ANNEX IISupplementary provisions
ANNEX II BG Предявяване на вземания ES Presentación de créditos CS Přihláška pohledávky DA Anmeldelse af fordringer DE Forderungsanmeldung ET Nõuete esitamine EL Αναγγελία απαιτήσεων EN Lodgement of claims FR Production de créances GA Taisceadh éileamh HR Prijava tražbina IT Insinuazione di crediti LV Prasījumu iesniegšana LT Reikalavimų pateikimas HU Követelések előterjesztése MT Tressiq ta' pretensjonijiet NL Indiening van schuldvorderingen PL Zgłoszenie wierzytelności PT Reclamação de créditos RO Depunerea cererilor de admitere a creanțelor SK Prihláška pohľadávok SL Prijava terjatev FI Saatavien ilmoittaminen SV Anmälan av fordringar (Paragraphs 1 to 3 of Article 55 of Regulation (EU) 2015/848 of the European Parliament and of the Council of 20 May 2015 on insolvency proceedings ( OJ L 141, 5.6.2015, p. 19 )). I hereby refer to the insolvency proceedings indicated below and lodge my claim(s) against the insolvency estate, as follows: Text of image GUIDELINES FOR FILLING IN THIS FORM This standard claims form should be used for lodging claims in accordance with Chapter IV of Regulation (EU) 2015/848 on insolvency proceedings. Requests to exclude goods from the debtor’s assets should be filed according to national law. The use of this standard claims form for the lodgement of claims is optional. Nonetheless, when lodging claims by means other than this standard form, the claim must contain all the information referred to as mandatory in this form. Language Claims may be lodged in any official language of the institutions of the European Union. Irrespective of this, you may later be required to provide a translation in the official language of the Member State of the opening of proceedings or, if there are several official languages in that Member State, in the official language or one of the official languages of the place where insolvency proceedings have been opened, or in another language which that Member State has indicated it can accept (the languages indicated by the Member States are to be found here: [https://e-justice.europa.eu/content_insolvency-447-en.do?clang=en (1)] Whenever you refer to a Member State in filling in this form, please use the following country codes: Austria (AT) Belgium (BE) Bulgaria (BG) Cyprus (CY) Czech Republic (CZ) Germany (DE) Estonia (EE) Greece (EL) Spain (ES) Finland (FI) France (FR) Croatia (HR) Hungary (HU) Ireland (IE) Italy (IT) Lithuania (LT) Luxembourg (LU) Latvia (LV) Malta (MT) Netherlands (NL) Poland (PL) Portugal (PT) Romania (RO) Sweden (SE) Slovenia (SI) Slovakia (SK) United Kingdom (UK) When you fill in a particular section of the form, please bear in mind the following: — The provision of information in points marked with an asterisk (*) is mandatory. — The provision of information in points marked with double asterisks (**) is mandatory subject to a condition. This condition is indicated in brackets in point concerned. — The provision of information in points without any specific marking is not mandatory. If you have several claims to lodge at the same time, you must fill out points 6 to 10 for each claim individually. You may find relevant information for points 1 and 2 in Section I of the form by which you were notified of the foreign insolvency proceedings. That form bears the heading ‘notice of insolvency proceedings’ and was sent to you by the foreign court which opened the insolvency proceedings, or by an insolvency practitioner appointed by that court to the proceedings. In point 1.1 ‘the court opening proceedings’ means the judicial body or any other competent body of a Member State empowered under its domestic law to open insolvency proceedings, to confirm such opening or to take decisions in the course of such proceedings. Point 1.2 should be filled in only if the insolvency proceedings have a reference number in the Member State where they have been opened. Point 1.3 should be filled in only if there is an insolvency practitioner appointed to the case. In points 2.2 and 3.3 ‘registration number’ means the individual identity number attached under national law to the entity or person. If the debtor is a company or a legal person, this is the number given in the appropriate national (business or association) register. If the debtor is a natural person exercising an independent business or professional activity (entrepreneurs), this is the identification number in the Member State where insolvency proceedings have been opened, under which he/she pursues his/her business or professional activity. If, according to the national insolvency law of the Member State where insolvency proceedings have been opened, the tax number or personal ID number of the debtor is used for the purpose of the identification of the natural person exercising an independent business or professional activity, this number should be indicated. (1) When using this form, please, always refer to the hyperlink actually leading to the relevant webpage of the European e-Justice Portal. Text of image In point 4 you should mark the first option referring to the person which the creditor indicated in point 3 only if the creditor is a natural person. If you mark the second option referring to a person different to the one indicated in point 3, you are supposed to fill in points 4.1 to 4.6, of which points 4.1, 4.2 and 4.6 are mandatory fields. In point 6.2 ‘the date on which the claim arose’ means the point in time on which the obligation of the debtor vis à vis the creditor was established (conclusion of a contract, occurrence of a damage or injury). In point 6.3 ‘the date on which the claim became due’ means the point in time when the debtor was required to perform on the basis of the obligation (the payment became due). Statutory penalties for late payment which are to be calculated as a percentage of the capital amount claimed should be asserted as statutory interest (see point 6.1.3). In point 7 If you have a preferential position you are owed debts which, according to domestic law, are to be paid in preference to certain other categories of debt. In point 8, security in rem refers to any security you hold in respect of your claim against the debtor. Such security may take several different forms such as a fixed charge on a specific asset or a floating charge over a group of assets. In point 9, with regard to set-off, if the creditor is a financial institution and demands set-off against the debtor, it should also indicate the details of the accounts concerned. Points 9.1 to 9.5 should be filled in only if you demand a set-off. Point 10: the form must be accompanied by copies of any supporting documents. Text of image ANNEX II 1. THE INSOLVENCY PROCEEDING CONCERNED 1.1. Name of the court opening insolvency proceedings (*) 1.2. Reference number of the case (to be filled in if there is any) (**) 1.3. Name of the insolvency practitioner(s) appointed in the proceedings (to be filled in if there are any) (**) 2. DEBTOR 2.1. Name (*) 2.1.1. Name (if the debtor is a company or a legal person): or 2.1.2. Surname: 2.1.3. First name(s): (if the debtor is a natural person) 2.2. Registration number (to be filled in if there is one under the national law in the Member State where the debtor has its centre of main interests) (**) 2.3. Address (unless point 2.4 applies) (**) 2.3.1. Street and number/PO box: 2.3.2. Place and postal code: 2.3.3. Country: 2.4. Date and place of birth (to be filled in if the debtor is a natural person and his/her address is protected) (**) 3. INFORMATION ABOUT THE CREDITOR WHO OWNS THE CLAIM(S) 3.1. Name (*): 3.1.1. Name: 3.1.2. Legal representative: (if the creditor is a company or a legal person) or 3.1.3. Surname: 3.1.4. First name(s): (if the creditor is a natural person) Points marked with (*): the provision of information is mandatory. Points marked with (**): the provision of information is mandatory subject to a condition. Point without any specific marking: the provision of information is facultative/optional. Text of image ANNEX II 3.2. Postal address (*): 3.2.1. Street and number/PO box: 3.2.2. Place and postal code: 3.2.3. Country: 3.3. Personal identification number or registration number (if either applies): 3.4. Contact person 3.4.1. Name (if different from you): 3.4.2. Email address: 3.4.3. Telephone number: 3.5. Reference number of the creditor: 4. INFORMATION ABOUT THE PERSON WHO IS LODGING THE CLAIM IN THE NAME OF THE CREDITOR IN POINT 3: the same person as indicated in point 3; or a different person from the creditor indicated in point 3, whose details are the following: 4.1. Name (*): 4.2. Postal address (*): 4.2.1. Street and number/PO box: 4.2.2. Place and postal code: 4.2.3. Country: 4.3. Email address: 4.4. Telephone number: 4.5. Fax 4.6. His/her relationship to the creditor indicated in point 3 (*): lawyer (on the basis of a power of attorney); or director of the creditor or other representative of the creditor legally authorized by the applicable company law; or Points marked with (*): the provision of information is mandatory. Points marked with (**): the provision of information is mandatory subject to a condition. Point without any specific marking: the provision of information is facultative/optional. Text of image ANNEX II employee of the creditor; or association for the protection of the creditors; or insolvency practitioner appointed in territorial/secondary proceedings; or insolvency practitioner appointed in a main proceeding; or other (please, specify): 5. DETAILS OF THE BANK ACCOUNT TO WHICH ANY DISTRIBUTION ON THE BASIS OF THE CLAIMS LODGED SHOULD BE TRANSFERRED 5.1. Account holder’s name: 5.2. Member State where the account is maintained (please indicate the country code): 5.3. Account number: 5.3.1. IBAN: 5.3.2. BIC: 6. THE CLAIM LODGED 6.1. Amount of the claim (*): 6.1.1. Principal (*): 6.1.2. Is interest claimed? (*) No Yes 6.1.3. If yes, is the interest: Contractual interest or Statutory interest If statutory, to be calculated in accordance with (please specify relevant statute): 6.1.4. Interest due from: (date (dd/mm/yyyy) or event) to (date (dd/mm/yyyy) or event). 6.1.5. Interest rate 6.1.5.1. … % from (date) to (date) 6.1.5.2. … % from (date) to (date) 6.1.5.3. … % from (date) to (date) Points marked with (*): the provision of information is mandatory. Points marked with (**): the provision of information is mandatory subject to a condition. Point without any specific marking: the provision of information is facultative/optional. Text of image ANNEX II 6.1.6. The capitalized amount of the interest: 6.1.7. Total amount of the claim (point 6.1.1 + point 6.1.6) (*): 6.1.8. Currency (*): Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Croatian kuna (HRK) Hungarian forint (HUF) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) United Kingdom pound (GBP) Other (please specify using the ISO code): 6.2. The date on which the claim arose (*): 6.3. The date on which the claim became due (if different from point 6.2): 6.4. Costs that arose from the assertion of the claim prior to the opening of insolvency proceedings (to be filled in if claimed) (**): 6.4.1. amount of such costs: 6.4.2. details of the costs: 6.4.3. Currency: Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Croatian kuna (HRK) Hungarian forint (HUF) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) United Kingdom pound (GBP) Other (please specify using the ISO code): 6.5. Nature of the claim (*): the claim relates to a contractual obligation of the debtor liability of the debtor resulting from a willful, tortious act arises from other non-contractual obligation relates to a right in rem of the creditor [outstanding statutory maintenance arrears that the debtor, in breach of his duty, has intentionally not paid] claims resulting from a contract of employment tax claim claims with regard to contributions to social security bodies other (please specify) 7. DO YOU CLAIM A PREFERENTIAL POSITION (*) no yes if yes, please, specify: Points marked with (*): the provision of information is mandatory. Points marked with (**): the provision of information is mandatory subject to a condition. Point without any specific marking: the provision of information is facultative/optional. Text of image ANNEX II 8. DO YOU CLAIM any security in rem; any reservation of title; any other right granting separate satisfaction from certain items of the debtor? 8.1. description of the assets covered by the security, by the reservation of title or by the other right granting separate satisfaction invoked: 8.2. the date on which the charge, mortgage, other security (please specify), the reservation of title or the other right granting separate satisfaction was formally given: 8.3. If the security, the reservation of title or the other right granting separate satisfaction has been registered with an appropriate public authority, the date and location of registration and any number with regard to registration (*): 9. DOES THE DEBTOR HAVE A CLAIM AGAINST YOU (THE CREDITOR) WHICH MAY RESULT IN A SET OFF? (*) yes (in this case, please indicate the details below) no 9.1. Amount of the claim of the debtor which may result in set-off against the creditor on the date when insolvency proceedings were opened: 9.2. The date on which the claim of the debtor in point 9.1 arose: 9.3. The amount claimed net of set-off (points 6.1.7 to 9.1): 9.4. Currency: Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Croatian kuna (HRK) Hungarian forint (HUF) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) United Kingdom pound (GBP) Other (please specify using the ISO code): 9.5. Identification of the debtor’s claim against which the creditor demands set-off: 10. LIST OF COPIES OF SUPPORTING DOCUMENTS ENCLOSED: Points marked with (*): the provision of information is mandatory. Points marked with (**): the provision of information is mandatory subject to a condition. Point without any specific marking: the provision of information is facultative/optional. I declare that the information provided in this application is true and complete to the best of my knowledge. Done at , date Signature