ANNEX IIISupplementary provisions
ANNEX III Revocation of a European Account Preservation Order (Article 10(2) of Regulation (EU) No 655/2014 of the European Parliament and of the Council of 15 May 2014 establishing a European Account Preservation Order procedure to facilitate cross-border debt recovery in civil and commercial matters) Country codes Whenever you refer to a Member State in filling in this form, please use the following country codes: AT Austria EL Greece IT Italy PT Portugal BE Belgium ES Spain LT Lithuania RO Romania BG Bulgaria FI Finland LU Luxembourg SE Sweden CY Cyprus FR France LV Latvia SI Slovenia CZ Czech Republic HR Croatia MT Malta SK Slovakia DE Germany HU Hungary NL Netherlands EE Estonia IE Ireland PL Poland Case number: Please attach a copy of the European Account Preservation Order (‘the Preservation Order’) that is being revoked. 1. Court revoking the Preservation Order 1.1. Name: 1.2. Address 1.2.1. Street and number/PO box: 1.2.2. Place and postcode: 1.2.3. Member State (please indicate the country code): 1.3. Telephone: 1.4. Fax 1.5. Email: 2. Date and reference of the Preservation Order 2.1. Date (dd/mm/yyyy) of the Preservation Order: 2.2. File number of the Preservation Order: 3. Creditor 3.1. Surname and given name(s)/name of company or organisation: 3.2. Address 3.2.1. Street and number/PO box: 3.2.2. Place and postcode: 3.2.3. Member State (please indicate the country code): 3.3. Telephone (if available): 3.4. Fax (if available): 3.5. Email (if available): 3.6. Name of creditor's representative, if any and if known, and contact details, if available 3.6.1. Surname and given name(s): 3.6.2. Address 3.6.2.1. Street and number/PO box: 3.6.2.2. Place and postcode: 3.6.2.3. Country (if a Member State, please indicate the country code): 3.6.3. Email: 4. Debtor 4.1. Surname and given name(s) (any middle name, if known)/name of company or organisation: 4.2. Address 4.2.1. Street and number/PO box: 4.2.2. Place and postcode: 4.2.3. Country (if a Member State, please indicate the country code): 4.3. Telephone (if available): 4.4. Fax (if available): 4.5. Email (if available): 4.6. Name of debtor's representative, if any and if known, and contact details, if available 4.6.1. Surname and given name(s): 4.6.2. Address 4.6.2.1. Street and number/PO box: 4.6.2.2. Place and postcode: 4.6.2.3. Country (if a Member State, please indicate the country code): 4.6.3. Email: 5. Revocation or termination of the Preservation Order The court hereby declares that the attached Preservation Order is revoked/terminated in accordance with Article 10 of Regulation (EU) No 655/2014 because the court has not received proof of the initiation of proceedings on the substance of the matter within the following deadline indicated by the court: (dd/mm/yyyy). The Preservation Order is hereby revoked/terminated as of (dd/mm/yyyy). The competent authority of the Member State of enforcement of the Preservation Order is requested to take the necessary steps to have the revocation/termination of the Preservation Order implemented. Done at: Date: (dd/mm/yyyy) Stamp, signature and/or any other authentication of the court: