ANNEX VISupplementary provisions
ANNEX VI Acknowledgment of receipt (Article 29(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) IMPORTANT INFORMATION The acknowledgment of receipt being sent to the authority, creditor or bank that transmitted the documents must be sent by the end of the working day following the date of receipt of the documents and must be sent by the swiftest possible means of transmission. Concerning the requirements governing the language of the transmitted documents, please note the requirements provided in Regulation (EU) No 655/2014, including Article 10(2), Article 23(4) and Article 49. 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 1. The court or authority that received the document(s) 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: 1.6. Reference number(s) of the document(s), if any, given by the court or authority that received the document(s): 2. The following document(s) was/were received pursuant to Regulation (EU) No 655/2014 on (dd/mm/yyyy) by the court or authority indicated in section 1 above (please indicate the incoming reference number of the document, if any): ☐ the revocation form (Article 10(2) of the Regulation) ☐ the request for information (Article 14(3) of the Regulation) ☐ the account information (Article 14(6) of the Regulation) ☐ Part A of the European Account Preservation Order (‘the Preservation Order’) and blank standard form for declaration (Article 23(3) of the Regulation) ☐ the declaration concerning the preservation of funds (Article 25(2) or (3) of the Regulation) ☐ the Preservation Order and other documents referred to in Article 28(3) of the Regulation (please provide details): ☐ the decision on a remedy (Article 36(5) of the Regulation) 3. The authority, creditor or bank that transmitted the document(s) 3.1. Name: 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): 4. (Please fill in if applicable) The language of the document(s) received is incorrect. The following document(s): must be translated into the following language: ☐ Bulgarian ☐ Spanish ☐ Czech ☐ German ☐ Estonian ☐ Greek ☐ English ☐ French ☐ Irish ☐ Croatian ☐ Italian ☐ Latvian ☐ Lithuanian ☐ Hungarian ☐ Maltese ☐ Dutch ☐ Polish ☐ Portuguese ☐ Romanian ☐ Slovak ☐ Slovenian ☐ Finnish ☐ Swedish 5. (Please fill in if applicable) Other reasons why the document(s) cannot be processed (for example, the document is illegible). Please explain the reasons: Done at: Date: (dd/mm/yyyy) Signature and/or stamp: