ANNEX 3Supplementary provisions
ANNEX 3 Text of image FORM III ATTESTATION concerning a court settlement in a matter of succession (Article 61(2) of Regulation (EU) No 650/2012 of the European Parliament and of the Council on jurisdiction, applicable law, recognition and enforcement of decisions and acceptance and enforcement of authentic instruments in matters of succession and on the creation of a European Certificate of Succession (1)) 1. Member State of origin (*) Belgium Bulgaria Czech Republic Germany Estonia Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden 2. Court which approved the court settlement or before which the court settlement was concluded and issuing the attestation 2.1. Name and designation of court (2) (*): 2.2. Address 2.2.1. Street and number/PO box (*): 2.2.2. Place and postcode (*): 2.3. Telephone (*): 2.4. Fax 2.5. E-mail: 2.6. Other relevant information (please specify): 3. Court settlement 3.1. Date (dd/mm/yyyy) of the court settlement (*): 3.2. Reference number of court settlement 3.3. Parties to the court settlement (3): 3.3.1. Party A 3.3.1.1. Surname and given name(s) or organisation name (*): 3.3.1.2. Date (dd/mm/yyyy) and place of birth or, if organisation, date (dd/mm/yyyy), place of registration and designation of the register/registration authority: Text of image 3.3.1.3. Identification number (4) 3.3.1.3.1. Identity number: 3.3.1.3.2. Social security number: 3.3.1.3.3. Registration number: 3.3.1.3.4. Other (please specify): 3.3.1.4. Address 3.3.1.4.1. Street and number/PO box: 3.3.1.4.2. Place and postcode: 3.3.1.4.3. Country: Belgium Bulgaria Czech Republic Germany Estonia Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden Other (please specify ISO-code): 3.3.1.5. E-mail: 3.3.1.6. Role in the proceedings (*) 3.3.1.6.1. Claimant 3.3.1.6.2. Defendant 3.3.1.6.3. Other (please specify): 3.3.1.7. Status in the succession (please tick more than one box, if relevant) (*) 3.3.1.7.1. Heir 3.3.1.7.2. Legatee 3.3.1.7.3. Executor 3.3.1.7.4. Administrator 3.3.1.7.5. Other (please specify): 3.3.2. Party B 3.3.2.1. Surname and given name(s) or organisation name (*): 3.3.2.2. Date (dd/mm/yyyy) and place of birth or, if organisation, date (dd/mm/yyyy), place of registration and designation of the register/registration authority: 3.3.2.3. Identification number 3.3.2.3.1. Identity number: 3.3.2.3.2. Social security number: 3.3.2.3.3. Registration number: 3.3.2.3.4. Other (please specify): Text of image 3.3.2.4. Address 3.3.2.4.1. Street and number/PO box: 3.3.2.4.2. Place and postcode: 3.3.2.4.3. Country Belgium Bulgaria Czech Republic Germany Estonia Greece Spain France Croatia Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden Other (please specify ISO-code): 3.3.2.5. E-mail: 3.3.2.6. Role in the proceedings (*) 3.3.2.6.1. Claimant 3.3.2.6.2. Defendant 3.3.2.6.3. Other (please specify): 3.3.2.7. Status in the succession (please tick more than one box, if relevant) (*) 3.3.2.7.1. Heir 3.3.2.7.2. Legatee 3.3.2.7.3. Executor 3.3.2.7.4. Administrator 3.3.2.7.5. Other (please specify): 4. Enforceability of the court settlement 4.1. Is the court settlement enforceable in the Member State of origin without any further conditions having to be met? (*) 4.1.1. Yes (please specify the enforceable obligation(s)): 4.1.2. Yes, but limited to part(s) of the court settlement (please specify the enforceable obligation(s)): 4.2. The obligation is enforceable against the following person(s) (*) 4.2.1. Party A 4.2.2. Party B 4.2.3. Other (please specify): Text of image 5. Interest 5.1. Is recovery of interest sought? (*) 5.1.1. Yes 5.1.2. No 5.2. If YES under point 5.1.1. (*) 5.2.1. Interest 5.2.1.1. Not specified in the court settlement 5.2.1.2. Yes, specified in the court settlement as follows: 5.2.1.2.1. Interest due from: (date (dd/mm/yyyy) or event) to: (date (dd/mm/yyyy) or event) (5) 5.2.1.2.2. Final amount: 5.2.1.2.3. Method to calculate the interest 5.2.1.2.3.1. Rate: % 5.2.1.2.3.2. Rate: % over reference rate (ECB/reference rate of national central bank:) in force on: (date (dd/mm/yyyy) or event) 5.2.2. Statutory interest to be calculated in accordance with (specify relevant statute): 5.2.2.1. Interest due from: (date (dd/mm/yyyy) or event) to: (date (dd/mm/yyyy) or event) (5) 5.2.2.2. Method to calculate the interest 5.2.2.2.1. Rate: % 5.2.2.2.2. Rate: % over reference rate (ECB/reference rate of national central bank:) in force on: (date (dd/mm/yyyy) or event) 5.2.3. Capitalisation of interest (please specify): 5.2.4. Currency euro (EUR) lev (BGN Czech koruna (CZK) kuna (HRK) forint (HUF) zloty (PLN) Romanian leu (RON) krona (SEK) Other (please specify (ISO code)): Text of image If additional sheets have been added, state the total number of pages (*): Done at (*): on (*): (dd/mm/yyyy) Signature and/or stamp of the court issuing the attestation (*): (*) Mandatory information. (1) OJ L 201, 27.7.2012, p. 107. (2) In accordance with Article 3(2) of Regulation (EU) No 650/2012, the term ‘court’ includes under certain conditions, in addition to judicial authorities, other authorities and legal professionals with competence in matters of succession which exercise judicial functions or act pursuant to a delegation of power by a judicial authority or act under the control of a judicial authority. The list of these other authorities and legal professionals is published in the Official Journal of the European Union. (3) If the court settlement concerns more than two parties, please attach an additional sheet. (4) Please indicate the most relevant number if applicable. (5) Add the number of periods necessary if more than one period.