13.1.2. BIC or other relevant bank code: …
13.1.3. Account holder: …
13.1.4. International Bank Account Number (IBAN): …
13.2. Payment by cheque
13.2.1. Cheque payable to: …
Cheque to be sent to
13.2.2.1. Surname and given name(s): …
Address:
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):
…
…
…
Done at: … on … (dd/mm/yyyy)
Signature of applicant: …
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)
OJ L 7, 10.1.2009, p. 1
.
(2) Please put a cross in the boxes which apply and number the documents in the order in which they are attached.
(3) If available.
(4) In cases of family violence (see Article 57(3) of Regulation (EC) No 4/2009).
(5) If relevant.
(6) If this information is available.
(7) If more than three persons, attach an additional sheet.
(8) For example the person with parental responsibility or the guardian of a protected adult.
(9) If this information is available and/or relevant.
ANNEX VII
(Articles 56 and 57 of Council Regulation (EC) No 4/2009 of 18 December 2008 on jurisdiction, applicable law, recognition and enforcement of decisions and cooperation in matters relating to maintenance obligations(1))
1. Application
Application to obtain a decision (Article 56(1)(c))
Application to obtain a decision (Article 56(1)(d))
Application for the modification of a decision (Article 56(1)(e))
Application for the modification of a decision (Article 56(1)(f))
Application for the modification of a decision (Article 56(2)(b))
Application for the modification of a decision (Article 56(2)(c))
2. Requesting Central Authority
2.1. Name: …
Address:
2.2.1. Street and number/PO box: …
2.2.2. Place and postal code: …
2.2.3. Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden
2.3. Telephone: …
2.4. Fax: …
2.5. E-mail: …
2.6. Reference number of the application: …
Application to be handled with the application(s) bearing the following reference number(s): …
Person responsible for following up the application:
2.7.1. Surname and given name(s): …
2.7.2. Telephone: …
2.7.3. E-mail: …
3. Requested Central Authority
3.1. Name: …
Address:
3.2.1. Street and number/PO box: …
3.2.2. Place and postal code: …
3.2.3. Member State
Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden