ANNEX 5

FORM V

European certificate oF succession

(Article 67 of Regulation (EU) No 650/2012 of the European Parliament and of the Council on
jurisdiction, applicable law, recognition and enforcement of decisions and acceptance and enforcement
of authentic instruments in matters of succession and on the creation of a European Certificate of
Succession 1)

The original of this Certificate remains in the possession of the issuing

authority

Certified copies of this Certificate are valid until the date indicated in the
appropriate box at the end of this form

Annexes included in the certificate*

 Annex I — Details concerning the applicant(s) (MANDATORY if the applicant(s) is(are) (a) legal
person(s))

 Annex II — Details concerning the representative of the applicant(s) (MANDATORY if the applicant(s)
is(are) represented)

 Annex III — Information on the matrimonial property regime or other equivalent property regime of the
deceased (MANDATORY if the deceased had such a regime at the time of death)

 Annex IV — Status and rights of the heir(s) (MANDATORY if the purpose of the certificate is to certify
those elements)

 Annex V — Status and rights of the legatee(s) having direct rights in the succession (MANDATORY if
the purpose of the certificate is to certify those elements)

 Annex VI — Powers to execute a will or to administer the estate (MANDATORY if the purpose of the
certificate is to certify those elements)

 No Annex is included

1. Member State of the issuing authority *

1
OJ L 201, 27.7.2012, p. 107.
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden

2. Issuing authority

2.1. Name and designation of the authority*: ………...………………………………………………………

2.2. Address
2.2.1. Street and number/PO box*: ……………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
2.2.2. Place and postcode*: …………………………………………………………………………………...

2.3. Telephone: ……………………………………………………………………………………………….

2.4. Fax ………………………………………………………………………………………………….…...
2.5. E-mail:.……………………………………………………………………………………….…………..

3. Information on the file

3.1. Reference number*: …………………………….………………………………………………………..

3.2. Date (dd/mm/yyyy) of issue of the Certificate*: …………………………………………………………

4. Competence of the issuing authority (Article 64 of Regulation (EU) No 650/2012)

4.1. The issuing authority is located in the Member State whose courts have jurisdiction to rule on the
succession pursuant to*
 Article 4 of Regulation (EU) No 650/2012 (General jurisdiction)
 Article 7(a) of Regulation (EU) No 650/2012 (Jurisdiction in the event of a choice of law)
 Article 7(b) of Regulation (EU) No 650/2012 (Jurisdiction in the event of a choice of law)
 Article 7(c) of Regulation (EU) No 650/2012 (Jurisdiction in the event of a choice of law)
 Article 10 of Regulation (EU) No 650/2012 (Subsidiary jurisdiction)
 Article 11 of Regulation (EU) No 650/2012 (Forum necessitatis)

4.2. Additional elements on the basis of which the issuing authority considers itself competent to issue the
Certificate 2:
………………………………………………………………………………….................................................
.............................................................................................................................................................................
.............................................................................................................................................................................
.............................................................................................................................................................................
.............................................................................................................................................................................
.............................................................................................................................................................................
..........................................................................................................................................................
*
Mandatory information.
2
. Please indicate such details as the last habitual residence of the deceased or a choice of court
agreement.
5. Details concerning the applicant (natural person 3)

5.1. Surname and given name(s)*: …………………..………………………………………………………..

…………………………………………………………………………………………………………………
………………….………………………………………………………………………………………………
5.2. Surname at birth (if different from point 5.1.): ..………………………….………………………………

5.3. Sex*
5.3.1.  M
5.3.2.  F

5.4. Date (dd/mm/yyyy) and place of birth (town/country (ISO code))*: ……..…………………………….
…………………………………………………………………………………………………………………

5.5. Civil status*

5.5.1.  Single
5.5.2.  Married
5.5.3.  Registered Partner
5.5.4.  Divorced
5.5.5.  Widowed
5.5.6.  Other (please specify): ……..………………………………………………………………………

5.6. Nationality*
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): …..…………………….……………………………………………..…

5.7. Identification number 4

5.7.1. National identity number: ……….…………………………………………………………………….
5.7.2. Social security number: ………………………………………………..................................................
5.7.3. Tax number: …………………………………………………….……………………………………..
5.7.4. Other (please specify): …………………………………………………………………………………

5.8. Address
5.8.1. Street and number/PO box*: ……………………..…………………………………………………….
………………………………………………………………….…………………………………....................
5.8.2. Place and postcode*: …………………………………………………………………………………
……………………………………………………………………………………………………………….
5.8.3. Country*
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia

3
. For legal persons, please complete and append Annex I.
If there is more than one applicant, please attach an additional sheet.
For representative, please complete and append Annex II.
4
. Please indicate the most relevant number if applicable.
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): ….…………………..………………………………………………….

5.9. Telephone: …..…………………..………….……….…………………………………………………..

5.10. Fax …………………….……………………………………………………………..………………..
5.11. E-mail: ……….………………………………..………………………………………….…………….

5.12. Relationship to the deceased

 Son  Daughter  Father  Mother  Grandson  Granddaughter  Grandfather
 Grandmother  Spouse  Registered Partner  De Facto Partner 5  Brother  Sister
 Nephew  Niece  Uncle  Aunt  Cousin  Other (please specify): ……………………………….

6. Details concerning the deceased

6.1. Surname and given name(s)*: ……….………….………………………………………………..………

…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
6.2. Surname at birth (if different from point 6.1.): ………………………………………..…………………

6.3. Sex*
6.3.1.  M
6.3.2.  F

6.4. Date (dd/mm/yyyy) and place of birth (town/country (ISO-code))*: ……………………………..……..

…………………………………………………………………………………………………………………
6.5. Civil status at the time of death*
6.5.1.  Single
6.5.2.  Married
6.5.3.  Registered Partner
6.5.4.  Divorced
6.5.5.  Widowed
6.5.6.  Other (please specify): …………………………………………………….......……………………

6.6. Nationality*
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): ……………...……………………………………….………………….
6.7. Identification number4
6.7.1. National identity number: ………………………..……………………………………………..………
6.7.2. Social security number: …………………………………………………………………………………
6.7.3. Tax number: …………………………………………………………………………………………….
6.7.4. Birth certificate number: …..…………………………………….…….………………………………..

5
. The concept of de facto partner includes legal institutions of cohabitation which exist in some
Member States such as ‘sambo’ (Sweden) or ‘avopuoliso’ (Finland).
6.7.5. Other (please specify): ………………………………………………………………………………….

6.8. Address at the time of death

6.8.1. Street and number/PO box*: ……………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
6.8.2. Place and postcode*: ……………………………………………………………………………………
6.8.3. Country*
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): …..…………………………..………………………………………….

6.9. Date (dd/mm/yyyy) and place of death*: ………………..………………………………………………

…………………………………………………………………………………………………………………
…………………………..……………………………………………………………………………………..
6.9.1. Death certificate number, date and place of issuance: ………………..………………………………..
…………………………………………………………………………………………………………………

7. Testate/intestate succession

7.1. The succession is*

7.1.1.  testate
7.1.2.  intestate
7.1.3.  partially testate and partially intestate

7.2. If the succession is testate or partially testate, the certificate is based on the following valid
disposition(s) of property upon death 6
7.2.1. Type:  Will  Joint will  Agreement as to succession
7.2.2. Date (dd/mm/yyyy) on which it was drawn up: …………………….………………………………….
7.2.3. Place where it was drawn up (town/country (ISO code)): …….…..…………………………………..
7.2.4. Name and designation of the authority before which it was established: …………….………..……...
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
7.2.5. Date (dd/mm/yyyy) on which it was registered or deposited: …………………………………………
7.2.6. Designation of the register or the depository: ………………………………………………………….
…………………………………………………………………………………………………………………
7.2.7. Reference number of the disposition in the register or in the depository: ……………………………..
7.2.8. Other reference number: ..………………………………………………………………………………
7.3. To the knowledge of the issuing authority, other dispositions of property upon death made by the
deceased, and which have been revoked or declared null and void, are the following 6
7.3.1. Type:  Will  Joint will  Agreement as to succession
7.3.2. Date (dd/mm/yyyy) on which it was drawn up: ….………………………………………….…………
7.3.3. Place where it was drawn up (town/country (ISO code)): ……………………..……………….……..
7.3.4. Name and designation of the authority before which it was established: ……………………………..
…………………………………………………………………………………………………………………
6
. If there is more than one disposition of property upon death, please attach an additional sheet.
…………………………………………………………………………………………………………………
7.3.5. Date (dd/mm/yyyy) on which it was registered or deposited: ………………………….……………..
7.3.6. Designation of the register or the depository: ……………………………………..…………..……….
…………………………………………………………………………………………………………………
7.3.7. Reference number of the disposition in the register or in the depository: …………………………….
7.3.8. Other reference number: ……………………………………………………………..…………………

7.4. Other relevant information in relation to Article 68(j) of Regulation (EU) No 605/2012 (please
specify): ………………………….………………………………………………………....…………………
………………..………………………………………………………………………………………………..
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

8. Law applicable to the succession

8.1. The law applicable to the succession is the law of*

□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): ..………………………………………………..……………………….

8.2. The law applicable was determined on the basis of the following elements*

8.2.1.  The deceased had his habitual residence in that State at the time of death (Article 21(1) of
Regulation (EU) No 650/2012).
8.2.2.  The deceased chose the law of that State of which he was a national (Article 22(1) of Regulation
(EU) No 650/2012) (see point 7.2.).
8.2.3.  The deceased was manifestly more closely connected with that State than with the State of his
habitual residence (Article 21(2) of Regulation (EU) No 650/2012), please specify: …………………….…
…………………………………………………………………………………………………………………
…………………..……………………………………………………………………………………………..
…………………………………………………………………………………………………………………
…………………...………………………..……………………………………………………………………
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…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

8.2.4.  The law of a third State applied under Article 21(1) of Regulation (EU) No 650/2012 referred to
the law of that State (Article 34(1) of Regulation (EU) No 650/2012). Please specify: ………………….…
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
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…………………………………………………………………………………………………………………

8.3.  The law applicable is that of a State with more than one legal system (Articles 36 and 37 of
Regulation (EU) No 650/2012).The following rules of law are applicable (please specify as the case may
be, the territorial unit):……………… ………………………………………………………………………...
…………………………………………………………………………………………………………………
……………………………………………..…………………………………………………………………..

8.4.  Special rules apply imposing restrictions concerning or affecting the succession in respect of certain
assets of the deceased apply (Article 30 of the Regulation (EU) No 650/2012) (please specify the rules and
assets concerned): ……………………………………………………………………………………………..
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

The authority certifies that it has taken all necessary steps to inform the
beneficiaries of the application for a certificate and that, at the time of
establishing the certificate, none of the elements contained in it were contested
by the beneficiaries.

The following points have not been filled in because they were not deemed to be
relevant for the purpose for which the Certificate was issued*: ..
…………………………………………………………………………………………
…………………………………………………………………………………….

If additional sheets have been added, state the total number of pages*:
…………..……………………………………………………………………………

Done at* …………………………… On* …………………………..(dd/mm/yyyy)

Signature and/or stamp of the issuing authority*:.…………… …………………

………………………………………………………………………………………..
 CERTIFIED COPY

This certified copy of the European Certificate of Succession has been issued
to*: …………………………………………………..………………………………
..………………………………………………………………………………………
……………………………………………………………..…………………………
(name of the applicant(s) or of the person(s) having demonstrated a legitimate
interest) (Article 70 of Regulation (EU) No 650/2012)

It is valid until*: …………………………….……………………… (dd/mm/yyyy)

Date of issue*: …………………………………………………..……(dd/mm/yyyy)

Signature and/or stamp of the issuing authority*: ………………………..…….

…………………………………………………………………………………………

FORM V — ANNEX I

Details concerning the applicant(s) (legal persons 7)

1. Organisation name*: ……………………….…………………………………………………………

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

2. Registration of the organisation*

2.1. Registration number4: ……………………………………………………………….……………...
2.2. Designation of the register/registration authority*:.……………………………..………………..
…………………………………………………………………………………………………………..
2.3. Date (dd/mm/yyyy) and place of registration*: ………………………………….………………..
……………………………………………………………………………………………………………

3. Address of the organisation

3.1. Street and number/PO box*: ……………….……………………………………………………….
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
3.2. Place and postcode*:
3.3. Country*
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria

7
. If more than one legal person applied, please attach an additional sheet.
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): …………..….………..…………………………………………….

4. Telephone: …………………….……………………………………………………………………..

5. Fax …….…………………………………………………………………………………………….

6. E-mail: …………………………………………..…………………………………………………….

7. Surname and given name(s) of person authorised to sign for the organisation*: ……………………
……………………………………………………………………………………………………………
…………...……………………………………………………………………………………………….

8. Other relevant information (please specify): …………………………………………………………

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

FORM V — ANNEX II
Details concerning the representative(s) of the applicant(s) 8

1. Surname and given name(s) or organisation name*: …………………………………………………

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

2. Registration of the organisation

2.1. Registration number: …………………………………………………………………….…………
2.2. Designation of the register/registration authority*:..………………………………………………..
2.3. Date (dd/mm/yyyy) and place of registration*: …………………………………………………….

3. Address
3.1. Street and number/PO box*: ………………………………………………………………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
3.2. Place and postcode*: ……………………………………………………………….………………..
3.3. Country*
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): …………………………………………..……………….……….

4. Telephone: ……………………………………………………………………………………………

5. Fax …………..………..……………………………………………………………………………..
8
. If more than one representative, please attach an additional sheet.
6. E-mail: …………………….………………………………………………………………………….

7. Representative capacity*
□ Guardian □ Parent □ Person authorised to sign for a legal person □ Person with power of attorney
□ Other (please specify): ………………………………………………………………………………

FORM V — ANNEX III

Information on the matrimonial property regime or other equivalent property regime of the
deceased 9

1. Surname and given name(s) of (ex-) spouse or (ex-) partner*: …………..…………………………

…………………………………………………………………………………………..………………
2. Surname at birth of (ex-) spouse or (ex-) partner (if different from point (1): ……………………….
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

3. Date and place of marriage or establishment of another relationship having comparable effects to
marriage: ……………………………………………………………….………………………………..
……………………………………………………………………………………………………………

4. Had the deceased entered into a marriage contract with the person mentioned in point 1?
4.1.  Yes
4.1.1. Date (dd/mm/yyyy) of contract: …………………………………………………………………..
4.2.  No

5. Had the deceased entered into a contract on property effects in the context of a relationship deemed
to have comparable effects to marriage with the person mentioned in point 1?
5.1.  Yes
5.1.1. Date (dd/mm/yyyy) of contract: ………..…………………………………………………………
5.2.  No

6. The law applied to the property regime was the law of

□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): ……………………………………………………………………
6.1. This law was determined on the basis of a choice of law*
6.1.1.  Yes
6.1.2.  No
6.2. In cases where the State whose law applied has more than one legal system, please specify (as the
case may be, the territorial unit): …….…….............................................................................................

7. The applied property regime was as follows:

9
. If more than one relevant property regime, please attach an additional sheet.
7.1.  Separation of property
7.2.  Universal community of property
7.3.  Community of property
7.4.  Community of accrued gains
7.5.  Deferred community property
7.6.  Other (please specify): ………..……………………………………………………………..…..
8. Please specify the property regime in the original language and the legal provisions referred to 10:
………………………………………………………………………………………………..………….
……………………………………………………………………………………………………………
………………………………………………………………………………………….………………..
9. The property relations based on the matrimonial property regime or other equivalent property
regime of the deceased and the person referred to point 1 have been liquidated and the assets shared:
9.1.  Yes
9.2.  No

FORM V — ANNEX IV

Status and rights of the heir(s) 11

1. Is the heir the applicant?*

1.1.  Yes
1.1.1.  Mentioned in section 5 of the certificate form (if relevant, please specify which applicant):
……………………………………………………………………………………………………………
…………………………………………….……………………………………………………………..
1.1.2.  Mentioned in Annex I (if relevant, please specify which applicant):
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

1.2.  No
1.2.1. Surname and given name(s) or organisation name: ……………………………………………….
……………………………………………………………………………………………………………
1.2.2. Surname at birth (if different from point 1.2.1.): ……………………………................................
1.2.3. Identification number4
1.2.3.1. National identity number: ……………………………………………………………………….
1.2.3.2. Social security number: …………………………………………………………………………
1.2.3.3. Tax number: ……………………………………………………………………………………..
1.2.3.4. Registration number: ..…………………………………………………………………………..
1.2.3.5. Other (please specify): ...………………………………………………………………………..
1.2.4. Address
1.2.4.1. Street and number/PO box: ……………..………………………………………………………
……………………………………………………………………………………………………………

1
0. More information on national regimes on property effects of marriage and registered
partnership can be found at the European E-Justice Portal (https://e-justice.europa.eu).
1
1. If more than one heir, please attach an additional sheet.
……………………………………………………………………………………………………………
1.2.4.2. Place and postcode: ………………………….………………………………………………….
1.2.4.3. Country
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): ……………………………………………………………………..
1.2.5. Telephone: ………………………………………………………………………………………..
1.2.6. Fax ……………………………………………………………………………………………….
1.2.7. E-mail:
……………………………………………………………………………………………..
1.2.8. Date (dd/mm/yyyy) and place of birth or, if organisation, date (dd/mm/yyyy), place of
registration and designation of the register/registration authority: ….………………………….……….
……………………………………………………………………………………………………………

2. The heir has accepted the succession

2.1.  Yes without conditions
2.2.  Yes under benefit of inventory (please specify effects): ………………………………………...
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
2.3.  Yes under other conditions (please specify effects): ….…………………………………………
……………………………………………………………………………………………………………
……………………………………………................................................................................................
2.4.  No acceptance required under the law applicable to the succession

3. The heir is designated by 12*:

3.1.  a disposition of property upon death
3.2.  operation of law

4.  The heir has waived the succession.

5.  The heir has accepted a reserved share.

6.  The heir has waived his or her right to a reserved share.

7.  The heir has been disqualified from inheriting:

7.1.  under a disposition of property upon death
7.2.  by operation of law
7.3.  by a court decision

8. The heir has the right to the following share of the estate (please specify): …………………………
……………………………………………………………………………………………………………
………………………………..………………………………………………………………………….

9. Asset(s) attributed to the heir and for which certification was requested (please specify asset(s) and

1
2. Please tick more than one tick box if relevant.
indicate all relevant identification details) 13: ...........……………………………………………………
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10. Conditions and restrictions relating to the rights of the heir (indicate whether the rights of the heir
are restricted under the law applicable to the succession and/or by the disposition of property upon
death): …………………….…………………………………………………………….………………..
……………………………………………………………………………………………………………
……………………….………….……………………………………………………………………….
……………………………………………………………………………………………………………
…………………………….……….…………………………………………………………………….
………………………………………………………………………….……...……………………...
……………………………………………….....………..
……………………………………………………………………………………………………………
…………………………………………………

11. Other relevant information or further explanations (please specify): …….………..……………….

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

FORM V — ANNEX V

Status and rights of legatee(s) having direct rights in the succession 14

1
3. Indicate if the heir acquired the ownership or other rights on the assets (in the latter case,
please indicate the nature of these rights and the other persons having also rights on the assets). In case
of a registered asset, please indicate the information required under the law of the Member State in
which the register is kept so as to permit the identification of the asset (e.g. for immovable property
exact address of the property, land register, land parcel or cadastral number, description of the property
(if necessary append relevant documents).
1
4. If more than one legatee, please attach an additional sheet.
1. Is the legatee the applicant?*

1.1.  Yes
1.1.1.  Mentioned in section 5 of the certificate form (if relevant, please specify which applicant):
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
1.1.2.  Mentioned in Annex I (if relevant, please specify which applicant): …………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

1.2.  No
1.2.1. Surname and given name(s) or organisation name: ……….……..………………………………
…………………………………………………………………………………………………………..
1.2.2. Surname at birth (if different from point 1.2.1.): ….……………………………………………..
1.2.3. Identification number4: ……………….…………………………………..………………………
1.2.3.1. National identity number: …..……………………………………….…………………………
1.2.3.2. Social security number: ……….………………………………………..………………………
1.2.3.3. Tax number: …….………………………………………………………………………..…….
1.2.3.4. Registration number: ……………………………………………………………………………
1.2.3.5. Other (please specify): ………………………………………………………………………….
1.2.4. Address
1.2.4.1. Street and number/PO box: ……..……………………………………….……………………..
……………………………………………………………………………………………………………
…………………………….
……………………………………………………………………………..1.2.4.2. Place and postcode:
……………………………………………………………………………..
1.2.4.3. Country:
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): ……..……………………..………………………………………

1.2.5. Telephone: ………………………………..…………………………….………………………..

1.2.6. Fax ……………………………………………………………………………………………….
1.2.7. E-mail: …….………………………………………………………………………………………
1.2.8. Date (dd/mm/yyyy) and place of birth or, if organisation, date (dd/mm/yyyy), place of
registration and designation of the register/registration authority: ….…………………………………
…………………………………………………………………………………………………………..
2. The legatee has accepted the legacy.
2.1.  Yes without conditions
2.2.  Yes under conditions (please specify): …………………….…………………………………….
……………………………………………………………………………………………………………
………………………………………………………………….………..
……………………………………………………………………………………………………………
………………………………
2.3.  No acceptance required under the law applicable to the succession

3.  The legatee has waived the legacy.

4. The legatee has the right to the following share of the estate (please specify): ………………………
……………………………………………………………………………………………………………
…………….……………………………………………………………………………………….….
……………………………………………………………………………………………………………
…

5. Asset(s) attributed to the legatee and for which certification was requested (please specify asset(s)
and indicate all relevant identification details) 15: …………………….………..…………………….…..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………….…………………..
……………………………………………………………………………………………………………
…………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

6. Conditions and restrictions relating to the rights of the legatee (indicate whether the rights of the
legatee are restricted under the law applicable to the succession and/or by the disposition of property
upon death)*: …………………………….………………………………………….…………………..
……………………………………………………………………………………………………………
…………………………………………..………………………………………………………………..
……………………………………………………………………………………………………………
……………………………………..……………………………………………………………………..
……………………………………………………………………………………………………………
……………………………..……………………………………………………………………………..
7. Other relevant information or further explanations (please specify): ………………………………..
……………………………………………………………………………………………………………
…………………………………………..……………………………………………………………….
……………………………………………………………………………………………………………
………………………………………..………………………………………………………………….
……………………………………………………………………………………………………………

1
5. Indicate if the legatee acquired the ownership or other rights on the assets (in the latter case,
please indicate the nature of these rights and the other persons having also rights on the assets). In case
of a registered asset, please indicate the information required under the law of the Member State in
which the register is kept so as to permit the identification of the asset (e.g. for immovable property
exact address of the property, land register, land parcel or cadastral number, description of the property
(if necessary append relevant documents).
…………………………………..……………………………………………………………………….

FORM V — ANNEX VI

Powers to execute a will or to administer the estate 16

1. Powers of the following person*:

1.1.  The applicant

1.1.1.  Mentioned in section 5 of the Certificate form (if relevant, please specify which applicant):
……………………………………………………………………………………………………………
……………..……………………………..………………………………………………………………
1.1.2.  Mentioned in Annex I (if relevant, please specify which applicant): …………………………
……………………..………………………………………………………………….
……………………………………………………………………………………………………………
……………..….

1.2.  The heir mentioned in Annex IV (if relevant, please specify which heir): ……………..……...
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

1.3.  The legatee mentioned in Annex V (if relevant, please specify which legatee): …….…………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

1.4.  Other
1.4.1. Surname and given name(s) or organisation name: ………………..……………………………
…………………………………………………………………………………………………………..
1.4.2. Surname at birth (if different from point 1.4.1.): ……………………………………………….
1.4.3. Identification number4: …………………………….………………………………………..…...
1.4.3.1. National identity number: …………..………………………………………………………….
1.4.3.2. Social security number: ………………….……………………………………………..………
1.4.3.3. Tax number: …………………….……………………………………………………………...
1.4.3.4. Registration number: ………..…………………………………………………………………
1.4.3.5. Other (please specify): …………………………………………………………………………
1.4.4. Address
1.4.4.1. Street and number/PO box: …………………………………………………………………….
………………………………………………………………………………………..…………………..
……………………………………………………………………………………………………………
1.4.4.2. Place and postcode: ….……………………………..……………………………………………
1.4.4.3. Country:
□ Belgium □ Bulgaria □ Czech Republic □ Germany □ Estonia □ Greece □ Spain □ France □ Croatia
□ Italy □ Cyprus □ Latvia □ Lithuania □ Luxembourg □ Hungary □ Malta □ Netherlands □ Austria

1
6. For more than one person, please attach an additional sheet.
□ Poland □ Portugal □ Romania □ Slovenia □ Slovakia □ Finland □ Sweden
□ Other (please specify ISO-code): …………………………….………………………………………
1.4.5. Telephone: ……………..…………….…………………………………………………..……….
1.4.6. Fax ……………………………………..………………………………………………………..
1.4.7. E-mail: ……………………………………..……………………………………………………...
1.4.8. Date (dd/mm/yyyy) and place of birth or, if organisation, date (dd/mm/yyyy), place of
registration and designation of the register/registration authority: …………………………….……….

2. Powers to*
2.1.  execute a will
2.2.  administer the estate or part of it

3. The powers to execute the will or administer the estate cover*

3.1.  the whole of the estate
3.2.  the whole of the estate except for the following parts or assets (please specify): ……….………
……………………………………………………………………………………………………………
……………………………….…………..….
……………………………………………………………………………………………………………
………..…………………………….
……………………………………………………………………………………………………………
……………………
3.3.  the following specific parts or assets of the estate (please specify): ……………………….……
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………….……………………………………………………………..

4. The person mentioned in section 1 has the following powers* 12:

4.1.  to obtain all information concerning the assets and debts of the estate
4.2.  to take cognisance of all wills and other documents relating to the estate
4.3.  to take or apply for any protective measures
4.4.  to take any urgent measures
4.5.  to collect the assets
4.6.  to collect the debts and give a valid receipt
4.7.  to perform and rescind contracts
4.8.  to open, operate and close a bank account
4.9.  to borrow
4.10.  to transfer or constitute charges on the assets
4.11.  to constitute rights in rem or mortgage on the assets
4.12.  to sell:  an immovable property  other property
4.13.  to lend
4.14.  to carry on a business
4.15.  to exercise the rights of a shareholder
4.16.  to sue and be sued
4.17.  to settle debts
4.18.  to distribute legacies
4.19.  to divide the estate
4.20.  to distribute the residue
4.21.  to request the recording of rights in immovable or movable property in a register
4.22.  to donate
4.23.  other (please specify): …………………………………………………………………………
………………………………………………….……………………………………………….
……………………………………………………………………………………………………………
……..

If the ticking of one or more of the boxes above does not give an exact indication of the powers vested
in the executor of the will/administrator of the estate, please add all necessary further specifications 17:
……………………………………………………………………………………….
……………………………….
……………………………………………………………………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………….……….
……………………………………………………………………………………………………………
…
……………………………………………………………………………………………….……….
…………………………………..
………………………………………………………………………….
……………………………………………………………………………………………………………
……………………………….…………………………………………………………………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………….……………………………………………………………………………………………..

Please specify if any of the powers referred to in section 4 are exercised as residual powers in
accordance with the second subparagraph of Article 29(2) or the first subparagraph of Article 29(3) of
Regulation (EU) No 650/2012*: ………………………………………………………………………...
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………………………………….………………………………………………………………..

5. The executor of the will/the administrator of the estate is designated by 12:

5.1.  a disposition of property upon death (see point 7.2. of the Certificate form)
5.2.  a court decision
5.3.  an agreement between the heirs
5.4.  the law

6. The powers derive from12:

6.1.  a disposition of property upon death (see point 7.2. of the Certificate form)

1
7. For instance, please specify whether one of the above-mentioned powers can be exercised by
the executor/administrator in his/her own name.
6.2.  a court decision
6.3.  an agreement between the heirs
6.4.  the law

7. The obligations and duties derive from12:

7.1.  a disposition of property upon death (see point 7.2. of the Certificate form)
7.2.  a court decision
7.3.  an agreement between the heirs
7.4.  the law

8. Conditions or restrictions relating to the powers referred to in section 4 18*: ………………………...

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………….……………………………………………………………..
……………………………………………………………………………………………………………
…………..……………………………………………………………………………………………….
……………………………………………………………………………………………………………

1
8. For instance, please specify whether one of the above-mentioned powers can be exercised by
the executor/administrator in his/her own name.