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1. TRANSMITTING AGENCY 1.1. Identity: 1.2. Address: 1.2.1. Street and number/PO box: 1.2.2. Place and postcode: 1.2.3. Country: 1.3. Tel.

1.4. Fax (): 1.5. Email: 2. RECEIVING AGENCY 2.1. Identity: 2.2. Address: 2.2.1. Street and number/PO box: 2.2.2. Place and postcode: 2.2.3. Country: 2.3. Tel.

2.4. Fax : 2.5. Email: 3. APPLICANT(S) () 3.1. Identity: 3.2. Address: 3.2.1. Street and number/PO box: 3.2.2. Place and postcode: 3.2.3. Country: 3.3. Tel. : 3.4. Fax : 3.5. Email : 4. ADDRESSEE 4.1. Identity: 4.1.1. Date of birth, if available: 4.2. Address 4.2.1. Street and number/PO box: 4.2.2. Place and postcode: 4.2.3. Country: 4.3. Tel. : 4.4. Fax : 4.5. Email : 4.6. Identification number/social security number/organisation number/or equivalent : 4.7. Any other information relating to the addressee : 5. METHOD OF SERVICE 5.1. In accordance with the law of the Member State addressed□ 5.2. By the following particular method□ 5.2.1. If this method is incompatible with the law of the Member State addressed, the document(s) should be served in accordance with the law of that Member State: 5.2.1.1. yes□ 5.2.1.2. no□

6. DOCUMENT TO BE SERVED 6.1. Nature of the document: 6.1.1. judicial□ 6.1.1.1. writ of summons□ 6.1.1.2. decision/judgment□ 6.1.1.3. appeal□ 6.1.1.4. other (please specify): 6.1.2. extrajudicial□ 6.2. Date or time limit after which service is no longer necessary : (day)(month) (year) 6.3. Language of document: 6.3.1. original BG □, ES □, CS □, DE □, ET □, EL □, EN □, FR □, GA □, HR □, IT □, LV □, LT □, HU □, MT □, NL □, PL □, PT □, RO □, SK □, SL □, FI □, SV □ (please specify) 6.3.2. translation BG □, ES □, CS □, DE □, ET □, EL □, EN □, FR □, GA □, HR □, IT □, LV □, LT □, HU □, MT □, NL □, PL □, PT □, RO □, SK □, SL □, FI □, SV □, other □ (please specify) 6.4. Number of enclosures: 7. LANGUAGE OF INFORMATION TO THE ADDRESSEE ABOUT THE RIGHT TO REFUSE THE DOCUMENT For the purposes of Article 12(2) of Regulation (EU) 2020/1784, please indicate in which of the following languages, in addition to the language of the Member State addressed, the information is to be provided:

7.1. Official language or one of the official languages of the Member State of origin (): BG □, ES □, CS □, DE □, ET □, EL □, EN □, FR □, GA □, HR □, IT □, LV □, LT □, HU □, MT □, NL □, PL □, PT □, RO □, SK □, SL □, FI □, SV□ 7.2. Official language of another Member State the addressee might understand: BG □, ES □, CS □, DE □, ET □, EL □, EN □, FR □, GA □, HR □, IT □, LV □, LT □, HU □, MT □, NL □, PL □, PT □, RO □, SK □, SL □, FI □, SV□ 8. A COPY OF THE DOCUMENT TO BE RETURNED WITH THE CERTIFICATE OF SERVICE (Article 5(4) of Regulation (EU) 2020/1784) 8.1. Yes (in this case, send two copies of the document to be served)□ 8.2. No□ 9. REASONS FOR NOT TRANSMITTING THROUGH THE DECENTRALISED IT SYSTEM (Article 5(4) of Regulation (EU) 2020/1784) () Electronic transmission was not possible due to: □ disruption of the decentralised IT system □ exceptional circumstances Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM B () Reference No of the transmitting agency: 1. TRANSMITTING AGENCY 1.1. Identity: 1.2. Address: 1.2.1. Street and number/PO box: 1.2.2. Place and postcode: 1.2.3. Country: 1.3. Tel. (): 1.4. Fax : 1.5. Email:

2. REQUESTED AUTHORITY 2.1. Identity: 2.2. Address: 2.2.1. Street and number/PO box: 2.2.2. Place and postcode: 2.2.3. Country: 2.3. Tel. : 2.4. Fax : 2.5. Email: 3. ADDRESSEE 3.1. Identity: 3.2. Last known address: 3.2.1. Street and number/PO box: 3.2.2. Place and postcode: 3.2.3. Country: 3.3. Known personal details of the addressee (if natural person), if available: 3.3.1. Name at birth: 3.3.2. Other known name(s): 3.3.3. Date and place of birth: 3.3.4. Identification number/social security number/or equivalent: 3.3.5. Mother’s or father’s name at birth: 3.3.6. Other information: 3.4. Known details of the addressee (if legal person), if available: 3.4.1. Registration number or equivalent: 3.4.2. Name(s) of the member(s) of the board/representative: 3.5. Tel. : 3.6. Fax : 3.7. Email : 3.8. Other information, if available: Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM C () Reference No of the transmitting agency: Reference No of the requested authority: 1. ADDRESSEE 1.1. Identity: 1.2. Known address: 1.2.1. Street and number/PO box: 1.2.2. Place and postcode: 1.2.3. Country: 1.3. No address could be determined□

1.4. Other information: Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM D Reference No of the transmitting agency: Reference No of the receiving agency: Addressee: 1. DATE OF RECEIPT: Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM E Reference No of the transmitting agency: Reference No of the receiving agency: Addressee: 1. The request cannot be executed without the following additional information: 1.1. Addressee’s identity (): 1.2. Date of birth : 1.3. Identification number/social security number/organisation number/or equivalent : 1.4. Other (please specify): 2. The request cannot be executed without the following documents: 2.1. Documents to be served : 2.2. Proof of payment : 2.3. Other (please specify): Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM F Reference No of the transmitting agency: Reference No of the receiving agency: Addressee: 1. REASON FOR RETURN:

1.1. The request is manifestly outside the scope of the Regulation: 1.1.1. address unknown□ 1.1.2. the matter is not civil or commercial□ 1.1.3. the service is not from one Member State to another Member State□ 1.1.4. other (please specify): 1.2. Non-compliance with the formal conditions required makes service impossible:□ 1.2.1. the document is not easily legible□ 1.2.2. the language used to complete the form is incorrect□ 1.2.3. other (please specify): 1.3. The method of service is incompatible with the law of the Member State addressed (Article 11(1) of Regulation (EU) 2020/1784)□ Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM G Reference No of the transmitting agency: Reference No of the receiving agency: Addressee: 1. APPROPRIATE RECEIVING AGENCY 1.1. Identity: 1.2. Address: 1.2.1. Street and number/PO box: 1.2.2. Place and postcode: 1.2.3. Country: 1.3. Tel.

1.4. Fax (): 1.5. Email: Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM H Reference No of the transmitting agency: Reference No of the receiving agency: Addressee: DATE OF RECEIPT: Done at: Date:

4.6. Identification number/social security number/organisation number/or equivalent : 4.7. Any other information relating to the addressee : Done at: Date: Signature and/or stamp or electronic signature and/or electronic seal: FORM J () Reference No of the transmitting agency: Reference No of the receiving agency: Addressee: 1. INFORMATION ON STATUS OF SERVICE OF DOCUMENT 1.1. The request was not received□ 1.2. The request cannot be executed within one month of receipt for the following reasons: 1.2.1. Determination of current address of addressee is in progress□ 1.2.2. Service is in progress – documents were sent to the addressee, however their delivery has not yet been confirmed□ 1.2.3. Service is in progress – documents were sent to the addressee, however the deadline for refusal has not expired□ 1.2.4. All options for service have not yet been exhausted□ 1.2.5. Service has already been executed, see copy of the certificate attached□ 1.2.6. Request replied to on (date). Reply attached□ 1.2.7. Request for additional information or document is pending□ 1.2.8. Other□ 1.3. It is estimated that the request will be executed by … Done at: Date:

1. COMPLETION OF SERVICE (Article 14) 1.1. Date and address of service

1.3. The addressee of the document was informed, in accordance with Article 12(2) of Regulation (EU) 2020/1784, in writing that the addressee may refuse to accept the document if it is not written in or accompanied by a translation into either a language which he or she understands or the official language or one of the official languages of the place of service.

2. INFORMATION IN ACCORDANCE WITH ARTICLE 11(2) OF REGULATION (EU) 2020/1784 It was not possible to effect service within one month of receipt□ 3. REFUSAL OF DOCUMENT (Article 12(4) of Regulation (EU) 2020/1784) 3.1. The addressee refused to accept the document due to the language used□ 3.1.1. Date of attempt of service: 3.1.2. Date of refusal, if available: 3.2. The document is annexed to this certificate.

3.2.1. Yes□ 3.2.2. No□ 4. REASON FOR NON-SERVICE OF DOCUMENT 4.1. Address unknown 4.1.1. Steps to establish the address were undertaken () yes□ no□ 4.2. Addressee cannot be located□ 4.3. Document could not be served before the date or time limit stated in item 6.2 in the request for service of documents (Form A)□ 4.4. Other (please specify)□ 4.5. The document is annexed to this certificate yes□ no□ Done at: Date:

Signature and/or stamp or electronic signature and/or electronic seal: FORM L Addressee: I. INFORMATION TO THE ADDRESSEE The enclosed document is served in accordance with Regulation (EU) 2020/1784 You may refuse to accept the enclosed document if it is not written in or accompanied by a translation into either a language which you understand or the official language or one of the official languages of the place of service. If you wish to exercise this right, you must refuse to accept the document at the time of service directly with the person serving the document or within two weeks of service by returning, to the address indicated below, this form completed by you, or a written declaration indicating that you refuse to accept the enclosed document because of the language in which it was provided. Please note that if you refuse to accept the enclosed document but the court or authority seised of the legal proceedings in the course of which the service became necessary subsequently decides that the refusal was not justified, it may apply legal consequences provided for by the law of the forum Member State, such as deeming the service valid, for unjustified refusals.