ANNEX IVCERTIFICATE REFERRED TO IN ARTICLE 42(1) CONCERNING THE RETURN OF THE CHILD11
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.Person to whom the child has to be returned (to the extent stated in the judgment)
3.1.
Full name
3.2.
Address
3.3.
Date and place of birth (where available)
4.Holders of parental responsibility12
4.1.Mother
4.1.1.
Full name
4.1.2.
Address (where available)
4.1.3.
Date and place of birth (where available)
4.2.Father
4.2.1.
Full name
4.2.2.
Address (where available)
4.2.3.
Date and place of birth (where available)
4.3.Other
4.3.1.
Full name
4.3.2.
Address (where available)
4.3.3.
Date and place of birth (where available)
5.Respondent (where available)
5.1.
Full name
5.2.
Address (where available)
6.Court which delivered the judgment
6.1.
Name of Court
6.2.
Place of Court
7.Judgment
7.1.
Date
7.2.
Reference number
8.Children who are covered by the judgment13
8.1.
Full name and date of birth
8.2.
Full name and date of birth
8.3.
Full name and date of birth
8.4.
Full name and date of birth
9.
The judgment entails the return of the child
10.Is the judgment enforceable in the Member State of origin?
10.1.
Yes
10.2.
No
11.
The children were given an opportunity to be heard, unless a hearing was considered inappropriate having regard to their age or degree of maturity
12.
The parties were given an opportunity to be heard
13.
The judgment entails the return of the children and the court has taken into account in issuing its judgment the reasons for and evidence underlying the decision issued pursuant to Article 13 of the Hague Convention of 25 October 1980 on the Civil Aspects of International Child Abduction
14.
Where applicable, details of measures taken by courts or authorities to ensure the protection of the child after its return to the Member State of habitual residence
15.
Names of parties to whom legal aid has been granted
Done at …, date …
Signature and/or stamp