ANNEX VIIISupplementary provisions
ANNEX VIII Transmission of a decision on a remedy to the Member State of enforcement (Article 36(5) 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 1. European Account Preservation Order (‘the Preservation Order’): 1.1. Date (dd/mm/yyyy) of the Preservation Order: 1.2. File number of the Preservation Order: 1.3. Total amount to be preserved according to the Preservation Order: Currency: ☐ Euro (EUR) ☐ Bulgarian lev (BGN) ☐ Czech koruna (CZK) ☐ Croatian Kuna (HRK) ☐ Hungarian forint (HUF) ☐ Polish zloty (PLN) ☐ Romanian leu (RON) ☐ Swedish krona (SEK) ☐ Other (please specify using the ISO code): 2. Court that issued the Preservation Order 2.1. Name: 2.2. Address 2.2.1. Street and number/PO box: 2.2.2. Place and postcode: 2.2.3. Member State (please indicate the country code): 2.3. Telephone: ( *1 ) 2.4. Fax ( *1 ) 2.5. Email (if available): 3. Court that issued the decision on the remedy (to be filled in only if different from the court (referred to in section 2) that has issued the Preservation Order) 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): 3.3. Telephone: 3.4. Fax 3.5. Email: 4. Applicant (for the remedy) 4.1. The applicant(s) for the remedy is/are, in the proceedings leading to the issuing of the Preservation Order (please tick the relevant box): ( 1 ) ☐ Creditor ☐ Debtor 4.2. Surname and given name(s)/name of company or organisation: 4.3. Address 4.3.1. Street and number/PO box: 4.3.2. Place and postcode: 4.3.3. Country (if a Member State, please indicate the country code): 4.4. Telephone (if available): 4.5. Fax (if available): 4.6. Email (if available): 4.7. Name of party's representative, if any and if known, and contact details, if available 4.7.1. Surname and given name(s): 4.7.2. Address 4.7.2.1. Street and number/PO box: 4.7.2.2. Place and postcode: 4.7.2.3. Country (if a Member State, please indicate the country code): 4.7.3. Email: 5. The other party ( 2 ) 5.1. The other party is, in the proceedings leading to the issuing of the Preservation Order (please tick the relevant box): ☐ Creditor ☐ Debtor 5.2. Surname and given name(s)/name of company or organisation: 5.3. Address 5.3.1. Street and number/PO box: 5.3.2. Place and postcode: 5.3.3. Country (if a Member State, please indicate the country code): 5.4. Telephone (if available): 5.5. Fax (if available): 5.6. Email (if available): 5.7. Name of party's representative, if any and if known, and contact details, if available 5.7.1. Surname and given name(s): 5.7.2. Address 5.7.2.1. Street and number/PO box: 5.7.2.2. Place and postcode: 5.7.2.3. Country (if a Member State, please indicate the country code): 5.7.3. Email: 6. Decision of the court on the remedy 6.1. Date (dd/mm/yyyy) of the decision: 6.2. File number of the decision: 6.3. The decision: ☐ The Preservation Order is revoked ☐ The Preservation Order is modified in the following way: The competent authority of the Member State of enforcement of the Preservation Order is requested to take the necessary steps to have the decision on the remedy implemented. Done at: Date: (dd/mm/yyyy) Stamp, signature and/or any other authentication of the court: ( *1 ) Optional ( 1 ) Where a decision on a remedy is issued in relation to a joint application that was made by the creditor and the debtor (for the revocation or modification of the Preservation Order) on the grounds that they agreed to settle the claim, both parties should be indicated in this section. In such circumstances, when filling in the form on paper, please use a separate sheet for each party and number each page. ( 2 ) Not to be filled in if the information in section 4 was already given both for the creditor and the debtor where a joint application for a remedy was made on the grounds that they agreed to settle the claim.