District No.

In the matter of

*Regulation (EC) No. 1215/2012 on jurisdiction and the recognition and enforcement of judgment in civil and commercial matters (the “Jurisdiction Regulation”).

*Council Regulation (EC) No. 1393/2007 on the service in the Member States of judicial and extrajudicial documents in civil or commercial matters.

*The Convention of the European Communities on jurisdiction and the enforcement of judgment in civil and commercial matters (the “Jurisdiction Regulation”).

*Council Regulation (EC) No. 1393/2007 on the service in the Member States of judicial and extrajudicial documents in civil or commercial matters.

*The Convention of the European Communities on jurisdiction and the enforcement of judgments in civil and commercial matters (and the Protocol annexed thereto) signed at Brussels on the 27th day of September, 1968 (the “Brussels Convention”).

*The Convention on jurisdiction and the enforcement of judgments in civil and commercial matters, done at Lugano on the 30th day of October, 2007 (the “Lugano Convention”).

*The Hague Convention on the Service Abroad of Judicial and Extrajudicial Documents in Civil or Commercial Matters signed at The Hague on the 15th day of November, 1965.

*Section 14 of the Jurisdiction of Courts and Enforcement of Judgments Act 1998.

Record number:

of ........... Claimant

and ............

of ............... Respondent

I, ..............., the District Court Clerk assigned to the above District Court area, hereby certify as follows:-

1. That the above-named proceedings were in respect of a claim by the claimant against the respondent brought before this Court on ...... day of .......... 20...... by *claim notice *(civil) summons issued on the ...... day of ......... 20...... claiming as follows ........

2. That *(the document beginning the proceedings) *(notice of the commencement of the proceedings) was served on the respondent on the ..... day of ......... 20.... in the following manner-...............

3. That the respondent *(appeared) *(did not appear) at the hearing of the proceedings.

4. That the respondent *(was represented) *(was not represented) at the hearing of the proceedings.

5. That the Court assumed jurisdiction in the proceedings pursuant to the provisions of Article(s) ........ of *(the Jurisdiction Regulation) *(the 1968 Convention) *(the Lugano Convention) above-named, on the grounds that-..............

6. That the Court gave judgment against the *(respondent) *(claimant) as follows:-.............

*7 That the judgment carries interest at the rate of ....... percent per annum on the judgment debt only (exclusive of costs and expenses) that is to say, on the sum of € ....... from the ..... day of ........... 20 ...... until it is paid.

8. That *(notice of appeal against) *(notice to set aside) the judgment *(has been entered) *(has not been entered).

9. That the time for lodging an appeal against the judgment *(expired) *(will expire) on the ..... day of ...... 20......

10. That enforcement of the judgment is not for the time being stayed or suspended and that the time available for its enforcement has not expired.

Dated this ..... day of ......... 20......

Signed ..........
District Court Clerk assigned to the above District Court area, District Court Office at ........
IRELAND

*delete where inapplicable