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

1.Member State of originU.K.

2.Court or authority issuing the certificateU.K.

2.1.NameU.K.

2.2.AddressU.K.

2.3.Tel./fax/e-mailU.K.

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

3.1.Full nameU.K.

3.2.AddressU.K.

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

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

4.1.MotherU.K.

4.1.1.Full nameU.K.
4.1.2.Address (where available)U.K.
4.1.3.Date and place of birth (where available)U.K.

4.2.FatherU.K.

4.2.1.Full nameU.K.
4.2.2.Address (where available)U.K.
4.2.3.Date and place of birth (where available)U.K.

4.3.OtherU.K.

4.3.1.Full nameU.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 nameU.K.

5.2.Address (where available)U.K.

6.Court which delivered the judgmentU.K.

6.1.Name of CourtU.K.

6.2.Place of CourtU.K.

7.JudgmentU.K.

7.1.DateU.K.

7.2.Reference numberU.K.

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

8.1.Full name and date of birthU.K.

8.2.Full name and date of birthU.K.

8.3.Full name and date of birthU.K.

8.4.Full name and date of birthU.K.

9.The judgment entails the return of the childU.K.

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

10.1.YesU.K.

10.2.NoU.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 maturityU.K.

12.The parties were given an opportunity to be heardU.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 AbductionU.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 residenceU.K.

15.Names of parties to whom legal aid has been grantedU.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.