested Central Authority shall, within 30 days from
the date of receipt of the application, acknowledge receipt using
the form set out in Annex VIII, and inform the Central Authority
of the requesting Member State what initial steps have been or
will be taken to deal with the application, and may request any
further necessary documents and information. Within the same
30-day period, the requested Central Authority shall provide to
the requesting Central Authority the name and contact details of
the person or unit responsible for responding to inquiries regard-
ing the progress of the application.

4. Within 60 days from the date of acknowledgement, the
requested Central Authority shall inform the requesting Central
Authority of the status of the application.

Requesting and requested Central Authorities shall keep

5.
each other informed of:

(a)

the person or unit responsible for a particular case;

(b)

the progress of the case;

and shall provide timely responses to enquiries.

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Central Authorities shall process a case as quickly as a

6.
proper consideration of the issues will allow.

Article 61

Access to information for Central Authorities

Central Authorities shall employ the most rapid and effi-

7.
cient means of communication at their disposal.

8.
A requested Central Authority may refuse to process an
application only if it is manifest that the requirements of this
Regulation are not fulfilled. In such a case, that Central Authority
shall promptly inform the requesting Central Authority of its rea-
sons for refusal using the form set out in Annex IX.

9.
The requested Central Authority may not reject an applica-
tion solely on the basis that additional documents or information
are needed. However, the requested Central Authority may ask the
requesting Central Authority to provide these additional docu-
ments or this information. If the requesting Central Authority
does not do so within 90 days or a longer period specified by the
requested Central Authority, the requested Central Authority may
decide that it will no longer process the application. In this case,
it shall promptly notify the requesting Central Authority using the
form set out in Annex IX.

Article 59

Languages

The request or application form shall be completed in the
1.
official language of the requested Member State or, if there are
several official languages in that Member State, in the official lan-
guage or one of the official languages of the place of the Central
Authority concerned, or in any other official language of the insti-
tutions of the European Union which that Member State has indi-
cated it can accept, unless the Central Authority of that Member
State dispenses with translation.

2.
The documents accompanying the request or application
form shall not be translated into the language determined in
accordance with paragraph 1 unless a translation is necessary in
order to provide the assistance requested, without prejudice to
Articles 20, 28, 40 and 66.

1.
Under the conditions laid down in this Chapter and by way
of exception to Article 51(4), the requested Central Authority
shall use all appropriate and reasonable means to obtain the infor-
mation referred to in paragraph 2 necessary to facilitate, in a given
case, the establishment, the modification, the recognition, the dec-
laration of enforceability or the enforcement of a decision.

The public authorities or administrations which, in the course of
their ordinary activities, hold, within the requested State, the
information referred to in paragraph 2 and which control the pro-
cessing thereof within the meaning of Directive 95/46/EC shall,
subject to limitations justified on grounds of national security or
public safety, provide the information to the requested Central
Authority at its request in cases where the requested Central
Authority does not have direct access to it.

Member States may designate the public authorities or adminis-
trations able to provide the requested Central Authority with the
information referred to in paragraph 2. Where a Member State
makes such a designation, it shall ensure that its choice of authori-
ties and administrations permits its Central Authority to have
access,
in accordance with this Article, to the information
requested.

Any other legal person which holds within the requested Mem-
ber State the information referred to in paragraph 2 and controls
the processing thereof within the meaning of Directive 95/46/EC
shall provide the information to the requested Central Authority
at the latter’s request if it is authorised to do so by the law of the
requested Member State.

The requested Central Authority shall, as necessary, transmit the
information thus obtained to the requesting Central Authority.

2.
The information referred to in this Article shall be the infor-
mation already held by the authorities, administrations or persons
referred to in paragraph 1. It shall be adequate, relevant and not
excessive and shall relate to:

(a)

the address of the debtor or of the creditor;

(b)

the debtor’s income;

3.
Any other communication between Central Authorities
shall be in the language determined in accordance with para-
graph 1 unless the Central Authorities agree otherwise.

(c)

the identification of the debtor’s employer and/or of the debt-
or’s bank account(s);

Article 60

Meetings

In order to facilitate the application of this Regulation, Cen-

1.
tral Authorities shall meet regularly.

These meetings shall be convened in compliance with Deci-

2.
sion 2001/470/EC.

(d)

the debtor’s assets.

For the purpose of obtaining or modifying a decision, only the
information listed in point (a) may be requested by the requested
Central Authority.

For the purpose of having a decision recognised, declared enforce-
able or enforced, all the information listed in the first subpara-
graph may be requested by the requested Central Authority.
However, the information listed in point (d) may be requested
only if the information listed in points (b) and (c) is insufficient to
allow enforcement of the decision.

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Article 62

Transmission and use of information

The right of a public body to act in place of an individual to
2.
whom maintenance is owed or to seek reimbursement of benefits
provided to the creditor in place of maintenance shall be gov-
erned by the law to which the body is subject.

The Central Authorities shall, within their Member State,
1.
transmit the information referred to in Article 61(2) to the com-
petent courts, the competent authorities responsible for service of
documents and the competent authorities responsible for enforce-
ment of a decision, as the case may be.

A public body may seek recognition and a declaration of

3.
enforceability or claim enforcement of:

2.
Any authority or court to which information has been
transmitted pursuant to Article 61 may use this only to facilitate
the recovery of maintenance claims.

(a) a decision given against a debtor on the application of a pub-
lic body which claims payment of benefits provided in place
of maintenance;

Except for information merely indicating the existence of an
address, income or assets in the requested Member State, the
information referred to in Article 61(2) may not be disclosed to
the person having applied to the requesting Central Authority,
subject to the application of procedural rules before a court.

3.
Any authority processing information transmitted to it pur-
suant to Article 61 may not store such information beyond the
period necessary for the purposes for which it was transmitted.

4.
Any authority processing information communicated to it
pursuant to Article 61 shall ensure the confidentiality of such
information, in accordance with its national law.

Article 63

Notification of the data subject

Notification of the data subject of the communication of all
1.
or part of the information collected on him shall take place in
accordance with the national law of the requested Member State.

2. Where there is a risk that it may prejudice the effective
recovery of the maintenance claim, such notification may be
deferred for a period which shall not exceed 90 days from the date
on which the information was provided to the requested Central
Authority.

CHAPTER VIII

PUBLIC BODIES

Article 64

Public bodies as applicants

(b) a decision given between a creditor and a debtor to the extent
in place of

the benefits provided to the creditor

of
maintenance.

4.
The public body seeking recognition and a declaration of
enforceability or claiming enforcement of a decision shall upon
request provide any document necessary to establish its right
under paragraph 2 and to establish that benefits have been pro-
vided to the creditor.

CHAPTER IX

GENERAL AND FINAL PROVISIONS

Article 65

Legalisation or other similar formality

No legalisation or other similar formality shall be required in the
context of this Regulation.

Article 66

Translation of supporting documents

Without prejudice to Articles 20, 28 and 40, the court seised may
require the parties to provide a translation of supporting docu-
ments which are not in the language of proceedings only if it
deems a translation necessary in order to give a decision or to
respect the rights of the defence.

Article 67

Recovery of costs

1.
For the purposes of an application for recognition and dec-
laration of enforceability of decisions or for the purposes of
enforcement of decisions, the term ‘creditor’ shall include a pub-
lic body acting in place of an individual to whom maintenance is
owed or one to which reimbursement is owed for benefits pro-
vided in place of maintenance.

Without prejudice to Article 54, the competent authority of the
requested Member State may recover costs from an unsuccessful
party having received free legal aid pursuant to Article 46, on an
exceptional basis and if his financial circumstances so allow.

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Article 68

(b) a description of the measures taken to meet the obligations

Relations with other Community instruments

under Article 51;

1.
Subject to Article 75(2), this Regulation shall modify Regu-
lation (EC) No 44/2001 by replacing the provisions of that Regu-
lation applicable to matters relating to maintenance obligations.

2.
This Regulation shall replace, in matters relating to mainte-
nance obligations, Regulation (EC) No 805/2004, except with
regard to European Enforcement Orders on maintenance obliga-
tions issued in a Member State not bound by the 2007 Hague
Protocol.

3.
In matters relating to maintenance obligations, this Regula-
tion shall be without prejudice to the application of Directive
2003/8/EC, subject to Chapter V.

(c) a description of how effective access to justice is guaranteed,

as required under Article 44, and

(d) a description of national enforcement rules and procedures,
including information on any limitations on enforcement, in
particular debtor protection rules and limitation or prescrip-
tion periods.

Member States shall keep this information permanently updated.

Article 71

This Regulation shall be without prejudice to the applica-

4.
tion of Directive 95/46/EC.

Information on contact details and languages (modelled on
Article 25 of Regulation (EC) No 861/2007)

Article 69

Relations with existing international conventions and
agreements

1.
This Regulation shall not affect the application of bilateral
or multilateral conventions and agreements to which one or more
Member States are party at the time of adoption of this Regula-
tion and which concern matters governed by this Regulation,
without prejudice to the obligations of Member States under
Article 307 of the Treaty.

Notwithstanding paragraph 1, and without prejudice to
2.
paragraph 3, this Regulation shall, in relations between Member
States, take precedence over the conventions and agreements
which concern matters governed by this Regulation and to which
Member States are party.

3.
This Regulation shall not preclude the application of the
Convention of 23 March 1962 between Sweden, Denmark, Fin-
land, Iceland and Norway on the recovery of maintenance by the
Member States which are party thereto, since, with regard to the
recognition, enforceability and enforcement of decisions, that
Convention provides for:

(a)

(b)

simplified and more expeditious procedures for the enforce-
ment of decisions relating to maintenance obligations, and

legal aid which is more favourable than that provided for in
Chapter V of this Regulation.

However, the application of the said Convention may not have
the effect of depriving the defendant of his protection under
Articles 19 and 21 of this Regulation.

Article 70

Information made available to the public

The Member States shall provide within the framework of the
European Judicial Network in civil and commercial matters estab-
lished by Decision 2001/470/EC the following information with
a view to making it available to the public:

(a) a description of the national laws and procedures concern-

ing maintenance obligations;

By 18 September 2010, the Member States shall communi-

1.
cate to the Commission:

(a)

the names and contact details of the courts or authorities
with competence to deal with applications for a declaration
of enforceability in accordance with Article 27(1) and with
appeals against decisions on such applications in accordance
with Article 32(2);

(b)

the redress procedures referred to in Article 33;

(c)

the review procedure for the purposes of Article 19 and the
names and contact details of the courts having jurisdiction;

(d)

(e)

(f)

the names and contact details of their Central Authorities
and, where appropriate, the extent of their functions, in
accordance with Article 49(3);

the names and contact details of the public bodies or other
bodies and, where appropriate, the extent of their functions,
in accordance with Article 51(3);

the names and contact details of the authorities with compe-
for the purposes of
tence in matters of enforcement
Article 21;

(g)

the languages accepted for translations of the documents
referred to in Articles 20, 28 and 40;

(h)

the languages accepted by their Central Authorities for com-
munication with other Central Authorities referred to in
Article 59.

The Member States shall apprise the Commission of any subse-
quent changes to this information.

2.
The Commission shall publish the information communi-
cated in accordance with paragraph 1 in the Official Journal of the
European Union, with the exception of the addresses and other
contact details of the courts and authorities referred to in
points (a), (c) and (f).

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The Commission shall make all information communicated
3.
in accordance with paragraph 1 publicly available through any
other appropriate means, in particular through the European Judi-
cial Network in civil and commercial matters established by Deci-
sion 2001/470/EC.

Article 72

Amendments to the forms

Any amendment to the forms provided for in this Regulation
shall be adopted in accordance with the advisory procedure
referred to in Article 73(3).

Article 73

Committee

The Commission shall be assisted by the committee estab-

1.
lished by Article 70 of Regulation (EC) No 2201/2003.

2. Where reference is made to this paragraph, Articles 4 and 7
of Decision 1999/468/EC shall apply.

The period laid down in Article 4(3) of Decision 1999/468/EC
shall be set at three months.

3. Where reference is made to this paragraph, Articles 3 and 7
of Decision 1999/468/EC shall apply.

Article 75

Transitional provisions

1.
This Regulation shall apply only to proceedings instituted,
to court settlements approved or concluded, and to authentic
instruments established after its date of application, subject to
paragraphs 2 and 3.

2.

(a)

(b)

Sections 2 and 3 of Chapter IV shall apply:

to decisions given in the Member States before the date of
application of this Regulation for which recognition and the
declaration of enforceability are requested after that date;

to decisions given after the date of application of this Regu-
lation following proceedings begun before that date, in so far
as those decisions fall with the scope of Regulation (EC)
No 44/2001 for
recognition and
the purposes of
enforcement.

Regulation (EC) No 44/2001 shall continue to apply to proce-
dures for recognition and enforcement under way on the date of
application of this Regulation.

The first and second subparagraphs shall apply mutatis mutandis
to court settlements approved or concluded and to authentic
instruments established in the Member States.

3.
Chapter VII on cooperation between Central Authorities
shall apply to requests and applications received by the Central
Authority as from the date of application of this Regulation.

Article 74

Review clause

Article 76

Entry into force

By five years from the date of application determined in the third
subparagraph of Article 76 at the latest, the Commission shall
submit to the European Parliament, the Council and the European
Economic and Social Committee a report on the application of
this Regulation, including an evaluation of the practical experi-
ences relating to the cooperation between Central Authorities, in
particular regarding those Authorities’ access to the information
held by public authorities and administrations, and an evaluation
of the functioning of the procedure for recognition, declaration of
enforceability and enforcement applicable to decisions given in a
Member State not bound by the 2007 Hague Protocol. If neces-
sary the report shall be accompanied by proposals for adaptation.

This Regulation shall enter into force on the 20th day following
its publication in the Official Journal of the European Union.

Articles 2(2), 47(3), 71, 72 and 73 shall apply from 18 Septem-
ber 2010.

Except for the provisions referred to in the second paragraph, this
Regulation shall apply from 18 June 2011, subject to the 2007
Hague Protocol being applicable in the Community by that date.
Failing that, this Regulation shall apply from the date of applica-
tion of that Protocol in the Community.

This Regulation shall be binding in its entirety and directly applicable in the Member States in
accordance with the Treaty establishing the European Community.

Done at Brussels, 18 December 2008.

For the Council
The President
M. BARNIER

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ANNEX I

EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE
OBLIGATIONS NOT SUBJECT TO PROCEEDINGS FOR RECOGNITION OR A DECLARATION
OF ENFORCEABILITY

(Articles 20 and 48 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law,
recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

IMPORTANT

To be issued by the court of origin

To be issued only if the decision or court settlement is enforceable in the Member State of origin

Mention only information which is given in the decision or court settlement or of which the court of
origin has been made aware

1.

Nature of the document

Decision

Court settlement

Date and reference number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The decision/court settlement is recognised and enforceable in another Member State without any
possibility of opposing its recognition and without the need for a declaration of enforceability
(Articles 17 and 48 of Regulation (EC) No 4/2009).

2.

Court of origin

2.1.

2.2.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:

2.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3. Member State

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

2.3.

Telephone/Fax/E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Claimant(s) (*)

(**)

3.1.

Person A

3.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) OJ L 7, 10.1.2009, p. 1.
(*)
(**) If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.

If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.

10.1.2009

EN

Official Journal of the European Union

L 7/23

3.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.

Address:

3.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.5.

Has benefited from

3.1.5.1.

legal aid:

Yes

3.1.5.2. exemption from costs and expenses:

Yes

No

No

3.1.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

3.2.

Person B

3.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.

Address:

3.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.5.

Has benefited from

3.2.5.1.

legal aid:

Yes

3.2.5.2. exemption from costs and expenses:

Yes

No

No

3.2.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

L 7/24

EN

Official Journal of the European Union

10.1.2009

3.3.

Person C

3.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.

Address:

3.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.5.

Has benefited from

3.3.5.1.

legal aid:

Yes

3.3.5.2. exemption from costs and expenses:

Yes

No

No

3.3.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

4.

Defendant(s) (*)

(**)

4.1.

Person A

4.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.

Address:

4.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the parties are not the claimant or defendant in the decision/court settlement, indicate either of the parties as claimant or defendant.

(*)
(**) If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.

10.1.2009

EN

Official Journal of the European Union

L 7/25

4.1.5.

Has benefited from

4.1.5.1.

legal aid:

Yes

4.1.5.2. exemption from costs and expenses:

Yes

No

No

4.1.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

4.2.

Person B

4.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.

Address:

4.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.5.

Has benefited from

4.2.5.1.

legal aid:

Yes

4.2.5.2. exemption from costs and expenses:

Yes

No

No

4.2.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

4.3.

Person C

4.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/26

EN

Official Journal of the European Union

10.1.2009

4.3.4.

Address:

4.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.5.

Has benefited from

4.3.5.1.

legal aid:

Yes

4.3.5.2. exemption from costs and expenses:

Yes

No

No

4.3.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

5.

Terms of the decision/court settlement

5.1.

Currency

Euro (EUR)
Hungarian forint (HUF)
Romanian leu (RON)

Bulgarian lev (BGN)

Czech koruna (CZK)

Estonian kroon (EEK)

Lithuanian litas (LTL)

Latvian lats (LVL)

Polish zloty (PLN)

Swedish krona (SEK)

Other (please specify ISO code):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.

Maintenance claim (*)

5.2.1. Maintenance claim A

5.2.1.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.1.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet.

10.1.2009

EN

Official Journal of the European Union

L 7/27

5.2.1.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.1.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.1.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.1.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/28

EN

Official Journal of the European Union

10.1.2009

5.2.2. Maintenance claim B

5.2.2.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.2.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.2.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/29

5.2.2.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3. Maintenance claim C

5.2.3.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.3.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.3.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/30

EN

Official Journal of the European Union

10.1.2009

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . .

Indexation applicable as from: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.3.

Costs and expenses

The decision/court settlement provides that

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

must pay the sum of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s)).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

If additional pages have been attached, state the number of pages: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Done at:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Signature and/or stamp of the court of origin:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/31

ANNEX II

EXTRACT FROM A DECISION/COURT SETTLEMENT IN MATTERS RELATING TO MAINTENANCE
OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF
ENFORCEABILITY

(Article 28 and Article 75(2) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction,
applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance
obligations (1))

IMPORTANT

To be issued by the court of origin

To be issued only if the decision or court settlement is enforceable in the Member State of origin

Mention only information which is given in the decision or court settlement or of which the court of
origin has been made aware

1.

Nature of the document

Decision

Court settlement

Date and reference number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Court of origin

2.1.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.

Address:

2.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3. Member State

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

2.3.

Telephone/Fax/E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Claimant(s) (*)

(**)

3.1.

Person A

3.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) OJ L 7, 10.1.2009, p. 1.
(*)

If the parties are not the claimant or defendant in the decision/court settlement, they should be identified as either the claimant or the
defendant without distinction.

(**) If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.

L 7/32

EN

Official Journal of the European Union

10.1.2009

3.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.

Address:

3.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.5.

Has benefited from

3.1.5.1.

legal aid:

Yes

3.1.5.2. exemption from costs and expenses:

Yes

No

No

3.1.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

3.2.

Person B

3.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.

Address:

3.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.5.

Has benefited from

3.2.5.1.

legal aid:

Yes

3.2.5.2. exemption from costs and expenses:

Yes

No

No

3.2.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

10.1.2009

EN

Official Journal of the European Union

L 7/33

3.3.

Person C

3.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.

Address:

3.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.5.

Has benefited from

3.3.5.1.

legal aid:

Yes

3.3.5.2. exemption from costs and expenses:

Yes

No

No

3.3.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

4.

Defendant(s) (*)

(**)

4.1.

Person A

4.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.

Address:

4.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the parties are not the claimant or defendant in the decision/court settlement, they should be identified as either the claimant or the
defendant without distinction.

(**) If the decision/court settlement concerns more than three claimants or three defendants, attach an additional sheet.

L 7/34

EN

Official Journal of the European Union

10.1.2009

4.1.5.

Has benefited from

4.1.5.1.

legal aid:

Yes

4.1.5.2. exemption from costs and expenses:

Yes

No

No

4.1.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

4.2.

Person B

4.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.

Address:

4.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.5.

Has benefited from

4.2.5.1.

legal aid:

Yes

4.2.5.2. exemption from costs and expenses:

Yes

No

No

4.2.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

4.3.

Person C

4.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/35

4.3.4.

Address:

4.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.5.

Has benefited from

4.3.5.1.

legal aid:

Yes

4.3.5.2. exemption from costs and expenses:

Yes

No

No

4.3.5.3.

free proceedings before an administrative authority listed in Annex X of Regulation (EC) No 4/2009:

Yes

No

5.

Terms of the decision/court settlement

5.1.

Currency

Euro (EUR)
Hungarian forint (HUF)
Romanian leu (RON)

Bulgarian lev (BGN)

Czech koruna (CZK)

Estonian kroon (EEK)

Lithuanian litas (LTL)

Latvian lats (LVL)

Polish zloty (PLN)

Swedish krona (SEK)

Other (please specify ISO code):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.

Maintenance claim (*)

5.2.1. Maintenance claim A

5.2.1.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.1.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet

L 7/36

EN

Official Journal of the European Union

10.1.2009

5.2.1.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.1.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.1.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.1.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/37

5.2.2. Maintenance claim B

5.2.2.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.2.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.2.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/38

EN

Official Journal of the European Union

10.1.2009

5.2.2.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3. Maintenance claim C

5.2.3.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.3.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.3.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/39

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.3.

Costs and expenses

The decision/court settlement provides that

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

must pay the sum of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

to: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s)).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

If additional pages have been attached, state the number of pages: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Done at:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Signature and/or stamp of the court of origin:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/40

EN

Official Journal of the European Union

10.1.2009

ANNEX III

EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE
OBLIGATIONS NOT SUBJECT TO PROCEEDINGS FOR RECOGNITION OR A DECLARATION OF
ENFORCEABILITY

(Article 48 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition
and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

IMPORTANT

To be issued by the competent authority in the Member State of origin

To be issued only if the authentic instrument is enforceable in the Member State of origin

Mention only information which is given in the authentic instrument or of which the competent authority
has been made aware

1.

Date and reference number of the authentic instrument:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The authentic instrument is recognised and enforceable in another Member State without any possi-
bility of opposing its recognition and without the need for a declaration of enforceability (Article 48
of Regulation (EC) No 4/2009).

2.

Nature of the authentic instrument

2.1.

Instrument formally drawn up or registered on:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Agreement concluded or authenticated on:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

2.2.

Competent authority:

2.2.1.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Address:

2.2.2.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.3. Member State

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

2.2.3.

Telephone/Fax/E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Creditor(s) (*)

3.1.

Person A

3.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) OJ L 7, 10.1.2009, p. 1.
(*)

If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.

10.1.2009

EN

Official Journal of the European Union

L 7/41

3.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.

Address:

3.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.

Person B

3.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.

Address:

3.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.

Person C

3.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.

Address:

3.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Debtor(s) (*)

4.1.

Person A

4.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.

Address:

4.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.

L 7/42

EN

Official Journal of the European Union

10.1.2009

4.2.

Person B

4.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.

Address:

4.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.

Person C

4.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.

Address:

4.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Contents of the authentic instrument

5.1.

Currency

Euro (EUR)
Hungarian forint (HUF)
Romanian leu (RON)

Bulgarian lev (BGN)

Czech koruna (CZK)

Estonian kroon (EEK)

Lithuanian litas (LTL)

Latvian lats (LVL)

Polish zloty (PLN)

Swedish krona (SEK)

Other (please specify ISO code):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.

Maintenance claim (*)

5.2.1. Maintenance claim A

5.2.1.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.1.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the authentic instrument concerns more than three maintenance claims, attach an additional sheet.

10.1.2009

EN

Official Journal of the European Union

L 7/43

5.2.1.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.1.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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5.2.1.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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5.2.1.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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L 7/44

EN

Official Journal of the European Union

10.1.2009

5.2.2. Maintenance claim B

5.2.2.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.2.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.2.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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10.1.2009

EN

Official Journal of the European Union

L 7/45

5.2.2.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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5.2.2.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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5.2.3. Maintenance claim C

5.2.3.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.3.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.3.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/46

EN

Official Journal of the European Union

10.1.2009

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.7.

Payment in kind (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.3.

Costs

The authentic instrument provides that

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

must pay the sum of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s)).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

If additional pages have been attached, state the number of pages: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Done at:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Signature and/or stamp of the competent authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/47

ANNEX IV

EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE
OBLIGATIONS SUBJECT TO PROCEEDINGS FOR RECOGNITION AND A DECLARATION OF
ENFORCEABILITY

(Article 48 and Article 75(2) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction,
applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance
obligations (1))

IMPORTANT

To be issued by the competent authority in the Member State of origin

To be issued only if the authentic instrument is enforceable in the Member State of origin

Mention only information which is given in the authentic instrument or of which the competent authority
has been made aware

1.

2.

Date and reference number of the authentic instrument:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nature of the authentic instrument

2.1.

Instrument formally drawn up or registered on:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Agreement concluded or authenticated on:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

2.2.

Competent authority:

2.2.1.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Address:

2.2.2.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.3. Member State:

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

2.2.3.

Telephone/Fax/E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Creditor(s) (*)

3.1.

Person A

3.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) OJ L 7, 10.1.2009, p. 1.
(*)

If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.

L 7/48

EN

Official Journal of the European Union

10.1.2009

3.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.

Address:

3.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.

Person B

3.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.

Address:

3.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.

Person C

3.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.

Address:

3.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

Debtor(s) (*)

4.1.

Person A

4.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.

Address:

4.1.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.

10.1.2009

EN

Official Journal of the European Union

L 7/49

4.2.

Person B

4.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.

Address:

4.2.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.2.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.

Person C

4.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.3.

Identity number or social security number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.

Address:

4.3.4.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.3.4.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Contents of the authentic instrument

5.1.

Currency

Euro (EUR)
Hungarian forint (HUF)
Romanian leu (RON)

Bulgarian lev (BGN)

Czech koruna (CZK)

Estonian kroon (EEK)

Lithuanian litas (LTL)

Latvian lats (LVL)

Polish zloty (PLN)

Swedish krona (SEK)

Other (please specify ISO code):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.

Maintenance claim (*)

5.2.1. Maintenance claim A

5.2.1.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.1.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If the decision/court settlement concerns more than three maintenance claims, attach an additional sheet.

L 7/50

EN

Official Journal of the European Union

10.1.2009

5.2.1.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.1.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.1.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.1.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.1.8.

Other form of payment (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/51

5.2.2. Maintenance claim B

5.2.2.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.2.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.2.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/52

EN

Official Journal of the European Union

10.1.2009

5.2.2.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.2.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.2.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3. Maintenance claim C

5.2.3.1. The maintenance is to be paid

by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s) of the person to whom the sum must actually be paid)

Person for whom maintenance is owed:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

5.2.3.2.

Amount to be paid in one sum

Period covered, where applicable:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(from date (dd/mm/yyyy) to date (dd/mm/yyyy) or event)

Due date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.3.

Amount to be paid in instalments

Due date
(dd/mm/yyyy)

Amount

5.2.3.4.

Sum to be paid regularly

Once a week

Once a month

Other (state frequency): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

Due day/date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/53

If applicable, until (date (dd/mm/yyyy) or event):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the maintenance claim is subject to indexation, please indicate how that indexation is to be calculated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indexation applicable as from . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.5.

Amount due retroactively

Period covered:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ((dd/mm/yyyy) to (dd/mm/yyyy))

Amount: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form of payment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.6.

Interest (if specified in the decision/court settlement)

If the maintenance claim is subject to interest, please indicate the rate:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interest due as from:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

5.2.3.7.

Payment in kind (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.3.8.

Other form of payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.3.

Costs

The authentic instrument provides that

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s))

must pay the sum of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s)).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

If additional pages have been attached, state the number of pages: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Done at:
Signature and/or stamp of the competent authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/54

EN

Official Journal of the European Union

10.1.2009

ANNEX V

REQUEST FOR SPECIFIC MEASURES

(Article 53 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition
and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

PART A: To be completed by the requesting Central Authority

1.

Requesting Central Authority

1.1.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2.

Address:

1.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2.3. Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

1.3.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.4.

Fax:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.5.

E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.6.

Reference number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.7.

Person responsible for following up the request:

1.7.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.7.2.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.7.3.

E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Requested Central Authority

2.1.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.

Address:

2.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3. Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

(1) OJ L 7, 10.1.2009, p. 1.

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

10.1.2009

EN

Official Journal of the European Union

L 7/55

3.

Request

3.1.

The purpose of the specific measure requested is to:

3.1.1.

help locate the debtor or the creditor (see points 3.3. and 3.4.)

3.1.2.

facilitate the search for information on the income or assets of the debtor or the creditor (see points 3.3.
and 3.4.)

3.1.3.

facilitate the obtaining of documentary or other evidence

3.1.4.

obtain assistance in establishing parentage

3.1.5.

initiate or facilitate the institution of proceedings to obtain a necessary provisional measure which is territorial
in nature

3.1.6.

facilitate service of a document

3.2.

Grounds for the request:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.

The information requested relates to:

3.3.1.

the following debtor

3.3.1.1. Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.1.2. Date (dd/mm/yyyy) and place of birth (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.1.3. Last known address:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.1.4.

Identity number or social security number (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.1.5. Any other information which may be useful (**):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.

the following creditor

3.3.2.1. Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.2. Date (dd/mm/yyyy) and place of birth (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.3. Last known address:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.4.

Identity number or social security number (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3.2.5. Any other information which may be useful (**):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If this information is available.

(*)
(**) For example, the name of a previous employer, names and addresses of family members, details of a vehicle or property which the person

in question might own.

L 7/56

EN

Official Journal of the European Union

10.1.2009

3.4.

Information requested

3.4.1.

Current address of the debtor/creditor

3.4.2.

Income of the debtor/creditor

3.4.3.

Assets of the debtor/creditor, including the location of the assets of the debtor/creditor

The creditor has produced a copy of the decision, court settlement or authentic instrument to be enforced, if
appropriate accompanied by the relevant form

Yes

No

There is a risk that notifying the person concerned by the collection of this information may prejudice the
effective recovery of the maintenance claim (Article 63(2) of Regulation (EC) No 4/2009).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

Done at:
Name and signature of the authorised official of the requesting Central Authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

PART B: To be completed by the requested Central Authority

4.

5.

Reference number of the requested Central Authority:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Person responsible for following up the request:

5.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.3.

Fax:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.4.

E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

Measures taken and results obtained

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/57

7.

Information collected:

7.1.

Without recourse to Articles 61, 62 and 63 of Regulation (EC) No 4/2009:

7.1.1.

Debtor’s/creditor’s address:

No

Yes (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.1.2.

Debtor’s/creditor’s revenue:

No

Yes (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.1.3.

Debtor’s/creditor’s assets:

No

Yes (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.2.

Pursuant to Articles 61, 62 and 63 of Regulation (EC) No 4/2009:

7.2.1.

Debtor’s/creditor’s address:

No

Yes (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.2.2.

Existence of debtor’s income:

No

7.2.3.

Existence of debtor’s assets:

No

IMPORTANT

Yes

Yes

(in the case of the application of Articles 61, 62 and 63 of Regulation (EC) No 4/2009)

Except for information merely indicating the existence of an address, income or assets in the requested Member
State, the information referred to in Article 61(1) may not be disclosed to the person having applied to the
requesting Central Authority, subject to the application of procedural rules before a court (Article 62(2), second
subparagraph, of Regulation (EC) No 4/2009).

L 7/58

EN

Official Journal of the European Union

10.1.2009

8.

Inability to communicate the requested information

The requested Central Authority is not able to provide the information requested, for the following reasons:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

Done at:
Name and signature of the authorised official of the requested Central Authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

10.1.2009

EN

Official Journal of the European Union

L 7/59

ANNEX VI

APPLICATION FORM WITH A VIEW TO THE RECOGNITION, DECLARATION OF ENFORCEABILITY
OR ENFORCEMENT OF A DECISION IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS

(Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law,
recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

PART A: To be completed by the requesting Central Authority

1.

Application

Application for recognition or for recognition and declaration of enforceability of a decision
(Article 56(1)(a))

Application for recognition of a decision (Article 56(2)(a))

Application for enforcement of a decision given or recognised in the requested Member State
(Article 56(1)(b))

2.

2.1.

2.2.

Requesting Central Authority

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:

2.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3.

Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

2.3.

2.4.

2.5.

2.6.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reference number of the application:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Application to be handled with the application(s) bearing the following reference number(s):

. . . . . . . . . . . . . . . . . . .

2.7.

Person responsible for following up the application:

2.7.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.7.2.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.7.3.

E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) OJ L 7, 10.1.2009, p. 1.

L 7/60

EN

Official Journal of the European Union

10.1.2009

3.

3.1.

3.2.

Requested Central Authority

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:

3.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.3.

Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

4.

Documents attached (*) to the application in the case of a decision made in a Member State

A copy of the decision/court settlement/authentic instrument

An extract from the decision/court settlement/authentic instrument using the form set out in Annex I,
Annex II, Annex III or Annex IV

A transliteration or translation of the contents of the form set out in Annex I, Annex II, Annex III or
Annex IV

Where appropriate, a copy of the decision on the declaration of enforceability

A document showing the amount of any arrears and the date such amount was calculated

A document indicating that the applicant has benefited from legal aid or from exemption from costs and
expenses

A document indicating that the applicant has benefited from free proceedings before an administrative
authority in the Member State of origin, and confirming that the applicant fulfils the financial require-
ments to qualify for legal aid or exemption from costs and expenses

A document establishing the right of the public body to apply for reimbursement of benefits paid to the
creditor and justifying the payment of such benefits

Other (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Documents attached (*) to the application in the case of a decision made in a third State

The complete text of the decision

A summary of or extract from the decision drawn up by the competent authority of the State of origin

A document stating that the decision is enforceable in the State of origin and, in the case of a decision by
an administrative authority, a document stating that the requirements of Article 19(3) of the 2007 Hague
Convention are met

(*) Please put a cross in the boxes which apply and number the documents in the order in which they are attached.

10.1.2009

EN

Official Journal of the European Union

L 7/61

If the defendant did not appear and was not represented in the proceedings in the State of origin, a docu-
ment or documents attesting, as appropriate, either that the defendant had proper notice of the proceed-
ings and an opportunity to be heard, or that the defendant had proper notice of the decision and the
opportunity to challenge it or appeal it on fact and law

A document showing the amount of any arrears and the date such amount was calculated

A document providing the information necessary to make appropriate calculations in the case of a deci-
sion providing for automatic adjustment by indexation

A document showing the extent to which the applicant received free legal assistance in the State of origin

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total number of documents attached to the application form: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Done at: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Name and signature of the authorised official of the requesting Central Authority: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART B: To be completed by the applicant or, as appropriate, by the person/authority authorised in the
requesting Member State to complete the form on the applicant’s behalf

6.

6.1.

Application

Application for recognition or for recognition and declaration of enforceability of a decision

The application is based on:

6.1.1.

Chapter IV, Section 2, of Regulation (EC) No 4/2009

6.1.2.

The 2007 Hague Convention

6.1.2.1.

Indicate the basis for recognition and enforcement under Article 20 of the 2007 Hague Convention:

. . . . . . . . .

6.1.2.2.

The defendant has appeared or been represented in the proceedings in the State of origin:

Yes

No

6.1.3.

The national law of the requested Member State

6.1.4.

Other (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.2.

Application for enforcement of a decision given or recognised in the requested Member State

L 7/62

EN

Official Journal of the European Union

10.1.2009

7.

7.1.

7.2.

Decision

Date and reference number:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name of the court of origin: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

Applicant

8.1.

Natural person

8.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.3.

Identity number or social security number (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.4.

Nationality: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.5.

Profession: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.6.

Marital status: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.7.

Address:

8.1.7.1.

c/o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (surname and given name(s)) (**)

8.1.7.2.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.7.3.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.7.4.

Member State

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

8.1.8.

Telephone/E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.1.9.

Has benefited from:

8.1.9.1.

legal aid:

Yes

8.1.9.2.

exemption from costs and expenses:

Yes

No

No

8.1.9.3.

free proceedings before an administrative authority listed in Annex IX to Regulation (EC) No 4/2009:

Yes

No

8.1.10.

Where appropriate, surname, given name(s) and details of applicant’s representative (lawyer, etc.):

. . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If available.

(*)
(**) In cases of family violence (see Article 57(3) of Regulation (EC) No 4/2009).

10.1.2009

EN

Official Journal of the European Union

L 7/63

8.2.

Public body

8.2.1.

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.2.

Address:

8.2.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.2.3.

Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

8.2.3.

Telephone/Fax/E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.4.

Name of the person representing the body in the proceedings (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.5.

Person responsible for following up the application:

8.2.5.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.5.2.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.5.3.

Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2.5.4.

E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

9.1.

9.2.

9.3.

9.4.

9.5.

9.6.

9.7.

Defendant

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date (dd/mm/yyyy) and place of birth (**):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Identity number or social security number (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nationality (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Profession (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marital status (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address (**):

9.7.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.7.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.7.3.

Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary Malta
Finland

Slovakia

10.

Any other information that may help locate the defendant:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If relevant.

(*)
(**) If this information is available.

L 7/64

EN

Official Journal of the European Union

10.1.2009

11.

11.1.

11.2.

11.3.

Person(s) for whom maintenance is sought or owed (*)

The person is the same as the applicant named in point 8

The person is the same as the defendant named in point 9

The applicant

The defendant

is the representative (**) defending the interests of the following person(s):

11.3.1.

Person A

11.3.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.1.3.

Identity number or social security number (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.1.4.

Nationality (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.1.5.

Profession (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.1.6. Marital status (***):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.2.

Person B

11.3.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.2.3.

Identity number or social security number (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.2.4.

Nationality (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.2.5.

Profession (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.2.6. Marital status (***):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.3.

Person C

11.3.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.3.3.

Identity number or social security number (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.3.4.

Nationality (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.3.5.

Profession (***): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.3.3.6. Marital status (***):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.

12.1.

12.2.

12.3.

Debtor

The person is the same as the applicant named in point 8

The person is the same as the defendant named in point 9

The applicant

The defendant

is the representative (**) defending the interests of the following person:

12.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If more than three persons, attach an additional sheet.

(*)
(**) For example the person with parental responsibility or the guardian of a protected adult.
(***) If this information is available and/or relevant.

10.1.2009

EN

Official Journal of the European Union

L 7/65

12.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.3.3.

Identity number or social security number (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.3.4.

Nationality (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.3.5.

Profession (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.3.6.

Marital status (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.

Information regarding payment, if the application is made by the creditor

13.1.

Payment by electronic means

13.1.1.

Name of the bank:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.1.2.

BIC or other relevant bank code: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.1.3.

Account holder:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.1.4.

International Bank Account Number (IBAN):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.2.

Payment by cheque

13.2.1.

Cheque payable to: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.2.2.

Cheque to be sent to

13.2.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.2.2.2.

Address:

13.2.2.2.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.2.2.2.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.2.2.2.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14.

Additional information (where applicable):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Done at: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Signature of applicant: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and/or, where appropriate:
Name and signature of the person/authority authorised in the requesting Member State to complete the form
on the applicant’s behalf:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If this information is available.

L 7/66

EN

Official Journal of the European Union

10.1.2009

ANNEX VII

APPLICATION FORM TO OBTAIN OR HAVE MODIFIED A DECISION IN MATTERS RELATING TO
MAINTENANCE OBLIGATIONS

(Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law,
recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

PART A: To be completed by the requesting Central Authority

1.

Application

Application to obtain a decision (Article 56(1)(c))

Application to obtain a decision (Article 56(1)(d))

Application for the modification of a decision (Article 56(1)(e))

Application for the modification of a decision (Article 56(1)(f))

Application for the modification of a decision (Article 56(2)(b))

Application for the modification of a decision (Article 56(2)(c))

2.

2.1.

2.2.

Requesting Central Authority

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:

2.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3.

Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

2.3.

2.4.

2.5.

2.6.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reference number of the application:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Application to be handled with the application(s) bearing the following reference number(s):

. . . . . . . . . . . . . . . . . . .

2.7.

Person responsible for following up the application:

2.7.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.7.2.

Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.7.3.

E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1) OJ L 7, 10.1.2009, p. 1.

10.1.2009

EN

Official Journal of the European Union

L 7/67

3.

3.1.

3.2.

Requested Central Authority

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:

3.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.2.3.

Member State

Bulgaria

France

Italy
Austria

Belgium
Spain
Netherlands
Sweden

Czech Republic
Cyprus
Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

4.

Documents attached (*) to the application, as appropriate

Decision of the requested Member State refusing recognition or a declaration of enforceability

Copy of the decision to be modified

Extract from the decision to be modified

Document(s) proving a change in income or any other change in circumstances

Birth certificate(s) or equivalent

Debtor’s acknowledgement of parentage

Document(s) proving biological parentage

Decision by a competent authority in relation to parentage

Results of genetic tests

Adoption certificate

Certificate of marriage or similar relationship

Document(s) proving the date of divorce/separation

Document(s) proving that the parties live together

Certificate(s) regarding schooling

Document(s) relevant to the financial situation

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total number of documents attached to the application form: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Done at: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Name and signature of the authorised official of the requesting Central Authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*) Please put a cross in the boxes which apply and number the documents in the order in which they are attached.

L 7/68

EN

Official Journal of the European Union

10.1.2009

PART B: To be completed by the applicant or, as appropriate, by the person/authority authorised in the
requesting Member State to complete the form on the applicant’s behalf

5.

5.1.

5.1.1.

5.1.2.

5.1.3.

5.1.4.

5.2.

5.2.1.

5.2.2.

Application

Application to obtain a decision

Parentage has not been established

No decision exists

Recognition and a declaration of enforceability of an existing decision are not possible

Amount requested:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Application for modification of a decision

The decision was given in the requested Member State

The decision was given in a State other than the requested Member State

5.2.3.

Date (dd/mm/yyyy) and reference number of the decision: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.4.

Name of the court of origin: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.2.5.

Changes in circumstances which have occurred:

Change in income:

of the person(s) for whom maintenance is sought or owed

of the person primarily responsible for the person(s) for whom maintenance is sought or owed

of the debtor

Change in expenses and charges:

of the person(s) for whom maintenance is sought or owed

of the person primarily responsible for the person(s) for whom maintenance is sought or owed

of the debtor

Change in the situation of the child/children

Change in marital status:

of the person(s) for whom maintenance is sought or owed

of the person primarily responsible for the person(s) for whom maintenance is sought or owed

of the debtor

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/69

5.2.6.

Modification(s) requested:

Increase in the amount of maintenance (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reduction in the amount of maintenance (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Modification of the frequency of payments (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Modification of the arrangements for payment (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Modification of the nature of payments (please specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Termination of the maintenance obligation (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

6.1.

6.2.

Applicant

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:

6.2.1.

Care of: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Surname and given name(s)) (*)

6.2.2.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.2.3.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.2.4.

Member State

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

6.3.

6.4.

6.5.

6.6.

6.7.

6.8.

6.9.

Telephone/E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Identity/social security number (**):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nationality: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Profession: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current marital status: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If applicable, surname, given name(s) and contact details of the applicant’s representative (lawyer, etc.

. . .):

. . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)
(**)

In cases of domestic violence (see Article 57(3) of Regulation (EC) No 4/2009).
If this information is available.

L 7/70

EN

Official Journal of the European Union

10.1.2009

7.

7.1.

7.2.

Defendant

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address (*):

7.2.1.

Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.2.2.

Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.2.3.

Member State

Belgium
Spain
Netherlands
Sweden

Bulgaria

France

Italy

Czech Republic
Cyprus

Austria

Poland

Latvia
Portugal

Lithuania
Romania

Germany

Estonia

Ireland
Luxembourg
Slovenia

Greece
Hungary

Malta

Slovakia

Finland

7.3.

7.4.

7.5.

7.6.

7.7.

Date (dd/mm/yyyy) and place of birth (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Identity/social security number (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nationality (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Profession (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current marital status (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

Any other information that may help locate the defendant:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

9.1.

9.2.

9.3.

Person(s) for whom maintenance is sought or owed (**)

The person is the same as the applicant named in point 6

The person is the same as the defendant named in point 7

The applicant

The defendant

is the representative (***) defending the interests of the following person(s):

9.3.1.

Person A

9.3.1.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.1.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.1.3.

Identity/social security number (****): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If this information is available.
If more than three persons, attach an additional sheet.

(*)
(**)
(***) For example, the person with parental responsibility or the guardian of a protected adult.
(****) If this information is available and/or relevant.

10.1.2009

EN

Official Journal of the European Union

L 7/71

9.3.1.4.

Nationality (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.1.5.

Profession (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.1.6.

Current marital status (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.1.7.

Maintenance is on the basis of the following relationship:

Parentage (please specify relationship):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marriage

Analogous relationship to marriage

Alliance (please specify relationship): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.

Person B

9.3.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.3.

Identity/social security number (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.4.

Nationality (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.5.

Profession (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.6.

Current marital status (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.2.7.

Maintenance is on the basis of the following relationship:

Parentage (please specify relationship):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marriage

Analogous relationship to marriage

Alliance (please specify relationship): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.3.

Person C

9.3.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.3.3.

Identity/social security number (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.3.4.

Nationality (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.3.5.

Profession (*):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.3.3.6.

Current marital status (*): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)

If this information is available and/or relevant.

L 7/72

EN

Official Journal of the European Union

10.1.2009

9.3.3.7.

Maintenance is on the basis of the following relationship:

Parentage (please specify relationship):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marriage

Analogous relationship to marriage

Alliance (please specify relationship): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.

Debtor

10.1.

10.2.

10.3.

The person is the same as the applicant named in point 6

The person is the same as the defendant named in point 7

The applicant

The defendant

is the representative (*) defending the interests of the following person:

10.3.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3.2.

Date (dd/mm/yyyy) and place of birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3.3.

Identity/social security number (**):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3.4.

Nationality (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3.5.

Profession (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3.6.

Current marital status (**): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3.7.

Maintenance is on the basis of the following relationship:

Parentage (please specify relationship):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Marriage

Analogous relationship to marriage

Affinity (please specify relationship):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.

Information on the financial situation of the persons concerned by the application (only give infor-
mation which is relevant for the purpose of obtaining or modifying a decision)

11.1.

Currency

Euro (EUR)
Hungarian forint (HUF)
Romanian leu (RON)

Bulgarian lev (BGN)

Czech koruna (CZK)

Estonian kroon (EEK)

Lithuanian litas (LTL)

Latvian lats (LVL)

Polish zloty (PLN)

Swedish krona (SEK)

Other (please specify ISO code):

. . . . . . . . . . . . . . . . . . . . . . . . . . .

(*)
(**)

For example, the person with parental responsibility or the guardian of a protected adult.
If this information is available.

10.1.2009

EN

Official Journal of the European Union

L 7/73

11.2.

The person(s) for whom maintenance is sought or owed and the person primarily responsible for that person (those persons)

11.2.1.

Gross income

Monthly

Annual

Person primarily
responsible for the
person(s) for
whom mainte-
nance is sought or
owed

Spouse or current
partner of the per-
son primarily
responsible for the
person(s) for
whom mainte-
nance is sought or
owed

Person for whom
maintenance is
sought or owed
(Person A)

Person for whom
maintenance is
sought or owed
(Person B)

Person for whom
maintenance is
sought or owed
(Person C)

Salary (including payments in
kind), pensions, disability pen-
sions, maintenance payments,
allowances, annuities, unemploy-
ment benefits

Income from non-salaried occupa-
tions

Income from securities/floating
capital/real property

Other sources of income

TOTAL

11.2.2.

Expenses and charges

Person primarily
responsible for the
person(s) for
whom mainte-
nance is sought or
owed

Spouse or current
partner of the per-
son primarily
responsible for the
person(s) for
whom mainte-
nance is sought or
owed

Person for whom
maintenance is
sought or owed
(Person A)

Person for whom
maintenance is
sought or owed
(Person B)

Person for whom
maintenance is
sought or owed
(Person C)

Monthly

Annual

Taxes

Insurance premiums, mandatory
social security and professional
contributions

Rent/cost of co-ownership, mort-
gage payments

Food and clothing

Medical expenses

Maintenance paid to a third party
by virtue of a legal obligation
and/or expenditure for other
dependent persons not covered by
the application

Education costs of children

Loan repayments, other debts

Other expenditure

TOTAL

L 7/74

EN

Official Journal of the European Union

10.1.2009

11.2.3.

Other assets

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Debtor

Current spouse or partner
of the debtor

Debtor

Current spouse or partner
of the debtor

11.3.

The debtor

11.3.1.

Gross income

Monthly

Annual

Salary (including payments in kind), pensions, disability
pensions, alimonies, allowances, annuities, unemployment
benefits

Income from non-salaried occupations

Income from securities/floating capital/real property

Other sources of income

TOTAL

11.3.2.

Expenses and charges

Monthly

Annual

Taxes

Insurance premiums, mandatory social security and profes-
sional contributions

Rent/cost of co-ownership, mortgage payments

Food and clothing

Medical expenses

Maintenance paid to a third party by virtue of a legal obli-
gation and/or expenditure for other dependent persons not
covered by the application

Education costs of children

Loan repayments, other debts

Other expenditure

11.3.3.

Other assets

TOTAL

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.1.2009

EN

Official Journal of the European Union

L 7/75

12.

Information regarding payment, if the application is made by the creditor

12.1.

Payment by electronic means

12.1.1.

Name of the bank:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.1.2.

BIC or other relevant bank code: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.1.3.

Account holder:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.1.4.

International Bank Account Number (IBAN):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.2.

Payment by cheque

12.2.1.

Cheque payable to: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.2.2.

Cheque to be sent to

12.2.2.1.

Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.2.2.2.

Address:

12.2.2.2.1. Street and number/PO box: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.2.2.2.2. Place and postal code:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.2.2.2.3. Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.

Additional information (where applicable):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Done at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)
Signature of applicant: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and/or, where applicable:
Name and signature of the person/authority authorised in the requesting Member State to complete the form
on the applicant’s behalf:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L 7/76

EN

Official Journal of the European Union

10.1.2009

ANNEX VIII

ACKNOWLEDGEMENT OF RECEIPT OF AN APPLICATION

(Article 58(3) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law,
recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

This acknowledgement of receipt must be sent within 30 days from the date of receipt of the application.

1.

Requesting Central Authority

1.1.

Reference number of the requesting Central Authority: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2.

Surname and given name(s) of the person responsible for following up the application:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Requested Central Authority

2.1.

Reference number of the requested Central Authority: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.

Person responsible for following up the application:

2.2.1. Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2. Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3. Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.4. E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Date received:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

4.

Initial steps which have been or will be taken to deal with the application

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Further necessary documents or information (please specify)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A status report will be sent within 60 days.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

Done at:
Name and signature of the authorised official of the requested Central Authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

(1) OJ L 7, 10.1.2009, p. 1.

10.1.2009

EN

Official Journal of the European Union

L 7/77

ANNEX IX

NOTIFICATION OF REFUSAL OR OF DECISION NO LONGER TO PROCESS AN APPLICATION

(Article 58(8) and (9) of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law,
recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations (1))

1.

Requesting Central Authority

1.1.

Reference number of the requesting Central Authority: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2.

Surname and given name(s) of the person responsible for following up the application:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

Requested Central Authority

2.1.

Reference number of the requested Central Authority: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.

Person responsible for following up the application:

2.2.1. Surname and given name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.2. Telephone:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.3. Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.2.4. E-mail:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

The requested Central Authority refuses to process the application because it is manifest that the
required conditions have not been met

Reasons (please specify):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

The requested Central Authority is no longer processing the application because the requesting Central
Authority has not supplied the additional information sought by the requested Central Authority within
90 days or a longer period specified by the latter

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on:

Done at:
Name and signature of the authorised official of the requested Central Authority:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (dd/mm/yyyy)

(1) OJ L 7, 10.1.2009, p. 1.

L 7/78

EN

Official Journal of the European Union

10.1.2009

The administrative authorities referred to in Article 2(2) of Regulation (EC) No 4/2009 are as follows:

ANNEX X

10.1.2009

EN

Official Journal of the European Union

L 7/79

The competent authorities referred to in Article 47(3) of Regulation (EC) No 4/2009 are as follows:

ANNEX XI