ANNEX I
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Application for a European order for payment
Form A Article 7 (1) of Regulation (EC) No 1896/2006 of the European Parliament
and of the Council creating a European order for payment procedure
Please ensure that you read the guidelines on the last page – they will help you to understand this form!
Please note in particular that this form must be completed in the language or one of the languages accepted by the court to be seised. The form is available in all official languages of the European Union; this may help you fill in the form in the required language.
1. Court
Court
Address
Postal code
City
Country
Case number
(to be completed by the court)
Received by the court
2. Parties and their representatives
Codes: 01 Claimant 03 Claimant's representative * 05 Claimant's legally authorised representative **
02 Defendant 04 Defendant's representative * 06 Defendant's legally authorised representative **
Code
Surname, first name/Name of company or organisation
Identification code (if applicable)
Address
Postal code
City
Country
Phone ***
Fax ***
e-Mail ***
Occupation ***
Other details ***
Code
Surname, first name/Name of company or organisation
Identification code (if applicable)
Address
Postal code
City
Country
Phone ***
Fax ***
e-Mail ***
Occupation ***
Other details ***
Code
Surname, first name/Name of company or organisation
Identification code (if applicable)
Address
Postal code
City
Country
Phone ***
Fax ***
e-Mail ***
Occupation ***
Other details ***
Code
Surname, first name/Name of company or organisation
Identification code (if applicable)
Address
Postal code
City
Country
Phone ***
Fax ***
e-Mail ***
Occupation ***
Other details ***
* e.g. lawyer ** e.g. parent, guardian, managing director *** optional
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3. Grounds for the court's jurisdiction
Codes:
01 Domicile of the defendant or co-defendant
02 Place of performance of the obligation in question
03 Place of the harmful event
04 Where a dispute arises out of the operations of a branch, agency or other establishment, the place in which the branch, agency or other establishment is situated
05 Domicile of the trust
06 Where a dispute arises concerning the payment of remuneration claimed in respect of the salvage of a cargo or freight, the place of the court under the authority of which the cargo or freight is or could have been arrested 07 Domicile of the policyholder, the insured or the beneficiary in insurance matters
08 Domicile of the consumer
09 Place where the employee carries out his work
10 Place where the business which engaged the employee is situated
11 Place where the immovable property is situated
12 Choice of court agreed by the parties
13 Domicile of the maintenance creditor
14 Other (please specify)
Code
Specification only for code 14
4. Cross-border nature of the case
Codes:
01 Belgium
02 Czech Republic
03 Germany
04 Estonia
05 Greece
06 Spain
07 France
08 Ireland
09 Italy
10 Cyprus
11 Lattland
12 Litauen
13 Luxemburg
14 Ungam
15 Malta
16 The Netherlands
17 Austria
18 Poland
19 Portugal
20 Slovenia
21 Slovakia
22 Finland
23 Sweden
24 United Kingdom
25 other (please specify)
Domicile or habitual residence of claimant
Domicile or habitual residence of defendant
Country of the court
5. Bank details (optional)
5.1 Payment of court fees by the claimant
Codes: 01 By bank transfer 02 By credit card 03 Collection by court from claimant's bank account
04 Legal aid 05 Other (please specify)
If you choose code 02 or 03, please fill in the bank details in Appendix 1
Code
If you choose code 05, please specify
5.2 Payment by defendant of amount awarded
Account holder
Bank name (BIC) or other relevant bank code
Account number
International bank account number (IBAN)
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EUR Euro CYP Cypriot Pound CZK Czech Koruna EEK Estonian Kroon GBP Pound sterling
HUF Hungarian Forint LTL Lithuanian Litas LVL Latvian Lats MTL Maltese Lira PLN Polish Zloty
SEK Swedish Krona SIT Slovenian Tolars SKK Slovak Koruna Other (according to international banking code)
6. Principal Currency
Total value of principal, excluding interest and costs
The claim relates to (Code 1)
01 Sales contract
02 Rental agreement - movable property
03 Rental agreement - immovable property
04 Rental agreement - commercial lease
05 Contract of service - electricity, gas, water, phone
06 Contract of service - medical services
07 Contract of service - transport
08 Contract of service - legal, tax, technical advice
09 Contract of service - hotel, restaurant
10 Contract of service - repair 11 Contract of service - brokerage
12 Contract of service - other (please specify)
13 Building contract
14 Insurance contract
15 Loan
16 Guarantee or other collateral(s)
17 Claims arising from non-contractual obligations if they are subject to an agreement between the parties or an admission of debt (e.g. damages, unjust enrichment) 18 Claims arising from joint ownership of property
19 Damages - contract
20 Subscription agreement (newspaper, magazine)
21 Membership fee
22 Employment agreement
23 Out-of-court settlement
24 Maintenance agreement
25 Other (please specify)
Circumstances invoked (Code 2)
30 Non-payment
31 Insufficient payment
32 Late payment 33 Non-delivery of goods or services
34 Delivery of defective goods or poor services 35 Goods or services not in conformity with the order
36 Other (please specify)
Other details (Code 3)
40 Place of purchase
41 Place of delivery
42 Date of purchase 43 Date of delivery
44 Type of goods or services concerned
45 Address of immovable property 46 In case of loan, purpose: Consumer credit
47 In case of loan, purpose: Mortgage credit
48 Other detail (please specify)
ID
1 Code 1
Code 2
Code 3
Explanatory statement
Date (or period)
Amount
ID
Code 1
Code 2
Code 3
Explanatory statement
Date (or period)
Amount
ID
Code 1
Code 2
Code 3
Explanatory statement
Date (or period)
Amount
ID
Code 1
Code 2
Code 3
Explanatory statement
Date (or period)
Amount
The claim has been assigned to the claimant by (if applicable)
Surname, first name/Name of company or organisation
Identification code (if applicable)
Address
Postal code
City
Country
Additional specifications for claims relating to consumer contracts (if applicable)
The claim concerns matters relating to consumer contracts If yes, the defendant is the consumer If yes, the defendant is domiciled within the meaning of Article 59 of Council Regulation (EC) No 44/2001 in the Member State where the court is seised
yes no yes no yes no
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7. Interest
Codes (please combine number with letter):
01 Statutory 02 Contractual 03 Capitalisation of interest 04 Interest rate on a loan ** 05 Amount calculated by the claimant 06 Other ***
A per year B per half year C per quarter D per month E Other ***
ID *
Code
Interest rate (%)
% over base rate (ECB)
on (amount)
Starting from
to
ID *
Code
Zinssatz (%)
% über dem Bassissatz der EZB
auf (Betrag)
Ab
bis
ID *
Code
Zinssatz (%)
% über dem Bassissatz der EZB
auf (Betrag)
Ab
bis
ID *
Code
Zinssatz (%)
% über dem Bassissatz der EZB
auf (Betrag)
Ab
bis
ID *
Please specify in case of Code 6 and/or E
* Fill in corresponding claim ID ** taken out by the claimant at least in the amount of the principal *** Please specify
8. Contractual penalties (if applicable)
Amount
Please specify
9. Costs (if applicable)
Codes: 01 Court fees 02 Other (please specify)
Code
Specification only for code 02
Currency
Amount
Code
Specification only for code 02
Currency
Amount
Code
Specification only for code 02
Currency
Amount
Code
Specification only for code 02
Currency
Amount
10. Evidence available in support of the claim
Codes: 01 Written evidence 02 Oral evidence 03 Expert evidence 04 Inspection of an object or site 05 Other (please specify)
ID *
Code
Description of evidence
Date (day/month/year)
ID *
Code
Description of evidence
Date (day/month/year)
ID *
Code
Description of evidence
Date (day/month/year)
ID *
Code
Description of evidence
Date (day/month/year)
* Fill in corresponding claim ID
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11. Additional statements and further information (if necessary)
Ihereby request the court to order the defendant(s) to pay to the claimant(s) the sum of the above principal plus interest, contractual penalties and costs.
I declare that to the best of my knowledge and belief the information provided is true.
I acknowledge that any deliberate false statement could lead to appropriate penalties under the law of the Member State of origin.
Done at
Date (day/month/year)
Signature and/or stamp
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Appendix 1 to the application for a European order for payment
Bank details for the purposes of payment of court fees by the claimant
Code: 02 By credit card 03 Collection by court from claimant's bank account
Code
Account holder
Bank name (BIC) or other relevant bank code / Credit card company
Account number / Credit card number
International bank account number (IBAN) / Expiry date and security number of credit card
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Appendix 2 to the application for a European order for payment
Opposition to a transfer to ordinary civil proceedings Case number (to be completed if this Appendix is sent to the court separately from the application form)
Done at
Date (day/month/year)
Signature and/or stamp
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GUIDELINES FOR FILLING IN THE APPLICATION FORM
Important information
This form must be filled in in the language or one of the languages accepted by the court to be seised. Please note that the form is available in all official languages of the European Union; this may help you fill in the form in the required language.
If the defendant lodges an opposition to your claim, proceedings will continue before the competent courts in accordance with the rules of ordinary civil procedure. If you do not wish to continue proceedings in that event, you should also fill in Appendix 2 to this form. This appendix should reach the court before the European order for payment is issued.
If the application concerns a claim against a consumer relating to a consumer contract, it must be lodged with the competent court of the Member State in which the consumer is domiciled. In other cases, the application must be lodged with the court having jurisdiction in accordance with the rules of Council Regulation (EC) No 44/2001 on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters. Information on the rules of jurisdiction can be found on the European Judicial Atlas (http://ec.europa.eu/justice_home/judicialatlascivil/html/index.htm).
Please make sure you duly sign and date the form on the last page.
Guidelines
At the start of each section you will find specific codes that should be inserted, as appropriate, in the relevant boxes.
1. Court When deciding which court to choose, you need to consider the grounds for the court's jurisdiction.
2. Parties and their representatives This field must identify the parties and their representatives, if any, in accordance with the codes indicated on the form. The box [Identification code] should refer, where applicable, to the special number which solicitors have in certain Member States for the purposes of electronic communication with the court (see Art. 7(6), second subparagraph, of Regulation (EC) No 1896/2006), to the registration number for companies or organisations or to any applicable identification number for natural persons. The box [Other details] may contain any other information that helps to identify the person (e.g. date of birth, position of the named person in the company or organisation concerned). If there are more than four parties and/or representatives, please use field [11].
3. Grounds for the court's jurisdiction See "Important information" above.
4. Cross-border nature of the case For you to be allowed to use this European order for payment procedure, at least two of the boxes in this field must refer to different States.
5. Bank details (optional) In field [5.1], you may inform the court by what means you intend to pay the court fees. Please note that not all methods of payment in this field are necessarily available at the court to which you are making this application. You should verify which method of payment will be accepted by the court. You can do this by contacting the court concerned or by consulting the website of the European Judicial Network in civil and commercial matters (http://ec.europa.eu/civiljustice/). If you choose to pay by credit card or to allow the court to collect the fees from your bank account, you should give the necessary credit card/bank account details in Appendix 1 to this form.
In field [5.2], you may indicate by what means you wish to receive payment from the defendant. If you wish to be paid by bank transfer, please give the necessary bank details.
6. Principal This field must contain a description of the principal and the circumstances forming the basis of the claim in accordance with the codes indicated on the form. You need to use an identification number ("ID") for each claim, numbering them from 1 through 4. Each claim must be specified on the line of the box following the ID number, by filling in the relevant numbers of codes 1, 2, and 3. If you need more space, please use field [11]. The box [Date (or period)] refers, for instance, to the date of the contract or harmful event or to the period of the rent.
7. Interest If interest is demanded, this should be specified for each claim as identified in field [6] in accordance with the codes indicated on the form. The code must contain both the relevant number (first row of the codes) and the letter (second row of the codes). For instance, if the interest rate has been agreed by contract and covers annual periods, the code is 02A. If interest is demanded up to the decision by the court, the last box [to] should be left blank. Code 01 refers to an interest rate laid down by statute. Code 02 refers to an interest rate agreed by the parties. If you use Code 03 (capitalisation of interest), the amount indicated should be the basis for the remainder of the term to be covered. Capitalisation of interest refers to the situation where the accrued interest is added to the principal and is taken into account for purposes of calculating further interest. Please note that in commercial transactions as referred to in Directive 2000/35/EC of 29 June 2000 on combating late payments, the statutory interest rate is the sum of the interest rate applied by the European Central Bank to its most recent main refinancing operation carried out before the first calendar day of the half-year in question ('the reference rate'), plus at least seven percentage points. For a Member State which is not participating in the third stage of economic and monetary union, the reference rate referred to above is the equivalent rate set at national level (e.g. by the national central bank). In both cases the reference rate in force on the first calendar day of the half-year in question will apply for the following six months (see Art. 3(1)(d) of Directive 2000/35/EC). The "base rate (ECB)" refers to the interest rate applied by the European Central Bank to its main refinancing operations.
8. Contractual penalties (if applicable)
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9. Costs (if applicable) If reimbursement of costs is demanded, these must be described using the codes indicated on the form. The box [specification] must be used only for code 02, i.e. when reimbursement of costs other than court fees is demanded. These other costs could include, for instance, fees of a claimant's representative or prelitigation costs. If you request reimbursement of the court fees but you do not know the exact amount, you must fill in the box [Code] (01) but you may leave the box [Amount] blank and it will be filled in by the court.
10. Evidence available in support of the claim This field must specify the evidence available in support of each claim using the codes indicated on the form. The box [Description of evidence] will contain, for instance, the title, name, date, and/or reference number of the document concerned, the amount mentioned on the document concerned, and/or the name of the witness or expert.
11. Additional statements and further information (if necessary) You may use this field if you need more space for any of the fields above or, if necessary, to provide additional information useful to the court. For instance, if there are several defendants each being liable for a portion of the claim, you should indicate here the amount individually owed by each defendant.
Appendix 1 Here you must indicate the details of your credit card or bank account if you choose to pay the court fees by credit card or if you allow the court to collect the fees from your bank account. Please note that not all methods of payment in this field are necessarily available at the court to which you are making this application. Please note that the information given in Appendix 1 will not be sent to the defendant.
Appendix 2 Here you must inform the court if you do not wish to continue proceedings in the event of the defendant opposing the claim. If you send this information to the court after having sent the application form, please make sure you fill in the case number given by the court. Please note that the information given in Appendix 2 will not be sent to the defendant.
