Certificate issued in accordance with Article 5

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ANNEX I

FORM I

Certificate issued in accordance with Article 5 of the Regulation (EU) No 606/2013 of the European Parliament and of the Council on mutual recognition of protection measures in civil matters (¹)

1. Date of ordering of the protection measure (dd/mm/yyyy):

2. Date on which the protection measure became enforceable if different [optional] (dd/mm/yyyy):

3. Reference number of the protection measure [optional]:

4. Authority which ordered the protection measure if different from the authority issuing the certificate [optional]

4. Authority which ordered the protection measure if different from the authority issuing the certificate

Yes

5. Date of issuing of the certificate (dd/mm/yyyy):

6. Reference number of the certificate: