Anexo III - Extracto de un Documento Público con Fuerza Ejecutiva en Materia de Obligación de Alimentos No Sometido a un Procedimiento de Reconocimiento y Declaración de Exequátur

• Date: 19 October 2016

ANNEX III

EXTRACT FROM AN AUTHENTIC INSTRUMENT IN MATTERS RELATING TO MAINTENANCE OBLIGATIONS NOT SUBJECT TO

PROCEEDINGS FOR RECOGNITION OR A DECLARATION OF ENFORCEABILITY

(Article 48 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))

IMPORTANT

To be issued by the competent authority in the Member State of origin

To be issued only if the authentic instrument is enforceable in the Member State of origin

Mention only information which is given in the authentic instrument or of which the competent authority has been made aware

1. Date and reference number of the authentic instrument:

The authentic instrument is recognised and enforceable in another Member State without any possibility of opposing its recognition

and without the need for a declaration of enforceability (Article 48 of Regulation (EC) No 4/2009).

2. Nature of the authentic instrument

2.1. Instrument formally drawn up or registered on:

(dd/mm/yyyy)

Agreement concluded or authenticated on:

(dd/mm/yyyy)

2.2. Competent authority:

2.2.1. Name:

2.2.2. Address:

2.2.2.1. Street and number/PO box:

2.2.2.2. Place and postal code:

2.2.2.3. Member State

Belgium Bulgaria Czechia

Germany Estonia Ireland

Greece Spain France

Croatia Italy Cyprus

Latvia Lithuania Luxembourg

Hungary Malta Netherlands

Austria Poland Portugal

Romania Slovenia Slovakia

Finland Sweden

2.2.3. Telephone/Fax/E-mail:

3. Creditor(s) (*)

3.1. Person A

3.1.1. Surname and given name(s):

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

1 9Generated by the European e-Justice Portal

(1) OJ L 7, 10.1.2009, p. 1.

(*) If the authentic instrument concerns more than three creditors or three debtors, attach an additional sheet.