European e-Justice Portal - Form D - Certificate concerning a judgment in the European small claims procedure or a court settlement

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1. Court/tribunal

Country *

Please specify *

1.1. Name *

1.2. Street and number/PO box *

1.3. City and postal code *

2. Claimant

2.1. Corporate name of company or organisation

Surname

First name

2.2. Personal identification number or passport number/ registration number

2.3. Street and number/PO box *

2.4. Postal code *

City *

2.5. Country *

Please specify *

2.6. Telephone

2.7. E-mail

2.8. Claimant’s representative, if any, and contact details

2.8.1. Surname, first name/name of company or organisation

2.8.2. Address

2.8.3. Postal code

2.8.4. City

2.8.5. Country

2.9. Other details

3. Defendant

3.1. Corporate name of company or organisation

Surname

First name

3.2. Personal identification number or passport number/ registration number

3.3. Street and number/PO box *

3.4. Postal code *

City *

3.5. Country *

Please specify *

3.6. Telephone

3.7. E-mail

3.8. Defendant’s representative, if any, and contact details

3.8.1. Surname, first name/name of company or organisation

3.8.2. Address

3.8.3. Postal code

3.8.4. City

3.8.5. Country

3.9. Other details