ANNEX IISupplementary provisions
ANNEX II Uniform instrument permitting enforcement in the requested Member State ( 1 ) UNIFORM INSTRUMENT PERMITTING ENFORCEMENT OF CLAIMS COVERED BY COUNCIL DIRECTIVE 2010/24/EU Date of issue: REVISED UNIFORM INSTRUMENT PERMITTING ENFORCEMENT OF CLAIMS COVERED BY COUNCIL DIRECTIVE 2010/24/EU Date of issue of the original uniform instrument: Date of revision: Reason for the revision: judgment/order of [name of the Court] administrative decision of [date] Reference number: EU Member State where this document is issued: Each EU Member State can request recovery assistance from other Member States for unpaid claims referred to in Article 2 of Council Directive 2010/24/EU of 16 March 2010. Recovery measures taken by the requested Member State are based on: a uniform instrument permitting enforcement, in accordance with Article 12 of this Directive, a revised uniform instrument permitting enforcement, in accordance with Article 15 of this Directive (to take account of the decision of the competent body referred to in Article 14(1) of this Directive), This document is the [revised] uniform instrument permitting enforcement. It concerns the claim(s) mentioned below, which remain(s) unpaid in [name of applicant Member State].The initial instrument for the enforcement of this/these claim(s) has been notified in so far as required under the national law of [name of applicant Member State]. Disputes concerning the claim(s) fall exclusively within the competence of the competent bodies of [name of applicant Member State], in accordance with Article 14 of Directive 2010/24/EU. Any such action must be brought before them in accordance with the procedural and language rules in force in [name of applicant Member State]. DESCRIPTION OF THE CLAIM(S) AND THE PERSON(S) CONCERNED IDENTIFICATION OF THE CLAIM 1. Reference: 2. 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 3. Name of the tax/duty concerned: 4. Period or date concerned: 5. Date establishment of the claim: 6. Date on which enforcement becomes possible: 7. Amount of the claim (initially due – still due): principal amount: administrative penalties and fines: interest till date before the day the request is sent: costs till date before the day the request is sent: fees for certificates and similar documents issued in connection with administrative procedures related to the tax/duty concerned: total amount of this claim: 8. Date of notification of the initial instrument permitting enforcement in [name of the applicant State] 9. Office responsible for the assessment of the claim: name, address and other contact details: 10. Further information concerning the claim or the possibilities for contesting the payment obligation can be obtained from: the office responsible for the assessment of the claim, mentioned under point 9, the office responsible for the Uniform instrument permitting enforcement: name, address and other contact details, IDENTIFICATION OF THE PERSON(S) CONCERNED IN THE NATIONAL INSTRUMENT(S) PERMITTING ENFORCEMENT 1. Name 2. Address 3. Cause of liability: principal debtor, 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, ( 1 ) The elements put in Italic are optional.