ANNEX IISupplementary provisions
ANNEX II Text of image FORM II Certificate issued in accordance with Article 14 of Regulation (EU) No 606/2013 of the European Parliament and of the Council on mutual recognition of protection measures in civil matters 1. Date of issuing of the certificate (dd/mm/yyyy): 2. Reference number of the certificate: 3. Applicant 3.1. Please indicate whether the applicant is: 3.1.1. The protected person 3.1.2. The person causing the risk 3.2. Surname and given name(s)/name: 3.3. Identity number [optional]: 3.4. Date of birth (dd/mm/yyyy): 3.5. Place of birth [optional]): 4. Authority which suspended or withdrew the protection measure, suspended or limited its enforceability or withdrew the certificate in accordance with point (b) of Article 9(1) of the Regulation (EU) No 606/2013 (if different from the authority issuing this certificate) [optional] 4.1. Official name: 4.2. Full address 4.2.1. Street and number/PO box: 4.2.2. City: 4.2.3. Postal code: 4.2.4. Member State AT BE BG CY CZ DE EE EL ES FI FR HR HU IE IT LT LU LV MT NL PL PT RO SE SI SK UK Other: 4.3. Tel. No: 4.4. Fax No [optional]: Text of image 4.5. E-mail [optional]: 4.6. Contact person [optional] 4.6.1. Surname and given name(s): 5. Authority which issued this certificate 5.1 Official name: 5.2 Full address 5.2.1 Street and number/PO box: 5.2.2 City: 5.2.3 Postal code: 5.2.4. Member State AT BE BG CY CZ DE EE EL ES FI FR HR HU IE IT LT LU LV MT NL PL PT RO SE SI SK UK Other: 5.3. Tel. No: 5.4. Fax No: 5.5. E-mail [optional]: 5.6. Contact person [optional] 5.6.1. Surname and given name(s): 5.6.2. Please indicate the language(s) that may be used for any communication that may arise with the issuing authority in addition to the official languages required for transcription and translation of the certificate [optional] BG ES CS DE ET EL EN FR GA HR IT LV LT HU MT NL PL PT RO SK SL FI SV Other: 6. Information about decision regarding the suspension, limitation or withdrawal of recognition or enforcement certified by this certificate 6.1. Date of the decision (dd/mm/yyyy): 6.2. Reference number of the decision: Text of image 6.3. Specification of the nature of the decision regarding the suspension, limitation or withdrawal of recognition or enforcement (more than one box may be ticked and additional information may be provided under point (7): 6.3.1. Suspension of the protection measure 6.3.2. Withdrawal of the protection measure 6.3.3. Suspension of the enforceability of the protection measure 6.3.4. Limitation of the enforceability of the protection measure 6.3.5. Withdrawal of the certificate where it was clearly wrongly granted, having regard to the requirements laid down in Article 6 and the scope of the Regulation (EU) No 606/2013 6.3.5.1. Please indicate which of the following circumstances has occurred (more than one box may be ticked) 6.3.5.1.1 the certificate was issued in regard to protection measure falling outside the scope of the Regulation (EU) No 606/2013 6.3.5.1.2 the protection measure has not been brought to the notice of the person causing the risk 6.3.5.1.3 the protection measure was ordered under a procedure that does not provide for prior notice to be given to the person causing the risk (‘ex-parte proceeding’) and the person causing the risk had not the right to challenge the protection measure 6.3.5.1.4 the protection measure was ordered in default of appearance of the person causing the risk and the document instituting the proceedings or an equivalent document was not served to the person causing the risk or he or she has not been otherwise informed of the initiation of the proceeding, in sufficient time and in such a way as to enable him or her to arrange his or her defence 6.4 If the present certificate applies to only some of the protection measures contained in the certificate foreseen under Article 5 of Regulation (EU) No 606/2013, please indicate to which ones: 7. Other comments related to information given above [optional]: Done at: This certificate shall be accompanied by a copy of the certificate foreseen under Article 5 of the Regulation (EU) No 606/2013 on the mutual recognition of protection measures in civil matters. Please print the form in the official language(s) which the Member State addressed has indicated it can accept and stamp or authenticate it otherwise.