Council Regulation (EC) No 4/2009Dangos y teitl llawn

ANNEX VII

APPLICATION FORM TO OBTAIN OR HAVE MODIFIED A DECISION IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS

(Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations(1))

PART A: To be completed by the requesting Central Authority

1. Application

• Application to obtain a decision (Article 56(1)(c))

• Application to obtain a decision (Article 56(1)(d))

• Application for the modification of a decision (Article 56(1)(e))

• Application for the modification of a decision (Article 56(1)(f))

• Application for the modification of a decision (Article 56(2)(b))

• Application for the modification of a decision (Article 56(2)(c))

2. Requesting Central Authority

2.1. Name: …

2.2.

Address:

2.2.1. Street and number/PO box: …

2.2.2. Place and postal code: …

2.2.3. Member State

 Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain France  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden

2.3. Telephone: …

2.4. Fax: …

2.5. E-mail: …

2.6. Reference number of the application: …

Application to be handled with the application(s) bearing the following reference number(s): …

2.7.

Person responsible for following up the application:

2.7.1. Surname and given name(s): …

2.7.2. Telephone: …

2.7.3. E-mail: …

3. Requested Central Authority

3.1. Name: …

3.2.

Address:

3.2.1. Street and number/PO box: …

3.2.2. Place and postal code: …

3.2.3. Member State

 Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain France  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden

4. Documents attached(2) to the application, as appropriate

• Decision of the requested Member State refusing recognition or a declaration of enforceability

• Copy of the decision to be modified

• Extract from the decision to be modified

• Document(s) proving a change in income or any other change in circumstances

• Birth certificate(s) or equivalent

• Debtor’s acknowledgement of parentage

• Document(s) proving biological parentage

• Decision by a competent authority in relation to parentage

• Results of genetic tests

• Adoption certificate

• Certificate of marriage or similar relationship

• Document(s) proving the date of divorce/separation

• Document(s) proving that the parties live together

• Certificate(s) regarding schooling

• Document(s) relevant to the financial situation

• Other (please specify): …

  …

  …

  …

Total number of documents attached to the application form: …

Done at: … on … (dd/mm/yyyy)

Name and signature of the authorised official of the requesting Central Authority:

…

PART B: To be completed by the applicant or, as appropriate, by the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf

5. Application

5.1.

 Application to obtain a decision

5.1.1.

 Parentage has not been established

5.1.2.

 No decision exists

5.1.3.

 Recognition and a declaration of enforceability of an existing decision are not possible

5.1.4.

 Amount requested:

…

…

…

5.2.

 Application for modification of a decision

5.2.1.

 The decision was given in the requested Member State

5.2.2.

 The decision was given in a State other than the requested Member State

5.2.3. Date (dd/mm/yyyy) and reference number of the decision: …

5.2.4. Name of the court of origin: …

5.2.5. Changes in circumstances which have occurred:

• Change in income:

• of the person(s) for whom maintenance is sought or owed

• of the person primarily responsible for the person(s) for whom maintenance is sought or owed

• of the debtor

• Change in expenses and charges:

• of the person(s) for whom maintenance is sought or owed

• of the person primarily responsible for the person(s) for whom maintenance is sought or owed

• of the debtor

• Change in the situation of the child/children

• Change in marital status:

• of the person(s) for whom maintenance is sought or owed

• of the person primarily responsible for the person(s) for whom maintenance is sought or owed

• of the debtor

• Other (please specify): …

  …

  …

5.2.6. Modification(s) requested:

• Increase in the amount of maintenance (please specify): …

• Reduction in the amount of maintenance (please specify): …

• Modification of the frequency of payments (please specify): …

• Modification of the arrangements for payment (please specify): …

• Modification of the nature of payments (please specify): …

• Termination of the maintenance obligation (please specify): …

• Other (please specify): …

  …

6. Applicant

6.1. Surname and given name(s): …

6.2.

Address:

6.2.1. Care of: … (Surname and given name(s))(3)

6.2.2. Street and number/PO box: …

6.2.3. Place and postal code: …

6.2.4. Member State

 Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden

6.3. Telephone/E-mail: …

6.4. Date (dd/mm/yyyy) and place of birth: …

6.5. Identity/social security number(4): …

6.6. Nationality: …

6.7. Profession: …

6.8. Current marital status: …

6.9. If applicable, surname, given name(s) and contact details of the applicant’s representative (lawyer, etc. …): …

…

…

7. Defendant

7.1. Surname and given name(s): …

7.2.

Address(4):

7.2.1. Street and number/PO box: …

7.2.2. Place and postal code: …

7.2.3. Member State

 Belgium  Bulgaria  Czech Republic  Germany  Estonia  Ireland  Greece  Spain  France  Italy  Cyprus  Latvia  Lithuania  Luxembourg  Hungary  Malta  Netherlands  Austria  Poland  Portugal  Romania  Slovenia  Slovakia  Finland  Sweden

7.3. Date (dd/mm/yyyy) and place of birth(4): …

7.4. Identity/social security number(4): …

7.5. Nationality(4): …

7.6. Profession(4): …

7.7. Current marital status(4): …

8. Any other information that may help locate the defendant:

…

…

…

9. Person(s) for whom maintenance is sought or owed(5)

9.1.

 The person is the same as the applicant named in point 6

9.2.

 The person is the same as the defendant named in point 7

9.3.



The applicant



The defendant

is the representative(6) defending the interests of the following person(s):

9.3.1. Person A

9.3.1.1. Surname and given name(s): …

9.3.1.2. Date (dd/mm/yyyy) and place of birth: …

9.3.1.3. Identity/social security number(7): …

9.3.1.4. Nationality(7): …

9.3.1.5. Profession(7): …

9.3.1.6. Current marital status(7): …

9.3.1.7. Maintenance is on the basis of the following relationship:

• Parentage (please specify relationship): …

• Marriage

• Analogous relationship to marriage

• Alliance (please specify relationship): …

• Other (please specify): …

9.3.2. Person B

9.3.2.1. Surname and given name(s): …

9.3.2.2. Date (dd/mm/yyyy) and place of birth: …

9.3.2.3. Identity/social security number(7): …

9.3.2.4. Nationality(7): …

9.3.2.5. Profession(7): …

9.3.2.6. Current marital status(7): …

9.3.2.7. Maintenance is on the basis of the following relationship:

• Parentage (please specify relationship): …

• Marriage

• Analogous relationship to marriage

• Alliance (please specify relationship): …

• Other (please specify): …

9.3.3. Person C

9.3.3.1. Surname and given name(s): …

9.3.3.2. Date (dd/mm/yyyy) and place of birth: …

9.3.3.3. Identity/social security number(7): …

9.3.3.4. Nationality(7): …

9.3.3.5. Profession(7): …

9.3.3.6. Current marital status(7): …

9.3.3.7. Maintenance is on the basis of the following relationship:

• Parentage (please specify relationship): …

• Marriage

• Analogous relationship to marriage

• Alliance (please specify relationship): …

• Other (please specify): …

10. Debtor

10.1.

 The person is the same as the applicant named in point 6

10.2.

 The person is the same as the defendant named in point 7

10.3.



The applicant



The defendant

is the representative(6) defending the interests of the following person:

10.3.1. Surname and given name(s): …

10.3.2. Date (dd/mm/yyyy) and place of birth: …

10.3.3. Identity/social security number(4): …

10.3.4. Nationality(4): …

10.3.5. Profession(4): …

10.3.6. Current marital status(4): …

10.3.7. Maintenance is on the basis of the following relationship:

• Parentage (please specify relationship): …

• Marriage

• Analogous relationship to marriage

• Affinity (please specify relationship): …

• Other (please specify): …

11. Information on the financial situation of the persons concerned by the application (only give information which is relevant for the purpose of obtaining or modifying a decision)

11.1. Currency

 Euro (EUR)  Bulgarian lev (BGN)  Czech koruna (CZK)  Estonian kroon (EEK)  Hungarian forint (HUF)  Lithuanian litas (LTL)  Latvian lats (LVL)  Polish zloty (PLN)  Romanian leu (RON)  Swedish krona (SEK)  Other (please specify ISO code): …

11.2. The person(s) for whom maintenance is sought or owed and the person primarily responsible for that person (those persons)

11.2.1. Gross income

 Monthly Annual	Person primarily responsible for the person(s) for whom maintenance is sought or owed	Spouse or current partner of the person primarily responsible for the person(s) for whom maintenance is sought or owed	Person for whom maintenance is sought or owed (Person A)	Person for whom maintenance is sought or owed (Person B)	Person for whom maintenance is sought or owed (Person C)
Salary (including payments in kind), pensions, disability pensions, maintenance payments, allowances, annuities, unemployment benefits
Income from non-salaried occupations
Income from securities/floating capital/real property
Other sources of income
TOTAL

11.2.2. Expenses and charges

 Monthly Annual	Person primarily responsible for the person(s) for whom maintenance is sought or owed	Spouse or current partner of the person primarily responsible for the person(s) for whom maintenance is sought or owed	Person for whom maintenance is sought or owed (Person A)	Person for whom maintenance is sought or owed (Person B)	Person for whom maintenance is sought or owed (Person C)
Taxes
Insurance premiums, mandatory social security and professional contributions
Rent/cost of co-ownership, mortgage payments
Food and clothing
Medical expenses
Maintenance paid to a third party by virtue of a legal obligation and/or expenditure for other dependent persons not covered by the application
Education costs of children
Loan repayments, other debts
Other expenditure
TOTAL

11.2.3. Other assets

…

…

…

11.3. The debtor

11.3.1. Gross income

 Monthly Annual	Debtor	Current spouse or partner of the debtor
Salary (including payments in kind), pensions, disability pensions, alimonies, allowances, annuities, unemployment benefits
Income from non-salaried occupations
Income from securities/floating capital/real property
Other sources of income
TOTAL

11.3.2. Expenses and charges

 Monthly Annual	Debtor	Current spouse or partner of the debtor
Taxes
Insurance premiums, mandatory social security and professional contributions
Rent/cost of co-ownership, mortgage payments
Food and clothing
Medical expenses
Maintenance paid to a third party by virtue of a legal obligation and/or expenditure for other dependent persons not covered by the application
Education costs of children
Loan repayments, other debts
Other expenditure
TOTAL

11.3.3. Other assets

…

…

…

12. Information regarding payment, if the application is made by the creditor

12.1.

Payment by electronic means

12.1.1. Name of the bank: …

12.1.2. BIC or other relevant bank code: …

12.1.3. Account holder: …

12.1.4. International Bank Account Number (IBAN): …

12.2.

Payment by cheque

12.2.1. Cheque payable to: …

12.2.2.

Cheque to be sent to

12.2.2.1. Surname and given name(s): …

12.2.2.2.

Address:

12.2.2.2.1. Street and number/PO box: …

12.2.2.2.2. Place and postal code: …

12.2.2.2.3. Country: …

13. Additional information (where applicable):

…

…

…

Done at… on … (dd/mm/yyyy)

Signature of applicant: …

and/or, where applicable:

Name and signature of the person/authority authorised in the requesting Member State to complete the form on the applicant’s behalf:

…

(1)

OJ L 7, 10.1.2009, p. 1.

(2)

Please put a cross in the boxes which apply and number the documents in the order in which they are attached.

(3)

In cases of domestic violence (see Article 57(3) of Regulation (EC) No 4/2009).

(4)

If this information is available.

(5)

If more than three persons, attach an additional sheet.

(6)

For example, the person with parental responsibility or the guardian of a protected adult.

(7)

If this information is available and/or relevant.