ANNEX IVSupplementary provisions
ANNEX IV Text of image EUROPEAN SMALL CLAIMS PROCEDURE FORM D CERTIFICATE CONCERNING A JUDGMENT IN THE EUROPEAN SMALL CLAIMS PROCEDURE (Article 20(2) of Regulation (EC) No 861/2007 of the European Parliament and of the Council establishing a European Small Claims Procedure) To be filled in by the court/tribunal 1. Court/tribunal 1.1. Name: 1.2. Street and number/PO box: 1.3. City and postal code: 1.4. Country: 2. Claimant 2.1. Surname, first name/name of company or organisation: 2.2. Street and number/PO box: 2.3. City and postal code: 2.4. Country: 2.5. Telephone (*): 2.6. E-mail (*): 2.7. Claimant’s representative, if any, and contact details (*): 2.8. Other details (*): 3. Defendant 3.1. Surname, first name/name of company or organisation: 3.2. Street and number/PO box: 3.3. City and postal code: 3.4. Country: 3.5. Telephone (*): 3.6. E-mail (*): 3.7. Defendant’s representative, if any, and contact details (*): 3.8. Other details (*): (*) Optional. Text of image 4. Judgment 4.1. Date: 4.2. Case number: 4.3. The substance of the judgment: 4.3.1. The court/tribunal has ordered __________ to pay to __________ (1) Principal: (2) Interest: (3) Costs: 4.3.2. The court/tribunal has made an order against __________ to __________ (If the judgment was given by an appeal courtor in the case of a review of a judgment.) This judgment supersedes the judgment given on ___/___/_____, case number __________, and any certificate relative thereto. THE JUDGMENT WILL BE RECOGNISED AND ENFORCED IN ANOTHER MEMBER STATE WITHOUT THE NEED FOR A DECLARATION OF ENFORCEABILITY AND WITHOUT ANY POSSIBILITY OF OPPOSING ITS RECOGNITION. Done at: _________ Date: ___/___/_____ Signature and/or stamp