ANNEX ICERTIFICATE REFERRED TO IN ARTICLE 39 CONCERNING JUDGMENTS IN MATRIMONIAL MATTERS1
1.
Member State of origin
2.Court or authority issuing the certificate
2.1.
Name
2.2.
Address
2.3.
Tel./fax/e-mail
3.Marriage
3.1.Wife
3.1.1.
Full name
3.1.2.
Address
3.1.3.
Country and place of birth
3.1.4.
Date of birth
3.2.Husband
3.2.1.
Full name
3.2.2.
Address
3.2.3.
Country and place of birth
3.2.4.
Date of birth
3.3.Country, place (where available) and date of marriage
3.3.1.
Country of marriage
3.3.2.
Place of marriage (where available)
3.3.3.
Date of marriage
4.Court which delivered the judgment
4.1.
Name of Court
4.2.
Place of Court
5.Judgment
5.1.
Date
5.2.
Reference number
5.3.Type of judgment
5.3.1.
Divorce
5.3.2.
Marriage annulment
5.3.3.
Legal separation
5.4.Was the judgment given in default of appearance?
5.4.1.
No
5.4.2.
Yes2
6.
Names of parties to whom legal aid has been granted
7.Is the judgment subject to further appeal under the law of the Member State of origin?
7.1.
No
7.2.
Yes
8.Date of legal effect in the Member State where the judgment was given
8.1.
Divorce
8.2.
Legal separation
Done at …, date …
Signature and/or stamp