ANNEX ISupplementary provisions
ANNEX I Text of image EUROPEAN ENFORCEMENT ORDER CERTIFICATE — JUDGMENT 1. Member State of origin: Belgium Czech Republic Germany Estonia Greece Spain France Ireland Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Slovakia Slovenia Finland Sweden United Kingdom 2. Court/Tribunal issuing the certificate: 2.1. Name: 2.2. Address: 2.3. Tel./fax/e-mail: 3. If different, Court/Tribunal giving the judgment: 3.1. Name: 3.2. Address: 3.3. Tel./fax/e-mail: 4. Judgment: 4.1. Date: 4.2. Reference number: 4.3. The parties: 4.3.1. Name and address of creditor(s): 4.3.2. Name and address of debtor(s): 5. Monetary claim as certified: 5.1. Principal amount: 5.1.1. Currency: Euro Pound sterling Maltese lira Slovenian tolar other (explain) Cyprus pound Hungarian forint Polish zloty Czech koruna Lithuanian litas Swedish kronor Estonian kroon Latvian lats Slovak koruna 5.1.2. If the claim is for periodical payments 5.1.2.1. Amount of each instalment: 5.1.2.2. Due date of first instalment: 5.1.2.3. Due dates of following instalments weekly monthly other (explain) 5.1.2.4. Period of the claim 5.1.2.4.1. Currently indefinite or 5.1.2.4.2. Due date of last instalment: Text of image 5.2. Interest 5.2.1. Interest rate 5.2.1.1. … % or 5.2.1.2. … % above the base rate of the ECB ( 1 ) 5.2.1.3. Other (explain) 5.2.2. Interest to be collected as from: 5.3. Amount of reimbursable costs if specified in the judgment: 6. Judgment is enforceable in the Member State of origin 7. Judgment is still subject to the possibility of a challenge Yes No 8. Judgment is on an uncontested claim under Article 3(1) 9. Judgment is in compliance with Article 6(1)(b) 10. The judgment concerns matters relating to consumer contracts Yes No 10.1. If yes: The debtor is the consumer Yes No 10.2. If yes: The debtor is domiciled in the Member State of origin (within the meaning of Article 59 of Regulation (EC) No 44/2001) 11. Service of the document instituting the proceedings under Chapter III, where applicable Yes No 11.1. Service was effected in compliance with Article 13 or service was effected in compliance with Article 14 or it is proved in accordance with Article 18(2) that the debtor has received the document 11.2. Due information The debtor was informed in compliance with Articles 16 and 17 12. Service of summons, where applicable Yes No ( 1 ) Interest rate applied by the European Central Bank to its main refinancing operations. Text of image 12.1. Service was effected in compliance with Article 13 or service was effected in compliance with Article 14 or it is proved in accordance with Article 18(2) that the debtor has received the summons 12.2. Due information The debtor was informed in compliance with Article 17 13. Cure of non-compliance with procedural minimum standards pursuant to Article 18(1) 13.1. Service of the judgment was effected in compliance with Article 13 or service of the judgment was effected in compliance with Article 14 or it is proved in accordance with Article 18(2) that the debtor has received the judgment 13.2. Due information The debtor was informed in compliance with Article 18(1)(b) 13.3. It was possible for the debtor to challenge the judgment Yes No 13.4. The debtor failed to challenge the judgment in compliance with the relevant procedural requirements Yes No Done at Date Signature and/or stamp