ANNEX ISupplementary provisions
ANNEX I Uniform notification form providing information about notified document(s) (to be transmitted to the addressee of the notification) ( 1 ) This document, accompanies document(s) hereby notified by the competent authority of [name of requested Member State]. This notification concerns documents of the competent authorities of [name of applicant Member State], which asked for notification assistance, in accordance with Article 8 of Council Directive 2010/24/EU of 16 March 2010. A. IDENTIFICATION OF THE ADDRESSEE OF THE NOTIFICATION 1. Name: 2. Address: 3. Date of birth: 4. Place of birth: B. PURPOSE OF THE NOTIFICATION 1. This notification is intended: to inform the addressee, about the document(s) to which this information document is attached, to interrupt the period of limitation with regard to the claim(s) mentioned in the notified document(s), to confirm the addressee, about his/her obligation to pay the amounts mentioned under point C, Please note that in case of non-payment, the authorities may take enforcement and/or precautionary measures to ensure the recovery of the claim(s). This may cause extra costs charged to the addressee. You are the addressee of this notification, as you are considered to be: the principal debtor, a co-debtor, a person other than the (co-)debtor, liable for settlement of the taxes, duties and other measures, or for other claims relating to these taxes, duties and other measures, under the laws in force in the applicant State, a person other than the (co-)debtor, holding assets belonging to, or having debts towards, the (co-)debtor or to any other person liable, a third party which may become affected by enforcement measures concerning other persons, (The following information will appear if the addressee of the notification is a person other than the (co-)debtor, holding assets belonging to, or having debts towards, the (co-)debtor or to any other person liable, or a third party which may become affected by enforcement measures concerning other persons: the notified documents concern claims relating to taxes and duties, for which the following person(s) is (are) liable: [name and address (known or assumed)]). 2. The applicant authority of [name of the applicant Member State] invited the competent authorities of [name of the requested Member State] to make this notification before [date]. Please note that this date is not specifically related to any period of limitation. C. DESCRIPTION OF THE NOTIFIED DOCUMENT(S) 1. Reference number: Date of establishment: 2. Nature of the notified document: Tax assessment, Payment order, Decision following an administrative appeal, Other administrative document: Judgment/order of: Other judicial document, 3. Name of the claim concerned (in the language of the applicant Member State): 4. Nature of the claim: a) customs duties, b) value added tax, c) excise duties, d) tax on income or capital, e) tax on insurance premiums, f) inheritance and gift taxes, g) national taxes and duties on immovable property, other than the above-mentioned ones, h) national taxes and duties on the use or ownership of means of transport, i) other taxes and duties levied by or on behalf of the applicant State, j) taxes and duties levied by or on behalf of territorial or administrative subdivisions of the applicant State, excluding taxes and duties levied by local authorities, k) taxes and duties levied by or on behalf of local authorities, l) other tax-based claim, m) refunds, interventions and other measures forming part of the system of total or partial financing of the European Agricultural Guarantee Fund (EAGF) and the European Agricultural Fund for Rural Development (EAFRD), including sums to be collected in connection with these actions, and levies and other duties provided for under the common organisation of the market for the sugar sector 5. Amount of the claim concerned, in the currency of [Name of the applicant Member State]: Principal amount: Administrative penalties and fines: Interest up to [date]: Costs up to [date]: Fees for certificates and similar documents issued in connection with administrative procedures related to the claim mentioned under point 3: Total amount for this claim: 6. The amount mentioned under point 5 should be paid: before: within [number] calendar days following the date of this notification, without any further delay, This payment should be made to: Reference to be used for the payment: 7. You can reply to the document(s) that are hereby notified. Last day for replying: Time period for replying: Name and address of the authority to whom a reply can be sent: 8. Contestation possibility The period for contestation of the claim or the notified document(s) has already come to its end, Last day for contestation: Time period for contestation: Name and address of the authority where a contestation has to be submitted: Please note that disputes concerning the claim, the instrument permitting enforcement or any other document originating from the authorities of [name of applicant Member State], fall within the competence of the competent bodies of [name of applicant Member State], in accordance with Article 14 of Council Directive 2010/24/EU. Any such dispute is governed by the procedural and language rules applying in [name of applicant Member State]. Please note that the recovery may begin before the end of the contestation period. 9. Office responsible with regard to the attached document(s) Name, Address, Telephone, E-mail, Language in which this office can be contacted, 10. Further information about: the notified document(s) and/or the possibility to contest the obligations can be obtained from: the office responsible with regard to the attached document(s), mentioned under point C.9. the following office: ( 1 ) The elements put in Italic are optional.