FORMS (REQUEST AND CERTIFICATE) SUMMARY OF THE DOCUMENT TO BE SERVED (annexes provided for Articles 3, 5, 6 and 7)

ANNEX TO THE CONVENTION Forms REQUEST FOR SERVICE ABROAD OF JUDICIAL OR EXTRAJUDICIAL DOCUMENTS Convention on the Service Abroad of Judicial and Extrajudicial Documents in Civil or Commercial Matters, signed at The Hague, the 15th of November 1965.

Identity and address of the applicant

Address of receiving authority

The undersigned applicant has the honour to transmit - in duplicate - the documents listed below and, in conformity with Article 5 of the above-mentioned Convention, requests prompt service of one copy thereof on the addressee, i.e,

(identity and address) ?????????????????????????????????????????????

a) in accordance with the provisions of sub-paragraph (a) of the first paragraph of Article 5 of the Convention*.

b) in accordance with the following particular method (sub-paragraph (b) of the first paragraph of Article 5)*: ???????..

c) by delivery to the addressee, if he accepts it voluntarily (second paragraph of Article 5)*.

The authority is requested to return or to have returned to the applicant a copy of the documents - and of the annexes* - with a certificate as provided on the reverse side.

List of documents

___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________

Done at ____________________, the ______________

Signature and/or stamp.

* Delete if inappropriate.

Reverse of the request CERTIFICATE

The undersigned authority has the honour to certify, in conformity with Article 6 of the Convention,

1) that the document has been served*

the (date)

at (place, street, number)

- in one of the following methods authorised by Article 5:

a) in accordance with the provisions of sub-paragraph (a) of the first paragraph of Article 5 of the Convention*.

b) in accordance with the following particular method*:

c) by delivery to the addressee, who accepted it voluntarily* .

The documents referred to in the request have been delivered to:

(identity and description of person)

relationship to the addressee (family, business or other):

2) that the document has not been served, by reason of the following facts*:

In conformity with the second paragraph of Article 12 of the Convention, the applicant is requested to pay or reimburse the expenses detailed in the attached statement*.

Annexes

Documents returned: ??????????????????????????????????????????????

In appropriate cases, documents establishing the service:

Done at . . . . . . . . . . . , the . . . . . . . .

Signature and/or stamp.

* Delete if inappropriate.

SUMMARY OF THE DOCUMENT TO BE SERVED Convention on the Service Abroad of Judicial and Extrajudicial Documents in Civil or Commercial Matters, signed at The Hague, the 15th of November 1965. (Article 5, fourth paragraph)

Name and address of the requesting authority:

Particulars of the parties*:

JUDICIAL DOCUMENT**

Nature and purpose of the document:

Nature and purpose of the proceedings and, where appropriate, the amount in dispute:

Date and place for entering appearance**:

Court which has given judgment**:

Date of judgment**:

Time-limits stated in the document**:

EXTRAJUDICIAL DOCUMENT**

Nature and purpose of the document:

Time-limits stated in the document**:

* If appropriate, identity and address of the person interested in the transmission of the document.

** Delete if inappropriate.