ANNEX IISupplementary provisions
ANNEX II ‘ANNEX II Uniform instrument permitting enforcement of claims covered by ☐ Directive 2010/24/EU ( 1 ) ( 2 ) ☐ UNIFORM INSTRUMENT PERMITTING ENFORCEMENT OF CLAIMS COVERED BY ☐ DIRECTIVE 2010/24/EU — Date of issue: — Reference number: ☐ REVISED UNIFORM INSTRUMENT PERMITTING ENFORCEMENT OF CLAIMS COVERED BY ☐ DIRECTIVE 2010/24/EU — Date of issue of the original uniform instrument: — Date of revision: — Reason for the revision: ☐ judgment or order of [name of the Court]of [date] ☐ administrative decision of [date] — Reference number: State where this document is issued: [name of applicant State] ☐ Each EU Member State can request recovery assistance from other Member States for unpaid claims referred to in Article 2 of Directive 2010/24/EU. This Directive has been adopted by the Council of the European Union on 16 March 2010 and is to be applied in all EU Member States. Recovery measures taken by the requested State are based on: ☐ a uniform instrument permitting enforcement, in accordance with ☐ Article 12 of Directive 2010/24/EU. ☐ a revised uniform instrument permitting enforcement, in accordance with ☐ Article 15 of Directive 2010/24/EU (to take account of the decision of the competent body referred to in Article 14(1) of that Directive). This document is the uniform instrument permitting enforcement (including precautionary measures). It concerns the claim(s) mentioned below, which remain(s) unpaid in the applicant State (name of applicant State). The initial instrument for the enforcement of this/these claim(s) has been notified in so far as required under the national law of the applicant State (name of applicant State). Disputes concerning the claim(s) fall exclusively 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 action shall be brought before them in accordance with the procedural and language rules in force in the applicant State (name of applicant State). DESCRIPTION OF THE CLAIM(S) AND THE PERSON(S) CONCERNED Identification of the claim(s) [number] 1. Reference: 2. 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) other 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 3. Name of the tax/duty concerned: 4. Period or date concerned: 5. Date of establishment of the claim: 6. Date on which enforcement becomes possible: 7. Amount of the claim still due: ☐ principal amount: ☐ administrative penalties and fines: ☐ interest till date before the day the request is sent: ☐ costs till date before the day the request is sent: ☐ fees for certificates and similar documents issued in connection with administrative procedures related to the tax/duty concerned: ☐ total amount of this claim: 8. Date of notification of the initial instrument permitting enforcement in the applicant State: (name of the applicant State): ☐ Date: ☐ No date available 9. Office responsible for the assessment of the claim: — Name: — Address: — Other contact details: — Language(s) in which this office can be contacted: 10. Further information concerning the claim or the possibilities for contesting the payment obligation can be obtained from: ☐ the office indicated above ☐ the following office responsible for the Uniform instrument permitting enforcement: — Name: — Address: — Other contact details: — Language(s) in which this office can be contacted: Identification of the person(s) concerned in the national instrument(s) permitting enforcement a) The following person is mentioned in the national instrument(s) permitting enforcement ☐ natural person ☐ other — Name — Address (known or assumed) — Other data relevant to the identification of the addressee ☐ Legal representative — Name — Address (known or assumed) — Other data relevant to the identification of the addressee Cause of liability: ☐ 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 b) the following person(s) is (are) also mentioned in the national instrument(s) permitting enforcement: ☐ natural person ☐ other — Name: — Address (known or assumed): — Other data relevant to the identification of the addressee: ☐ Legal representative — Name: — Address (known or assumed): — Other data relevant to the identification of the addressee: Cause of liability: ☐ 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 Other information Overall total amount of the claim(s) — in the currency of the applicant State: — in the currency of the requested State: — in EUR: ’ ( 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 and possibilities of the electronic communication system, provided that the set of data and information contained therein is not substantially altered.