ANNEX ISupplementary provisions
ANNEX I ‘ANNEX I Uniform notification form providing information about notified document(s) (to be transmitted to the addressee of the notification) ( 1 ) ( 2 ) This document, established in accordance with ☐ Article 10 of Commission Implementing Regulation (EU) No 1189/2011 accompanies document(s) hereby notified by the competent authority of the following State: [name of requested State]. This notification concerns documents of the competent authorities of the following State: [name of applicant State], which asked for notification assistance, in accordance with ☐ Article 8 of Council Directive 2010/24/EU . A. ADDRESSEE OF THE NOTIFICATION — Name: — Address (known or assumed): — Other data relevant to the identification of the addressee: B. PURPOSE OF THE NOTIFICATION This notification is intended: ☐ to inform the addressee, about the document(s) to which this document is attached. ☐ to interrupt the period of limitation with regard to the claim(s) mentioned in the notified document(s). ☐ to confirm the addressee, about his/her obligation to pay the amounts mentioned under point D. Please note that in case of non-payment, the authorities may take enforcement and/or precautionary measures to ensure the recovery of the claim(s). This may cause extra costs charged to the addressee. You are the addressee of this notification, as you are considered to be: ☐ the principal debtor ☐ a co-debtor ☐ a person other than the (co-)debtor, liable for settlement of the taxes, duties and other measures, or for other claims relating to these taxes, duties and other measures, under the laws in force in the applicant State ☐ a person other than the (co-)debtor, holding assets belonging to, or having debts towards, the (co-)debtor or to any other person liable ☐ a third party which may become affected by enforcement measures concerning other persons (The following information will appear if the addressee of the notification is a person other than the (co-)debtor, holding assets belonging to, or having debts towards, the (co-)debtor or to any other person liable, or a third party which may become affected by enforcement measures concerning other persons: The notified documents concern claims relating to taxes and duties, for which the following person(s) is (are) liable as ☐ the principal debtor: [name and address (known or assumed)] ☐ a co-debtor: [name and address (known or assumed)] ☐ a person other than the (co-)debtor, liable for settlement of the taxes, duties and other measures, or for other claims relating to these taxes, duties and other measures, under the laws in force in the applicant State: [name and address (known or assumed)]). The applicant authority of the applicant State (name of the applicant State) invited the competent authorities of the requested State (name of the requested State) to make this notification before [date]. Please note that this date is not specifically related to any period of limitation. C. OFFICE(S) RESPONSIBLE FOR THE NOTIFIED DOCUMENT(S) Office responsible with regard to the attached document(s): — Name: — Address: — Other contact details: — Language(s) in which this office can be contacted: Further information about ☐ the notified document(s) ☐ and/or the possibility to contest the obligations can be obtained ☐ at the abovementioned office responsible with regard to the attached document(s), and/or ☐ from the following office: — Name: — Address: — Other contact details: — Language(s) in which this office can be contacted: D. DESCRIPTION OF THE NOTIFIED DOCUMENT(S) Document [number] — Reference number: — Date of establishment: — Nature of the notified document: ☐ Tax assessment ☐ Payment order ☐ Decision following an administrative appeal ☐ Other administrative document: ☐ Judgment or order of: ☐ Other judicial document: — Name of the claim(s) concerned (in the language of the applicant State): — Nature of the claim(s) concerned: ☐ a) customs duties ☐ b) value added tax ☐ c) excise duties ☐ d) tax on income or capital ☐ e) tax on insurance premiums ☐ f) inheritance and gift taxes ☐ g) national taxes and duties on immovable property, other than the abovementioned ones ☐ h) national taxes and duties on the use or ownership of means of transport ☐ i) ther taxes and duties levied by or on behalf of the applicant State ☐ j) taxes and duties levied by or on behalf of territorial or administrative subdivisions of the applicant State, excluding taxes and duties levied by local authorities ☐ k) taxes and duties levied by or on behalf of local authorities ☐ l) other tax-based claim ☐ m) refunds, interventions and other measures forming part of the system of total or partial financing of the European Agricultural Guarantee Fund (EAGF) and the European Agricultural Fund for Rural Development (EAFRD), including sums to be collected in connection with these actions, and levies and other duties provided for under the common organisation of the market for the sugar sector — Amount of the claim(s) concerned: ☐ Principal amount: ☐ Administrative penalties and fines: ☐ Interest up to [date]: ☐ Costs up to [date]: ☐ Fees for certificates and similar documents issued in connection with administrative procedures related to the claim mentioned under point [x]: ☐ Total amount for this (these) claim(s): — The amount mentioned under point [x] should be paid: ☐ before: ☐ within [number] days following the date of this notification ☐ without any further delay — This payment should be made to: — Holder of the bank account: — International Bank Account Number (IBAN): — Bank Identification Code (BIC): — Name of the bank: — Reference to be used for the payment: — The addressee can reply to the document(s) that is (are) hereby notified. ☐ Last day for replying: ☐ Time period for replying: — Name and address of the authority to whom a reply can be sent: — Possibility to contest: ☐ The period to contest the claim or the notified document(s) has already come to its end. ☐ Last day for contesting the claim: ☐ Time period to contest the claim: [number of days] following ☐ the date of this notification. ☐ the establishment of the notified document(s) ☐ another date: — Name and address of the authority where a contestation has to be submitted: Please note that disputes concerning the claim, the instrument permitting enforcement or any other document originating from the authorities of the applicant State (name of applicant State), fall within the competence of the competent bodies of the applicant State (name of applicant State), in accordance with ☐ Article 14 of Directive 2010/24/EU. Any such dispute is governed by the procedural and language rules applying in the applicant State (name of applicant State). ☐ Please note that the recovery may begin before the end of the period within which the claim may be contested. — Other information: ’ ( 1 ) The elements put in Italic are optional. ( 2 ) Where this form is transmitted by electronic means, its structure and lay-out may be adapted to the requirements of the electronic communication system, provided that the set of data and information contained therein is not substantially altered.