ANNEX IISupplementary provisions
ANNEX II Text of image CERTIFICATE CONCERNING AN AUTHENTIC INSTRUMENT/COURT SETTLEMENT ( 1 ) IN CIVIL AND COMMERCIAL MATTERS Article 60 of Regulation (EU) No 1215/2012 of the European Parliament and of the Council on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters 1. COURT OR COMPETENT AUTHORITY ISSUING THE CERTIFICATE 1.1. Name: 1.2. Address: 1.2.1. Street and number/PO box: 1.2.2. Place and postal code: 1.2.3. Member State: AT BE BG CY CZ DE EE EL ES FI FR HU IE IT LT LU LV MT NL PL PT RO SE SI SK UK 1.3. Telephone: 1.4. Fax 1.5. E-mail (if available): 2. AUTHENTIC INSTRUMENT 2.1. Authority which has drawn up the authentic instrument (if different from the authority issuing the certificate) 2.1.1. Name and designation of authority: 2.1.2. Address: 2.2. Date (dd/mm/yyyy) on which the authentic instrument was drawn up by the authority referred to in point 2.1: 2.3. Reference number of the authentic instrument (if applicable): 2.4. Date (dd/mm/yyyy) on which the authentic instrument was registered in the Member State of origin (to be filled in only if the date of registration determines the legal effect of the instrument and this date is different from the date indicated in point 2.2): 2.4.1. Reference number in the register (if applicable): 3. COURT SETTLEMENT 3.1. Court which approved the court settlement or before which the court settlement was concluded (if different from the court issuing the certificate) 3.1.1. Name of court: 3.1.2. Address: 3.2. Date (dd/mm/yyyy) of the court settlement: 3.3. Reference number of the court settlement: 4. PARTIES TO THE AUTHENTIC INSTRUMENT/COURT SETTLEMENT: 4.1. Name(s) of creditor(s) (surname and given name(s)/name of company or organisation) ( 2 ): 4.1.1. Identification number (if applicable and if available): 4.1.2. Date (dd/mm/yyyy) and place of birth or, if legal person, of incorporation/formation/registration (if relevant and if available): 4.2. Name(s) of debtor(s) (surname and given name(s)/name of company or organisation) ( 3 ): 4.2.1. Identification number (if applicable and if available): 4.2.2. Date (dd/mm/yyyy) and place of birth or, if legal person, of incorporation/formation/registration (if relevant and if available): 4.3. Name of other parties, if any (surname and given name(s)/name of company or organisation) ( 4 ) Text of image 4.3.1. Identification number (if applicable and if available): 4.3.2. Date (dd/mm/yyyy) and place of birth or, if legal person, of incorporation/formation/registration (if relevant and if available): 5. ENFORCEABILITY OF THE AUTHENTIC INSTRUMENT/COURT SETTLEMENT IN THE MEMBER STATE OF ORIGIN 5.1. The authentic instrument/court settlement is enforceable in the Member State of origin 5.1.1. Yes 5.2. Terms of the authentic instrument/court settlement and interest 5.2.1 Authentic instrument/court settlement relating to a monetary claim 5.2.1.1. Short description of the subject matter: 5.2.1.2. Under the authentic instrument/court settlement … (surname and given name(s)/name of company or organisation) ( 5 ) has to make a payment to: … (surname and given name(s)/name of company or organisation) 5.2.1.2.1. If more than one person has been held liable for one and the same claim, the whole amount may be collected from any one of them: 5.2.1.2.1.1. Yes 5.2.1.2.1.2. No 5.2.1.3. Currency: euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Hungarian forint (HUF) Lithuanian litas (LTL) Latvian lats (LVL) Polish zloty (PLN) Pound Sterling (GBP) Romanian leu (RON) Swedish krona (SEK) Other (please specify (ISO code)): 5.2.1.4. Principal amount: 5.2.1.4.1. Amount to be paid in one sum 5.2.1.4.2. Amount to be paid in instalments ( 6 ) Due date (dd/mm/yyyy) Amount 5.2.1.4.3. Amount to be paid regularly 5.2.1.4.3.1. per day 5.2.1.4.3.2. per week 5.2.1.4.3.3. other (state frequency): 5.2.1.4.3.4. From date (dd/mm/yyyy) or event: 5.2.1.4.3.5. If applicable, until … (date (dd/mm/yyyy) or event) 5.2.1.5. Interest, if applicable 5.2.1.5.1. Interest: 5.2.1.5.1.1. Not specified in the authentic instrument/court settlement 5.2.1.5.1.2. Yes, specified in the authentic instrument/court settlement as follows: Text of image 5.2.1.5.1.2.1. Amount: or 5.2.1.5.1.2.2. Rate … % 5.2.1.5.1.2.3. Interest due from … (date (dd/mm/yyyy) or event) to … (date (dd/mm/yyyy) or event) ( 7 ) 5.2.1.5.2. Statutory interest (if applicable) to be calculated in accordance with (please specify relevant statute): 5.2.1.5.2.1. Interest due from … (date (dd/mm/yyyy) or event) to … (date (dd/mm/yyyy) or event) ( 7 ) 5.2.1.5.3. Capitalisation of interest (if applicable, please specify): 5.2.2. Authentic instrument/court settlement relating to a non-monetary enforceable obligation: 5.2.2.1. Short description of the enforceable obligation 5.2.2.2. The obligation referred to in point 5.2.2.1 is enforceable against the following person(s) ( 8 ) (surname and given name(s)/name of company or organisation): Done at: … Signature and/or stamp of the court or competent authority issuing the certificate: ( 1 ) Delete as appropriate throughout the certificate. ( 2 ) Insert information for all creditors if more than one. ( 3 ) Insert information for all debtors if more than one. ( 4 ) Insert information for other parties (if any). ( 5 ) If more than one person has been ordered to make a payment, insert information for all persons. ( 6 ) Insert information for each instalment. ( 7 ) Insert information for all periods if more than one. ( 8 ) Insert information for all persons if more than one.