Versions of Schedule

1. Requested Central Authority 2. Contact person in requesting State a. Address a. Address (if different) b. Telephone number b. Telephone number (if different) c. Fax number c. Fax number (if different) d. E-mail d. E-mail (if different) e. Reference number e. Language(s) 3. Requested Central Authority Contact person Address 4. The requested Central Authority acknowledges receipt on (dd/mm/yyyy) of the transmittal form from the requesting Central Authority (reference number ; dated (dd/mm/yyyy) concerning the following application under:□Article 10(1) a)□Article 10(1) b)□Article 10(1) c)□Article 10(1) d)□Article 10(1) e)□Article 10(1) f)□Article 10(2) a)□Article 10(2) b)□Article 10(2) c) Family name(s) of applicant: Family name(s) of the person(s) for whom maintenance is sought or payable: Family name(s) of debtor: 5. Initial steps taken by the requested Central Authority:□The file is complete and is under consideration□See attached status of application report□Status of application report will follow□Please provide the following additional information and / or documentation:□The requested Central Authority refuses to process this application as it is manifest that the requirements of the Convention are not fulfilled (Art. 12(8)). The reasons:□are set out in an attached document□will be set out in a document to follow The requested Central Authority requests that the requesting Central Authority inform it of any change in the status of the application. Name: (in block letters) Date: Authorised representative of the Central Authority