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[F1ANNEX VI U.K. APPLICATION FORM WITH A VIEW TO THE RECOGNITION, DECLARATION OF ENFORCEABILITY OR ENFORCEMENT OF A DECISION IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS

PART B U.K. 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

6. APPLICATION U.K.

6.1.  Application for recognition or for recognition and declaration of enforceability of a decision U.K.

The application is based on:

6.1.1.

 Chapter IV, Section 2, of Regulation (EC) No 4/2009

6.1.2.

 The 2007 Hague Convention

6.1.2.1.

Indicate the basis for recognition and enforcement under Article 20 of the 2007 Hague Convention:

6.1.2.2.

The defendant has appeared or been represented in the proceedings in the State of origin:

Yes No
6.1.3.

 The national law of the requested Member State

6.1.4.

 Other (please specify): …

6.2.  Application for enforcement of a decision given or recognised in the requested Member State U.K.

7. DECISION U.K.

7.1. Date and reference number: … U.K.
7.2. Name of the court of origin: … U.K.

8. APPLICANT U.K.

8.1. Natural person U.K.
8.1.1. Surname and given name(s): … U.K.
8.1.2. Date (dd/mm/yyyy) and place of birth: … U.K.
8.1.3. Identity number or social security number (1) : … U.K.
8.1.4. Nationality: … U.K.
8.1.5. Occupation: … U.K.
8.1.6. Civil status: … U.K.
8.1.7. Address: U.K.

The address given below is the applicant’s personal address.

The applicant is in a situation of family violence (2) . The address given below is an address care of: … (surname and given name(s))

8.1.7.1. Street and number/PO box: … U.K.
8.1.7.2. Place and postal code: … U.K.
8.1.7.3. Member State U.K.

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

8.1.8. Telephone/E-mail: … U.K.
8.1.9. Has benefited from: U.K.
8.1.9.1.

legal aid:

Yes No
8.1.9.2.

exemption from costs and expenses:

Yes No
8.1.9.3.

free proceedings before an administrative authority listed in Annex X to Regulation (EC) No 4/2009:

Yes No
8.1.10. If applicable, surname, given name(s) and contact details of the applicant’s representative (lawyer, etc. …): … U.K.

8.2. Public body: U.K.
8.2.1. Name: … U.K.
8.2.2. Address: U.K.
8.2.2.1.

Street and number/PO box: …

8.2.2.2.

Place and postal code: …

8.2.2.3.

Member State

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

8.2.3. Telephone/Fax/E-mail: … U.K.
8.2.4. Name of the person representing the body in the proceedings (3) : U.K.

8.2.5. Person responsible for following up the application: U.K.
8.2.5.1.

Surname and given name(s): …

8.2.5.2.

Telephone: …

8.2.5.3.

Fax …

8.2.5.4.

E-mail: …

9. DEFENDANT U.K.

9.1. Surname and given name(s): … U.K.
9.2. Date (dd/mm/yyyy) and place of birth (4) : … U.K.
9.3. Identity number or social security number (5) : … U.K.
9.4. Nationality (6) : … U.K.
9.5. Occupation (7) : … U.K.
9.6. Civil status (8) : … U.K.
9.7. Address (9) : U.K.
9.7.1. Street and number/PO box: … U.K.
9.7.2. Place and postal code: … U.K.
9.7.3. Member State U.K.

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

10. ANY OTHER INFORMATION THAT MAY HELP LOCATE THE DEFENDANT: … U.K.

11. PERSON(S) FOR WHOM MAINTENANCE IS SOUGHT OR OWED (10) U.K.

11.1.  The person is the same as the applicant named in point 8 U.K.
11.2.  The person is the same as the defendant named in point 9 U.K.
11.3.
The applicant The defendant

is the representative (11) defending the interests of the following person(s):

11.3.1. Person A U.K.
11.3.1.1. Surname and given name(s): … U.K.
11.3.1.2. Date (dd/mm/yyyy) and place of birth: … U.K.
11.3.1.3. Identity number or social security number (12) : … U.K.
11.3.1.4. Nationality (13) : … U.K.
11.3.1.5. Occupation (14) : … U.K.
11.3.1.6. Civil status (15) : … U.K.
11.3.2. Person B U.K.
11.3.2.1. Surname and given name(s): … U.K.
11.3.2.2. Date (dd/mm/yyyy) and place of birth: … U.K.
11.3.2.3. Identity number or social security number (16) : … U.K.
11.3.2.4. Nationality (17) : … U.K.
11.3.2.5. Occupation (18) : … U.K.
11.3.2.6. Civil status (19) : … U.K.
11.3.3. Person C U.K.
11.3.3.1. Surname and given name(s): … U.K.
11.3.3.2. Date (dd/mm/yyyy) and place of birth: … U.K.
11.3.3.3. Identity number or social security number (20) : … U.K.
11.3.3.4. Nationality (21) : … U.K.
11.3.3.5. Occupation (22) : … U.K.
11.3.3.6. Civil status (23) : … U.K.

12. DEBTOR U.K.

12.1.  The person is the same as the applicant named in point 8 U.K.
12.2.  The person is the same as the defendant named in point 9 U.K.
12.3.
The applicant The defendant

is the representative (24) defending the interests of the following person:

12.3.1.

Surname and given name(s): …

12.3.2.

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

12.3.3.

Identity number or social security number (25) : …

12.3.4.

Nationality (26) : …

12.3.5.

Occupation (27) : …

12.3.6.

Civil status (28) : …

13. INFORMATION REGARDING PAYMENT, IF THE APPLICATION IS MADE BY THE CREDITOR U.K.

13.1. Payment by electronic means U.K.
13.1.1. Name of bank: … U.K.
13.1.2. BIC or other relevant bank code: … U.K.
13.1.3. Account holder: … U.K.
13.1.4. International Bank Account Number (IBAN): … U.K.
13.2. Payment by cheque U.K.
13.2.1. Cheque payable to: … U.K.
13.2.2. Cheque to be sent to U.K.
13.2.2.1. Surname and given name(s): … U.K.
13.2.2.2. Address: U.K.
13.2.2.2.1.

Street and number/PO box: …

13.2.2.2.2.

Place and postal code: …

13.2.2.2.3.

Country: …

14. ADDITIONAL INFORMATION (WHERE APPLICABLE): U.K.

Done at: … on … (dd/mm/yyyy)

Applicant’s signature: …

and/or, where appropriate:

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

]

(1)

[F1If available.]

(2)

[F1The national law of the requested Member State may, however, require the applicant to provide his/her personal address for the purposes of the proceedings (see Article 57(3) of Regulation (EC) No 4/2009].]

(3)

[F1If relevant.]

(4)

[F1If available.]

(5)

[F1If available.]

(6)

[F1If available.]

(7)

[F1If available.]

(8)

[F1If available.]

(9)

[F1If available.]

(10)

[F1If more than three persons, attach an additional sheet.]

(11)

[F1For example, the person with parental responsibility or the guardian of a protected adult.]

(12)

[F1If available and/or relevant.]

(13)

[F1If available and/or relevant.]

(14)

[F1If available and/or relevant.]

(15)

[F1If available and/or relevant.]

(16)

[F1If available and/or relevant.]

(17)

[F1If available and/or relevant.]

(18)

[F1If available and/or relevant.]

(19)

[F1If available and/or relevant.]

(20)

[F1If available and/or relevant.]

(21)

[F1If available and/or relevant.]

(22)

[F1If available and/or relevant.]

(23)

[F1If available and/or relevant.]

(24)

[F1For example, the person with parental responsibility or the guardian of a protected adult.]

(25)

[F1If available.]

(26)

[F1If available.]

(27)

[F1If available.]

(28)

[F1If available.]