ANNEX IV U.K.CERTIFICATE REFERRED TO IN ARTICLE 42(1) CONCERNING THE RETURN OF THE CHILD(1)

1. Member State of origin U.K.

2. Court or authority issuing the certificate U.K.

2.1. Name U.K.

2.2. Address U.K.

2.3. Tel./fax/e-mail U.K.

3. Person to whom the child has to be returned (to the extent stated in the judgment) U.K.

3.1. Full name U.K.

3.2. Address U.K.

3.3. Date and place of birth (where available) U.K.

4. Holders of parental responsibility(2) U.K.

4.1. Mother U.K.

4.1.1. Full name U.K.

4.1.2. Address (where available) U.K.

4.1.3. Date and place of birth (where available) U.K.

4.2. Father U.K.

4.2.1. Full name U.K.

4.2.2. Address (where available) U.K.

4.2.3. Date and place of birth (where available) U.K.

4.3. Other U.K.

4.3.1. Full name U.K.

4.3.2. Address (where available) U.K.

4.3.3. Date and place of birth (where available) U.K.

5. Respondent (where available) U.K.

5.1. Full name U.K.

5.2. Address (where available) U.K.

6. Court which delivered the judgment U.K.

6.1. Name of Court U.K.

6.2. Place of Court U.K.

7. Judgment U.K.

7.1. Date U.K.

7.2. Reference number U.K.

8. Children who are covered by the judgment(3) U.K.

8.1. Full name and date of birth U.K.

8.2. Full name and date of birth U.K.

8.3. Full name and date of birth U.K.

8.4. Full name and date of birth U.K.

9. The judgment entails the return of the child U.K.

10. Is the judgment enforceable in the Member State of origin? U.K.

10.1. Yes U.K.

10.2. No U.K.

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 U.K.

12. The parties were given an opportunity to be heard U.K.

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 U.K.

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 U.K.

15. Names of parties to whom legal aid has been granted U.K.

Done at …, date …

Signature and/or stamp

(1)

Council Regulation (EC) No 2201 of 27 November 2003 concerning jurisdiction and the recognition and enforcement of judgments in matrimonial matters and the matters of parental responsibility, repealing Regulation (EC) No 1347/2000.

(2)

This item is optional.

(3)

If more than four children are covered, use a second form.