ANNEX VI - Acknowledgment of receipt

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Annex VI

Acknowledgment of receipt

(Article 29(2) of Regulation (EU) No 655/2014 of the European Parliament and of the Council of 15 May 2014 establishing a European Account Preservation Order procedure to facilitate cross-border debt recovery in civil and commercial matters)

IMPORTANT INFORMATION

The acknowledgment of receipt being sent to the authority, creditor or bank that transmitted the documents must be sent by the end of the working day following the date of receipt of the documents and must be sent by the swiftest possible means of transmission.

Concerning the requirements governing the language of the transmitted documents, please note the requirements provided in Regulation (EU) No 655/2014, including Article 10(2), Article 23(4) and Article 49.

Country codes

Whenever you refer to a Member State in filling in this form, please use the following country codes:

AT Austria	EL Greece	IT Italy	PT Portugal
BE Belgium	ES Spain	LT Lithuania	RO Romania
BG Bulgaria	FI Finland	LU Luxembourg	SE Sweden
CY Cyprus	FR France	LV Latvia	SI Slovenia
CZ Czechia	HR Croatia	MT Malta	SK Slovakia
DE Germany	HU Hungary	NL Netherlands
EE Estonia	IE Ireland	PL Poland

1. The court or authority that received the document(s)

Member State:

1.1. Name:

1.2. Address

1.2.1. Street and number/ PO box:

1.2.2. Place and postcode:

1.2.3 Member State (please indicate the country code):

1.3. Telephone:

1.4. Fax:

1.5. Email:

1.6. Reference number(s) of the document(s), if any, given by the court or authority that received the document(s):

2. The following document(s) was/were received pursuant to Regulation (EU) No 655/2014 on

(dd/mm/yyyy) by the court or authority indicated in section 1 above (please indicate the incoming reference number of the document, if any):*

the revocation form (Article 10(2) of the Regulation)