IMPORTANT INFORMATION FOR CREDITORS

You are hereby informed in accordance with Article 54 of Regulation (EU) 2015/848 of the European Parliament and of the Council of 20 May 2015 on insolvency proceedings that insolvency proceedings (1) have been opened in another Member State with regard to your debtor (indicated in point 1 of this form).

You are invited to lodge any claims you have against the debtor, as set out below.

You may be invited to lodge any claims you have against the debtor by separate notice at a later point in time, provided that the requirements for lodging a claim under national law are met.

You do not need to lodge your claims individually.

If you are invited to lodge your claims, you can do this by using the standard form for the lodgement of claims which

is attached to this notice or

can be downloaded from the following link:

Language

Claims may be lodged in any official language of the institutions of the European Union. Irrespective of this, you may later be required to provide a translation in the official language of the Member State of the opening of proceedings or, if there are several official languages in that Member State, in the official language or one of the official languages of the place where insolvency proceedings have been opened, or in another language which that Member State has indicated it can accept (the languages indicated by the Member States are to be found here: [https://e-justice.europa.eu/content_insolvency-447-en.do?clang=en] (2)).

Additional information

You can find further information on insolvency proceedings in the Member States under the following link: [https://e-justice.europa.eu/content_insolvency-447-en.do?clang=en (2)]

You can trace relevant information on the particular insolvency proceeding concerned by this notification through the following website of the European e-Justice Portal: […] (2) (3)

(1) ‘Insolvency proceedings’ are proceedings in the meaning of Article 1 of Regulation (EU) 2015/848 of the European Parliament and of the Council of 20 May 2015 on insolvency proceedings (OJ L 141, 5.6.2015, p. 19). These proceedings are listed in Annex A of that Regulation.

(2) When using this form, please, always refer to the hyperlink actually leading to the relevant webpage of the European e-Justice Portal.

(3) Please, take note, that this function of the European e-Justice Portal will only be operational from 26 June 2019 (see Article 92 of Regulation (EU) 2015/848).

GUIDELINES FOR FILLING IN THIS FORM

This Standard Notice form must be filled in by the court having jurisdiction in the insolvency proceedings against the debtor or by the insolvency practitioner appointed by that court in those proceedings.

The form needs to be sent to known creditors who are located in other Member States.

Language of this form

This notification form shall be transmitted in the official language of the State of the opening of proceedings or, if there are several official languages in that Member State, in the official language or one of the official languages of the place where insolvency proceedings have been opened, or in another language which that State has indicated it can accept, in accordance with Article 55(5) of Regulation (EU) 2015/848, if it can be assumed that that language is easier for the foreign creditors to understand.

Means of notification

In order to ensure a swift transmission of information to creditors residing or seated in another Member State of the European Union, Regulation (EC) No 1393/2007 of the European Parliament and of the Council (1) on the service of documents does not apply with regard to the obligation to inform creditors.

Guidelines to specific points of the form

Section II of the form should only be filled in, if by this notice you are also inviting the creditor to lodge his/her claims against the debtor. If you do not fill in Section II, you are required to send another notification to the foreign creditors as soon as the obligation arises under the applicable insolvency law for those creditors to lodge their claims individually in the proceedings.

When you fill in a particular section of the form, please bear in mind the following:

— The provision of information in points marked with an asterisk (*) is mandatory.

— The provision of information in points marked with double asterisks (**) is mandatory but subject to a condition. This condition is either indicated in brackets in the point concerned or in the sentence preceding the point.

— The provision of information in points without any specific marking is not mandatory.

Whenever you refer to a Member State in filling in this form, please use the following country codes: Austria (AT) Belgium (BE) Bulgaria (BG) Cyprus (CY) Czech Republic (CZ) Germany (DE) Estonia (EE) Greece (EL) Spain (ES) Finland (FI) France (FR) Croatia (HR) Hungary (HU) Ireland (IE) Italy (IT) Lithuania (LT) Luxembourg (LU) Latvia (LV) Malta (MT) Netherlands (NL) Poland (PL) Portugal (PT) Romania (RO) Sweden (SE) Slovenia (SI) Slovakia (SK) United Kingdom (UK)

In point 1.2 ‘registration number’ means the individual identity number attributed under national law to the entity or person. If the debtor is a company or a legal person, this is the number given in the appropriate national (business or association) register. If the debtor is a natural person exercising an independent business or professional activity (‘entrepreneurs’), this is the identification number in the Member State where insolvency proceedings have been opened, under which he/she pursues his/her business or professional activity. If, according to the national insolvency law of the Member State where insolvency proceedings have been opened, the tax number or personal ID number of the debtor is used for the purpose of the identification of the natural person exercising an independent business or professional activity, this number should be indicated.

(1) Regulation (EC) No 1393/2007 of the European Parliament and of the Council of 13 November 2007 on the service in the Member States of judicial and extrajudicial documents in civil or commercial matters (service of documents), and repealing Council Regulation (EC) No 1348/2000 (OJ L 324, 10.12.2007, p. 79).

In point 2.1, the ‘type of insolvency proceedings’ should be indicated by referring to the appropriate national proceedings listed in Annex A to Regulation (EU) 2015/848 that were opened and, where applicable, any relevant subtype of such proceedings opened in accordance with national law.

In point 2.3 ‘the court opening insolvency proceedings’ means the judicial body or any other competent body of a Member State empowered under its domestic law to open insolvency proceedings, to confirm such opening or to take decisions in the course of such proceedings.

The date or the last day of the time limit indicated in point 5 must not be less than 30 days following the publication of the opening of insolvency proceedings in the insolvency register of the Member State of the opening of proceedings, or if the information with regard to the debtor is not included in the national register, following the date of receipt of this notice by the creditor.

SECTION I

Details of the case

1. DEBTOR

1.1. Name (*)

1.1.1. Name (if the debtor is a company or a legal person):

or

1.1.2. Surname:

1.1.3. First name(s):

(if the debtor is a natural person)

1.2. Registration number (to be filled in if there is one under the national law in the Member State where insolvency proceedings have been opened) (**):

1.3. Address (unless point 1.5 is applicable) (**):

1.3.1. Street and number/PO box:

1.3.2. Place and postal code:

1.3.3. Country:

1.4. Alternative address:

1.4.1. Street and number/PO box:

1.4.2. Place and postal code:

1.4.3. Country:

1.5. Date and place of birth (to be filled in if the debtor is a natural person and his/her address is protected) (**):

1.6. Any additional information in relation to the identity of the debtor:

1.6.1. Personal ID number of the debtor:

1.6.2. Mother’s full maiden name:

1.6.3. Father’s name:

1.6.4. Nationality:

1.6.5. Other (please, specify):

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Points without any specific marking: the provision of information is facultative/optional.

2. THE INSOLVENCY PROCEEDINGS CONCERNED

2.1. Type of insolvency proceedings opened with regard to the debtor (*):

2.2. The date of the opening of insolvency proceedings (within the meaning of Regulation (EU) 2015/848) (*):

2.3. The court (1) opening the insolvency proceedings (*):

2.3.1. Name:

2.3.2. Address:

2.3.2.1. Street and number/PO box:

2.3.2.2. Place and postal code:

2.3.2.3. Country:

2.4. Reference number of the case (to be filled in if there is any) (**):

2.5. Insolvency practitioner(s) appointed in the proceedings (to be filled in if there are any) (**):

2.5.1. Name:

2.5.2. Address:

2.5.2.1. Street and number/PO box:

2.5.2.2. Place and postal code:

2.5.2.3. Country:

2.5.2.4. Email address:

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Points without any specific marking: the provision of information is facultative/optional.

(1) The term ‘court’ under this point means, in line with Article 2(6)(ii) of Regulation (EU) 2015/848 of the European Parliament and of the Council of 20 May 2015 on insolvency proceedings, the judicial body or any competent body of a Member State empowered to open insolvency proceedings, to confirm such opening or to take decisions in the course of such proceedings.

SECTION II

Information concerning the lodgement of claims

3. BODY OR AUTHORITY EMPOWERED TO ACCEPT THE LODGEMENT OF CLAIMS (*)

The court indicated in point 2.3 of this form;

or

The insolvency practitioner indicated in point 2.5 of this form;

or

The body or authority empowered to accept lodgement of claims is different from the person/body indicated in points 2.3 or 2.5 of this form. Its data are the following:

3.1. Name (to be filled in only if the body or authority empowered to accept the lodgement is neither the court mentioned in point 2.3 nor the insolvency practitioner mentioned in point 2.5 of this form) (**):

3.2. Address (to be filled in only if the body or authority empowered to accept the lodgement is neither the court mentioned in point 2.3 nor the insolvency practitioner mentioned in point 2.5 of this form) (**):

3.2.1. Street and number/PO box:

3.2.2. Place and postal code:

3.2.3. Country:

3.3. Telephone:

3.4. Email:

4. MEANS OF COMMUNICATION BY WHICH CLAIMS MAY BE SUBMITTED (*)

by post (to the postal address indicated under point (3)

only by registered mail

or

by telefax (to the following fax number):

or

by email (to the following email address):

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.

only in compliance with the following technical standard (please specify):

or

Other (please, specify):

5. TIME LIMITS FOR LODGING CLAIMS (TO BE FILLED IN IF THERE ARE ANY) (**)

claims shall be lodged at the latest:

or

reference to the criteria for calculating that time limit:

6. CONSEQUENCES OF FAILURE TO SUBMIT CLAIMS WITHIN THE TIME PERIOD INDICATED IN POINT 5 (*)

You will have to bear any additional costs associated with late submission.

You will be precluded from participating in distributions (interim or final) occurring before submission (or admission) of your claim.

You will lose your right to vote in any decision making process or at meetings of creditors occuring before the submission of your claim.

You will be required to file an individual petition to the court for admission of your claim.

The debt based on your claim will be regarded as extinguished in the context of the proceedings.

Your claim may not be taken into account in the proceedings.

Your secured or preferential rights associated to the claim will be waived.

Other (please, specify):

7. OTHER CONDITIONS TO BE MET WHEN LODGING YOUR CLAIM

The law applicable to the insolvency proceedings requires that the amount of the claim (point 6.1.8 of the standard form ‘lodgement of claims’) and the costs arising from the assertion of that claim (point 6.4.3 of the standard form ‘lodgement of claims’) are indicated in the currency of the Member State where insolvency proceedings have been opened. This currency is the following:

Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Croatian kuna (HRK) Hungarian forint (HUF) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) United Kingdom pound (GBP)

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.

Other (please, specify):

8. OBLIGATION OF CREDITORS WHOSE CLAIMS ARE PREFERENTIAL OR SECURED IN REM (*)

You must expressly indicate the specific nature of the claim in the lodgement of claims, or

you need to lodge your claims, or

you do not need to lodge your claims, or

you need to lodge your claims only for the portion which is not covered by the value of the security or of the priority; or

you must indicate the amount up to which the claims are probably secured]

other (please, specify):

9. LOWER RANKING CLAIMS

Lower ranking and subordinate claims shall be lodged only if expressly requested by the insolvency court.

10. FURTHER INFORMATION WHICH MAY BE RELEVANT TO THE CREDITOR

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.

SECTION III

Date and signature

This notice is given by:

Name:

In the capacity of

the court having jurisdiction over the insolvency proceedings

the insolvency practitioner appointed to the insolvency proceedings

Done at , date

Signature and/or stamp

GUIDELINES FOR FILLING IN THIS FORM

This standard claims form should be used for lodging claims in accordance with Chapter IV of Regulation (EU) 2015/848 on insolvency proceedings. Requests to exclude goods from the debtor’s assets should be filed according to national law.

The use of this standard claims form for the lodgement of claims is optional. Nonetheless, when lodging claims by means other than this standard form, the claim must contain all the information referred to as mandatory in this form.

Language

Claims may be lodged in any official language of the institutions of the European Union. Irrespective of this, you may later be required to provide a translation in the official language of the Member State of the opening of proceedings or, if there are several official languages in that Member State, in the official language or one of the official languages of the place where insolvency proceedings have been opened, or in another language which that Member State has indicated it can accept (the languages indicated by the Member States are to be found here: [https://e-justice.europa.eu/content_insolvency-447-en.do?clang=en (1)]

Whenever you refer to a Member State in filling in this form, please use the following country codes: Austria (AT) Belgium (BE) Bulgaria (BG) Cyprus (CY) Czech Republic (CZ) Germany (DE) Estonia (EE) Greece (EL) Spain (ES) Finland (FI) France (FR) Croatia (HR) Hungary (HU) Ireland (IE) Italy (IT) Lithuania (LT) Luxembourg (LU) Latvia (LV) Malta (MT) Netherlands (NL) Poland (PL) Portugal (PT) Romania (RO) Sweden (SE) Slovenia (SI) Slovakia (SK) United Kingdom (UK)

When you fill in a particular section of the form, please bear in mind the following:

— The provision of information in points marked with an asterisk (*) is mandatory.

— The provision of information in points marked with double asterisks (**) is mandatory subject to a condition. This condition is indicated in brackets in point concerned.

— The provision of information in points without any specific marking is not mandatory.

If you have several claims to lodge at the same time, you must fill out points 6 to 10 for each claim individually.

You may find relevant information for points 1 and 2 in Section I of the form by which you were notified of the foreign insolvency proceedings. That form bears the heading ‘notice of insolvency proceedings’ and was sent to you by the foreign court which opened the insolvency proceedings, or by an insolvency practitioner appointed by that court to the proceedings.

In point 1.1 ‘the court opening proceedings’ means the judicial body or any other competent body of a Member State empowered under its domestic law to open insolvency proceedings, to confirm such opening or to take decisions in the course of such proceedings.

Point 1.2 should be filled in only if the insolvency proceedings have a reference number in the Member State where they have been opened. Point 1.3 should be filled in only if there is an insolvency practitioner appointed to the case.

In points 2.2 and 3.3 ‘registration number’ means the individual identity number attached under national law to the entity or person. If the debtor is a company or a legal person, this is the number given in the appropriate national (business or association) register. If the debtor is a natural person exercising an independent business or professional activity (entrepreneurs), this is the identification number in the Member State where insolvency proceedings have been opened, under which he/she pursues his/her business or professional activity. If, according to the national insolvency law of the Member State where insolvency proceedings have been opened, the tax number or personal ID number of the debtor is used for the purpose of the identification of the natural person exercising an independent business or professional activity, this number should be indicated.

(1) When using this form, please, always refer to the hyperlink actually leading to the relevant webpage of the European e-Justice Portal.

In point 4 you should mark the first option referring to the person which the creditor indicated in point 3 only if the creditor is a natural person. If you mark the second option referring to a person different to the one indicated in point 3, you are supposed to fill in points 4.1 to 4.6, of which points 4.1, 4.2 and 4.6 are mandatory fields.

In point 6.2 ‘the date on which the claim arose’ means the point in time on which the obligation of the debtor vis à vis the creditor was established (conclusion of a contract, occurrence of a damage or injury). In point 6.3 ‘the date on which the claim became due’ means the point in time when the debtor was required to perform on the basis of the obligation (the payment became due). Statutory penalties for late payment which are to be calculated as a percentage of the capital amount claimed should be asserted as statutory interest (see point 6.1.3).

In point 7 If you have a preferential position you are owed debts which, according to domestic law, are to be paid in preference to certain other categories of debt. In point 8, security in rem refers to any security you hold in respect of your claim against the debtor. Such security may take several different forms such as a fixed charge on a specific asset or a floating charge over a group of assets.

In point 9, with regard to set-off, if the creditor is a financial institution and demands set-off against the debtor, it should also indicate the details of the accounts concerned. Points 9.1 to 9.5 should be filled in only if you demand a set-off.

Point 10: the form must be accompanied by copies of any supporting documents.

ANNEX II

1. THE INSOLVENCY PROCEEDING CONCERNED

1.1. Name of the court opening insolvency proceedings (*)

1.2. Reference number of the case (to be filled in if there is any) (**)

1.3. Name of the insolvency practitioner(s) appointed in the proceedings (to be filled in if there are any) (**)

2. DEBTOR

2.1. Name (*)

2.1.1. Name (if the debtor is a company or a legal person):

or

2.1.2. Surname:

2.1.3. First name(s):

(if the debtor is a natural person)

2.2. Registration number (to be filled in if there is one under the national law in the Member State where the debtor has its centre of main interests) (**)

2.3. Address (unless point 2.4 applies) (**)

2.3.1. Street and number/PO box:

2.3.2. Place and postal code:

2.3.3. Country:

2.4. Date and place of birth (to be filled in if the debtor is a natural person and his/her address is protected) (**)

3. INFORMATION ABOUT THE CREDITOR WHO OWNS THE CLAIM(S)

3.1. Name (*):

3.1.1. Name:

3.1.2. Legal representative:

(if the creditor is a company or a legal person)

or

3.1.3. Surname:

3.1.4. First name(s):

(if the creditor is a natural person)

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.

ANNEX II

3.2. Postal address (*):

3.2.1. Street and number/PO box:

3.2.2. Place and postal code:

3.2.3. Country:

3.3. Personal identification number or registration number (if either applies):

3.4. Contact person

3.4.1. Name (if different from you):

3.4.2. Email address:

3.4.3. Telephone number:

3.5. Reference number of the creditor:

4. INFORMATION ABOUT THE PERSON WHO IS LODGING THE CLAIM IN THE NAME OF THE CREDITOR IN POINT 3:

the same person as indicated in point 3;

or

a different person from the creditor indicated in point 3, whose details are the following:

4.1. Name (*):

4.2. Postal address (*):

4.2.1. Street and number/PO box:

4.2.2. Place and postal code:

4.2.3. Country:

4.3. Email address:

4.4. Telephone number:

4.5. Fax

4.6. His/her relationship to the creditor indicated in point 3 (*):

lawyer (on the basis of a power of attorney); or

director of the creditor or other representative of the creditor legally authorized by the applicable company law; or

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.

ANNEX II

employee of the creditor; or

association for the protection of the creditors; or

insolvency practitioner appointed in territorial/secondary proceedings; or

insolvency practitioner appointed in a main proceeding; or

other (please, specify):

5. DETAILS OF THE BANK ACCOUNT TO WHICH ANY DISTRIBUTION ON THE BASIS OF THE CLAIMS LODGED SHOULD BE TRANSFERRED

5.1. Account holder’s name:

5.2. Member State where the account is maintained (please indicate the country code):

5.3. Account number:

5.3.1. IBAN:

5.3.2. BIC:

6. THE CLAIM LODGED

6.1. Amount of the claim (*):

6.1.1. Principal (*):

6.1.2. Is interest claimed? (*)

No

Yes

6.1.3. If yes, is the interest:

Contractual interest or

Statutory interest

If statutory, to be calculated in accordance with (please specify relevant statute):

6.1.4. Interest due from: (date (dd/mm/yyyy) or event)

to (date (dd/mm/yyyy) or event).

6.1.5. Interest rate

6.1.5.1. … % from (date) to (date)

6.1.5.2. … % from (date) to (date)

6.1.5.3. … % from (date) to (date)

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.

ANNEX II

6.1.6. The capitalized amount of the interest:

6.1.7. Total amount of the claim (point 6.1.1 + point 6.1.6) (*):

6.1.8. Currency (*):

Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Croatian kuna (HRK) Hungarian forint (HUF) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) United Kingdom pound (GBP) Other (please specify using the ISO code):

6.2. The date on which the claim arose (*):

6.3. The date on which the claim became due (if different from point 6.2):

6.4. Costs that arose from the assertion of the claim prior to the opening of insolvency proceedings (to be filled in if claimed) (**):

6.4.1. amount of such costs:

6.4.2. details of the costs:

6.4.3. Currency:

Euro (EUR) Bulgarian lev (BGN) Czech koruna (CZK) Croatian kuna (HRK) Hungarian forint (HUF) Polish zloty (PLN) Romanian leu (RON) Swedish krona (SEK) United Kingdom pound (GBP) Other (please specify using the ISO code):

6.5. Nature of the claim (*):

the claim relates to a contractual obligation of the debtor

liability of the debtor resulting from a willful, tortious act

arises from other non-contractual obligation

relates to a right in rem of the creditor

[outstanding statutory maintenance arrears that the debtor, in breach of his duty, has intentionally not paid]

claims resulting from a contract of employment

tax claim

claims with regard to contributions to social security bodies

other (please specify)

7. DO YOU CLAIM A PREFERENTIAL POSITION (*)

no

yes

if yes, please, specify:

Points marked with (*): the provision of information is mandatory.

Points marked with (**): the provision of information is mandatory subject to a condition.

Point without any specific marking: the provision of information is facultative/optional.