Annex E - Financial circumstances
| Published date | 21 March 2018 |
| Subject Matter | Family law forms |
N.B. Sections II to VI should be completed only as necessary for the purposes of the application to which this form is attached and to the best of the applicant’s knowledge. When completing the Financial Circumstances Form, please consult Country Profile of the requested State to verify what information is required for a specific application.
CONFIDENTIALITY AND PERSONAL DATA PROTECTION NOTICE
Personal data gathered or transmitted under the Convention shall be used only for the purposes for which it was gathered or transmitted. Any authority processing such information shall ensure its confidentiality, in accordance with the law of its State.
An authority shall not disclose or confirm information gathered or transmitted in application of this Convention if it determines that to do so could jeopardise the health, safety or liberty of a person in accordance with Article 40.
A determination of non-disclosure has been made by a Central Authority in accordance with Article 40. If this box is ticked, information under items V.D. 2, 4, 6, 8, 10, 12, 14 and 16 and VI.D. 9 and 11 should only be provided in the Restricted Information on the Applicant page of this form.
- REFERENCE INFORMATION
- Requesting Central Authority
- Address
- Telephone number
- Fax number
- Reference number
- Contact person in Requested State
- Address (if different)
- Telephone number (if different)
- Fax number (if different)
- E-mail (if different)
- Language(s)
- The applicant, (family name(s) and given name(s)), born
(dd/mm/yyyy), is: □ creditor, □ representative of the person(s) for whom maintenance is sought or payable, or □ debtor
- This form is being submitted in relation to: (it is possible to tick more than one box)
□ Establishment of a decision (Art. 10(1) c) and d))
(Complete all sections)
□ Recognition or recognition and enforcement of a decision (Art. 10(1) a))
(Complete sections III and IV)
□ Enforcement of a decision made or recognised in the requested State (Art. 10(1) b))
(Complete sections III and IV)
□ Modification of a decision (Art. 10(1) e) and f) and (2) b) and c))
(Complete all sections)
□ Applying for legal assistance (Art. 17 a))
(Complete sections II, V and VI if the applicant is the person identified under II)
(Complete sections III, V and VI if the applicant is the person identified under III)
- Unless otherwise specified, the currency (ISO code) used to complete this form and, if applicable, the exchange rate (and date of exchange rate) if the amounts are converted into the currency of the requested State is: _(dd/mm/yyyy)
- GENERAL INFORMATION ABOUT THE CREDITOR OR THE PERSON(S) FOR WHOM MAINTENANCE IS SOUGHT OR PAYABLE (IF KNOWN)
- Information about the creditor or the person(s) for whom maintenance is sought or payable
|
1. The creditor or the person for whom maintenance is sought is: □ Father □ Mother □ Caretaker other than parent □ Foster care provider □ Both the child and the above person (marked) are considered as creditors □ The child her/himself is the only creditor □ Public body □ Other person (see the application) |
|
|
2. Occupation, trade or profession |
|
|
3. Estimated gross monthly earnings (specify currency) |
4. Other monthly income (& source) (specify currency) |
|
5. Present marital status □ Married □ Single □ Partner □ Divorced □ Separated |
|
- Information about creditor’s dependents
|
Family name(s) Given name(s) |
Age |
Relationship to creditor |
Subject of this application? |
|
|
|
|
|
□ Yes |
□ No |
|
|
|
|
□ Yes |
□ No |
|
|
|
|
□ Yes |
□ No |
|
|
|
|
□ Yes |
□ No |
|
|
|
|
□ Yes |
□ No |
- Information about current □ spouse or □ partner of creditor □ other member of the household contributing to the expenses of the household
|
1. Family name(s), given name(s) |
2. Employed? □ Yes □ No □ Unknown |
|
3. Estimated gross monthly earnings (specify currency) |
4. Other monthly income (& source) (specify currency) |
|
5. The person identified above pays child support / maintenance □ voluntarily or □ judicial / administrative decision in the amount of per (specify currency and instalment period). As of (dd/mm/yyyy) the total amount paid is: ; and the total amount outstanding is: (specify currency). |
|
- GENERAL INFORMATION ABOUT THE DEBTOR (IF KNOWN)
- Information about the debtor
|
1. The debtor is: □ Father □ Mother □ Caretaker other than parent □ Foster care □ Spouse □ Partner □ Child □ Other person |
|
|
2. Occupation, trade or profession: |
|
|
3. Name and address of the employer: |
|
|
4. Estimated gross monthly earnings (specify currency) |
5. Other monthly income (& source) (specify currency) |
|
6. Present Marital Status □ Married □ Single □ Partner □ Divorced □ Separated |
|
- Information about debtor’s dependents
|
Family name(s) Given name(s) |
Age |
Relationship to debtor |
Subject of this application? |
|
|
1. |
|
|
□ Yes |
□ No |
|
2. |
|
|
□ Yes |
□ No |
|
3. |
|
|
□ Yes |
□ No |
|
4. |
|
|
□ Yes |
□ No |
|
5. |
|
|
□ Yes |
□ No |
- Information about current □ spouse or □ partner of debtor □ other member of ...
To continue reading
Request your trial