Certificate Referred to in Article 41(1) concerning Judgments on Rights of Access

• Date: 23 November 2015

ANNEX III

CERTIFICATE REFERRED TO IN ARTICLE 41(1) CONCERNING JUDGMENTS ON RIGHTS OF ACCESS (1)

1. Member State of origin

2. Court or authority issuing the certificate

2.1. Name

2.2. Address

2.3. Tel./fax/e-mail

3. Person(s) with rights of access

3.1. Full name

3.2. Address

3.3. Date and place of birth (where available)

4. Holders of parental responsibility other than those mentioned under 3 (2) (3)

4.1.

4.1.1. Full name

4.1.2. Address

4.1.3. Date and place of birth (where available)

4.2.

4.2.1. Full name

4.2.2. Address

4.2.3. Date and place of birth (where available)

4.3. Other

4.3.1. Full name

4.3.2. Address

4.3.3. Date and place of birth (where available)

5. Court which delivered the judgment

5.1. Name of Court

5.2. Place of Court

6. Judgment

6.1. Date

6.2. Reference number

7. Children who are covered by the judgment (4)

7.1. Full name and date of birth

7.2. Full name and date of birth

1 2 Generated by the European e-Justice Portal

(1) Council Regulation (EC) No 2201/2003 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)In cases of joint custody, a person already mentioned under item 3 may also be mentioned in item 4.

(3) Please put a cross in the box corresponding to the person against whom the judgment should be enforced.

(4) If more than four children are concerned, use a second form.