ANNEX

ANNEX I

Application for a European order for payment

Form A Article 7(1) of Regulation (EC) No 1896/2006 of the European Parliament and of the Council creating a European order for payment procedure

Please ensure that you read the guidelines on the last page – they will help you to understand this form!

Please note in particular that this form must be completed in the language or one of the languages accepted by the court to be seised.

The form is available in all official languages of the European Union; this may help you fill in the form in the required language.

1. Court

Case number (to be completed by the court)

Court

Received by the court (day/month/year)

Address

Signature and/or stamp

Postal code

City

Country

2. Parties and their representatives

Codes:

01 Claimant

03 Claimant's representative *

05 Claimant's legally authorised representative **

02 Defendant

04 Defendant's representative *

06 Defendant's legally authorised representative **

Code

Corporate name of company or organisation

Identification code (if applicable)

Surname

First Name

Address

Postal code

City

Country

Phone ***

Fax ***

email ***

Occupation ***

Other details ***

Code

Corporate name of company or organisation

Identification code (if applicable)

Surname

First Name

Address

Postal code

City

Country

Phone ***

Fax ***

email ***

Occupation ***

Other details ***

Code

Corporate name of company or organisation

Identification code (if applicable)

Surname

First Name

Address

Postal code

City

Country

Phone ***

Fax ***

email ***

Occupation ***

Other details ***

Code

Corporate name of company or organisation

Identification code (if applicable)

Surname

First Name

Address

Postal code

City

Country

Phone ***

Fax ***

email ***

Occupation ***

Other details ***

* e.g. lawyer ** e.g. parent, guardian, managing director *** optional

3. Grounds for the court's jurisdiction

Codes:

01 Domicile of the defendant or co-defendant

02 Place of performance of the obligation in question

03 Place of the harmful event

04 Where a dispute arises out of the operations of a branch, agency or other establishment, the place in which the branch, agency or other establishment is situated

05 Domicile of the trust

06 Where a dispute arises concerning the payment of remuneration claimed in respect of the salvage of a cargo or freight, the place of the court under the authority of which the cargo or freight is or could have been arrested

07 Domicile of the policyholder, the insured or the beneficiary in insurance matters

08 Domicile of the consumer

09 Place where the employee carries out his work

10 Place where the business which engaged the employee is situated

11 Place where the immovable property is situated

12 Choice of court agreed by the parties

13 Domicile of the maintenance creditor

14 Other (please specify)

Code

Specification only for code 14

4. Cross-border nature of the case

Codes:

01

02

03

04

05

Belgium

Bulgaria

Czech Republic

Germany

Estonia

06

07

08

09

10

Greece

Spain

France

Croatia

Ireland

11

12

13

14

15

Italy

Cyprus

Latvia

Lithuania

Luxembourg

16

17

18

19

20

Hungary

Malta

The Netherlands

Austria

Poland

21

22

23

24

25

Portugal

Romania

Slovenia

Slovakia

Finland

26

27

28

Sweden

United Kingdom

other (please specify)

Domicile or habitual residence of claimant

Domicile or habitual residence of defendant

Country of the court

5. Bank details (optional)

5.1. Payment of court fees by the claimant

Codes:

01 By bank transfer

02 By credit card

03 Collection by court from claimant's bank account

04 Legal aid

05 Other (please specify)

If you choose code 02 or 03, please fill in the bank details in Appendix 1

Code

If you choose code 05, please specify

5.2. Payment by defendant of amount awarded

Account holder

Bank name (BIC) or other relevant bank code

Account number

International bank account number (IBAN)

EUR

Euro

BGN

Bulgarian Lev

CZK

Czech Koruna

GBP

Pound sterling

HUF

Hungarian Forint

HRK

Croatian kuna

PLN

Polish Zloty

RON

Romanian Leu

SEK

Swedish Krona

Other (according to international banking code)

6. Principal

Currency:

Total value of principal, excluding interest and costs:

The claim relates to (Code 1)

01 Sales contract

02 Rental agreement — movable property

03 Rental agreement — immovable property

04 Rental agreement — commercial lease

05 Contract of service — electricity, gas, water, phone

06 Contract of service — medical services

07 Contract of service — transport

08 Contract of service — legal, tax, technical advice

09 Contract of service — hotel, restaurant

10 Contract of service — repair

11 Contract of service — brokerage

12 Contract of service — other (please specify)

13 Building contract

14 Insurance contract

15 Loan

16 Guarantee or other collateral(s)

17 Claims arising from non-contractual obligations if they are subject to an agreement between the parties or an admission of debt (e.g. damages, unjust enrichment)

18 Claims arising from joint ownership of property

19 Damages — contract

20 Subscription agreement (newspaper, magazine)

21 Membership fee

22 Employment agreement

23 Out-of-court settlement

24 Maintenance agreement

25 Other (please specify)

Circumstances invoked (Code 2)

30 Non-payment

31 Insufficient payment

32 Late payment

33 Non-delivery of goods or services

34 Delivery of defective goods or poor services

35 Goods or services not in conformity with the order

36 Other (please specify)

Other details (Code 3)

40 Place of purchase

41 Place of delivery

42 Date of purchase

43 Date of delivery

44 Type of goods or services concerned

45 Address of immovable property

46 In case of loan, purpose: Consumer credit

47 In case of loan, purpose: Mortgage credit

48 Other detail (please specify)

ID 1

Code 1

Code 2

Code 3

Explanatory statement

Date* (or period)

Amount

ID 2

Code 1

Code 2

Code 3

Explanatory statement

Date* (or period)

Amount

ID 3

Code 1

Code 2

Code 3

Explanatory statement

Date* (or period)

Amount

ID 4

Code 1

Code 2

Code 3

Explanatory statement

Date* (or period)

Amount

* Date format: day/month/year

The claim has been assigned to the claimant by (if applicable)

Corporate name of company or organisation

Identification code (if applicable)

Surname

First Name

Address

Postal code

City

Country

Additional specifications for claims relating to consumer contracts (if applicable)

The claim concerns matters relating to consumer contracts

If yes, the defendant is the consumer

If yes, the defendant is domiciled within the meaning of Article 59 of Council Regulation (EC) No 44/2001 in the Member State where the court is seised

yes

no

yes

no

yes

no

7. Interest

Codes (please combine number with letter):

01 Statutory

A per year

02 Contractual

B per half year

03 Capitalisation of interest

C per quarter

04 Interest rate on a loan **

D per month

05 Amount calculated by the claimant

E Other ***

06 Other ***

ID *

Code

Interest rate (%)

% over base rate (ECB)

on (amount)

Starting from

to

ID *

Code

Interest rate (%)

% over base rate (ECB)

on (amount)

Starting from

to

ID *

Code

Interest rate (%)

% over base rate (ECB)

on (amount)

Starting from

to

ID *

Code

Interest rate (%)

% over base rate (ECB)

on (amount)

Starting from

to

ID * Please specify in case of Code 6 and/or E

* Fill in corresponding claim ID ** Taken out by the claimant for at least the amount of the principal *** Please specify

8. Contractual penalties (if applicable)

Amount

Please specify

9. Costs (if applicable)

Codes:

01 Court fees

02 Other (please specify)

Code

Specification only for code 02

Currency

Amount

Code

Specification only for code 02

Currency

Amount

Code

Specification only for code 02

Currency

Amount

Code

Specification only for code 02

Currency

Amount

10. Evidence available in support of the claim

Codes:

01 Written evidence

02 Oral evidence

03 Expert evidence

04 Inspection of an object or site

05 Other (please specify)

ID *

Code

Description of evidence

Date (day/month/year)

ID *

Code

Description of evidence

Date (day/month/year)

ID *

Code

Description of evidence

Date (day/month/year)

ID *

Code

Description of evidence

Date (day/month/year)

* Fill in corresponding claim ID

11. Additional statements and further information (if necessary)

I hereby request the court to order the defendant(s) to pay to the claimant(s) the sum of the above principal plus interest, contractual penalties and costs.

I declare that to the best of my knowledge and belief the information provided is true.

I acknowledge that any deliberate false statement could lead to appropriate penalties under the law of the Member State of origin.

Done at

Date (day/month/year)

Signature and/or stamp

Appendix 1 to the application for a European order for payment

Bank details for the purposes of payment of court fees by the claimant

Codes:

02 By credit card

03 Collection by court from claimant's bank account

Code

Account holder

Bank name (BIC) or other relevant bank code / Credit card company

Account number / Credit card number

International bank account number (IBAN) / Expiry date and security number of credit card

Appendix 2 to the application for a European order for payment

Further procedure in a case of lodging of a statement of opposition

Codes:

01 If the defendant lodges a statement of opposition, I request that the proceedings discontinue.

02 If the defendant lodges a statement of opposition, I request that the proceedings

continue in accordance with the rules of the European Small Claims Procedure, if applicable.

03 If the defendant lodges a statement of opposition, I request that the proceedings

continue in accordance with any appropriate national civil procedure.

Case number (to be completed if this Appendix is sent to the court separately from the application form):

Corporate name of company or organisation

Surname

First name

Code

If despite of my choice above, my claim does not fall in the scope of the European small claims Procedure (Code 02), I request that the proceedings

discontinue

continue in accordance with any appropriate national civil procedure

Done at

Date (day/month/year)

Signature and/or stamp

GUIDELINES FOR FILLING IN THE APPLICATION FORM

Important information

This form must be filled in in the language or one of the languages accepted by the court to be seised. Please note that the form is available in all official languages of the European Union; this may help you fill in the form in the required language.

If the defendant lodges an opposition to your claim, proceedings will continue before the competent courts in accordance with the rules of ordinary civil procedure. If you do not wish to continue proceedings in that event, you should also fill in Appendix 2 to this form. This appendix should reach the court before the European order for payment is issued.

If the application concerns a claim against a consumer relating to a consumer contract, it must be lodged with the competent court of the Member State in which the consumer is domiciled. In other cases, the application must be lodged with the court having jurisdiction in accordance with the rules of Council Regulation (EC) No 44/2001 (*). Information on the rules of jurisdiction can be found at the European e-Justice Portal https://e-justice.europa.eu/content_jurisdiction-85-en.do

Please make sure you duly sign and date the form on the last page.

Guidelines

At the start of each section you will find specific codes that should be inserted, as appropriate, in the relevant boxes.

1. Court When deciding which court to choose, you need to consider the grounds for the court’s jurisdiction.

2. Parties and their representatives This field must identify the parties and their representatives (e.g. lawyer of, guardian of), if any, in accordance with the codes indicated on the form. The box [Identification code] should refer, where applicable, to the special number which solicitors have in certain Member States for the purposes of electronic communication with the court (see Art. 7(6), second subparagraph, of Regulation (EC) No 1896/2006), to the registration number for companies or organisations or to any applicable identification number for natural persons. The box [Other details] may contain any other information that helps to identify the person (e.g. date of birth, position of the named person in the company or organisation concerned). If there are more than four parties and/or representatives, please use field [11].

3. Grounds for the court's jurisdiction See ‘Important information’ above.

4. Cross-border nature of the case For you to be allowed to use this European order for payment procedure, at least two of the boxes in this field must refer to different States.

5. Bank details (optional) In field [5.1], you may inform the court by what means you intend to pay the court fees. Please note that not all methods of payment in this field are necessarily available at the court to which you are making this application. You should verify which method of payment will be accepted by the court. You can do this by contacting the court concerned or by consulting the website of the European Judicial Network in civil and commercial matters (http://ec.europa.eu/civiljustice/). If you choose to pay by credit card or to allow the court to collect the fees from your bank account, you should give the necessary credit card/bank account details in Appendix 1 to this form.

In field [5.2], you may indicate by what means you wish to receive payment from the defendant. If you wish to be paid by bank transfer, please give the necessary bank details.

6. Principal This field must contain a description of the principal and the circumstances forming the basis of the claim in accordance with the codes indicated on the form. You need to use an identification number (‘ID’) for each claim, numbering them from 1 through 4. Each claim must be specified on the line of the box following the ID number, by filling in the relevant numbers of codes 1, 2 and 3. If you need more space, please use field [11]. The box [Date (or period)] refers, for instance, to the date of the contract or harmful event or to the period of the rent.

7. Interest If interest is sought, this should be specified for each claim in accordance with the codes indicated on the form. The code must contain both the relevant number (first row of the codes) and the letter (second row of the codes). For instance, if the interest rate has been agreed by contract and covers annual periods, the code is 02A. If it is for the court to decide the amount of interest the last box [to] should be left blank, and code 06E should be used. Code 01 refers to an interest rate laid down by statute. Code 02 refers to an interest rate agreed by the parties. If you use Code 03 (capitalisation of interest), the amount indicated should be the basis for the remainder of the term to be covered. Capitalisation of interest refers to the situation where the accrued interest is added to the principal and is taken into account for the purpose of calculating further interest. Please note that in commercial transactions as referred to in Directive 2000/35/EC of the European Parliament and of the Council (**), the statutory interest rate is the sum of the interest rate applied by the European Central Bank to its most recent main refinancing operation carried out before the first calendar day of the half-year in question (‘the reference rate’), plus at least seven percentage points. For a Member State which is not participating in the third stage of economic and monetary union, the reference rate referred to above is the equivalent rate set at national level (e.g. by the national central bank). In both cases the reference rate in force on the first calendar day of the half-year in question will apply for the following six months (see Article 3(1)(d) of Directive 2000/35/EC). The ‘base rate (ECB)’ refers to the interest rate applied by the European Central Bank to its main refinancing operations.

8. Contractual penalties (if applicable)

9. Costs (if applicable) If reimbursement of costs is sought, these must be described using the codes indicated on the form. The box [specification] must be used only for code 02, i.e. when reimbursement of costs other than court fees is demanded. These other costs could include, for instance, fees of a claimant’s representative or prelitigation costs. If you request reimbursement of the court fees but you do not know the exact amount, you must fill in the box [Code] (01) but you may leave the box [Amount] blank and it will be filled in by the court. Costs should be stated in the same currency as the principal.

10. Evidence available in support of the claim This field must specify the evidence available in support of each claim using the codes indicated on the form. The box [Description of evidence] will contain, for instance, the title, name, date, and/or reference number of the document concerned, the amount mentioned on the document concerned, and/or the name of the witness or expert.

11. Additional statements and further information (if necessary) You may use this field if you need more space for any of the fields above or, if necessary, to provide additional information useful to the court. For instance, if there are several defendants each being liable for a portion of the claim, you should indicate here the amount individually owed by each defendant or if you request joint liability of two or more defendants.

Appendix 1 Here you must indicate the details of your credit card or bank account if you choose to pay the court fees by credit card or if you allow the court to collect the fees from your bank account. Please note that not all methods of payment in this field are necessarily available at the court to which you are making this application. Please note that the information given in Appendix 1 will not be sent to the defendant.

Appendix 2 Here you must inform the court what should happen if you do not wish to continue proceedings in the event of the defendant opposing the claim. Please use the appropriate code. One of the options is that proceedings continue in the European Small Claims Procedure (***). That procedure applies, however, only if your claim does not exceed EUR 5 000. You can find further conditions for this procedure in the European e-Justice Portal at: https://e-justice.europa.eu/content_small_claims-42-en.do If you choose this procedure, please indicate also what should happen if the procedure cannot be applied. Please tick the appropriate box. If you send this information to the court after having sent the application form, please make sure you fill in the case number given by the court. Please note that the information given in Appendix 2 will not be sent to the defendant.

(*) Council Regulation (EC) No 44/2001 of 22 December 2000 on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters (OJ L 12, 16.1.2001, p. 1).

(**) Directive 2000/35/EC of the European Parliament and of the Council of 29 June 2000 on combating late payments in commercial transactions (OJ L 200, 8.8.2000, p. 35).

(***) Regulation (EC) No 861/2007 of the European Parliament and of the Council of 11 July 2007 establishing a European Small Claims Procedure (OJ L 199, 31.7.2007, p. 1).