CERTIFICATE

referred toinArticle4ofCouncilFrameworkDecision2006/783/JHAontheapplicationoftheprincipleof mutualrecognitiontoconfiscation orders

(a)Issuingand executing States:

IssuingState:

ExecutingState:

(b)Court whichissuedtheconfiscationorder:

Officialname:

Address:

Filereference:

Tel.(countrycode)(area/citycode):

Fax(countrycode) (area/citycode):

Email(when available):

Languagesinwhichit ispossibleto communicatewiththeCourt:

Contactdetailsforperson(s)tocontactinordertoobtainadditionalinformationforthepurposeoftheexecutionofthe

confiscation order, or,whereapplicable,forthepurposeofcoordinationoftheexecutionofaconfiscationorder transmitted

totwoormoreexecutingStates, orforthepurposeofthetransfertotheissuingStateofmoniesorproperties obtained

fromtheexecution(name,title/grade,tel.,fax, and,whenavailable,email):

(c)AuthoritycompetentfortheexecutionoftheconfiscationorderintheissuingState(iftheauthorityisdifferentfromtheCourtunder point(b)):

Official name:

Address:

Tel. (country code) (area/city code):

Fax (country code) (area/city code):

Email (when available):

Languages in which it is possible to communicate with the authority competent for the execution:

Contactdetailsforperson(s)tocontactinordertoobtainadditionalinformationforthepurposeoftheexecutionofthe

confiscationorder or,whereapplicable,forthepurposeofcoordinationoftheexecutionofaconfiscationorder

transmittedtotwoormoreexecutingStates, orforthepurposeofthetransfertotheissuingStateofmoniesor

propertiesobtained fromtheexecution,(name,title/grade,tel.,fax, and,whenavailable, email):

(d)Where a central authority has been made responsible for the administrative transmission and reception of confiscation orders in the issuing State:

Nameofthe centralauthority:

Contactperson,if applicable(title/gradeand name):

Address:

Filereference:

Tel.(countrycode)(area/citycode):

Fax(countrycode) (area/citycode):

Email(whenavailable):

(e)Authorityor authoritieswhichmaybe contacted(ifpoint(c)and/or(d)has(have)beencompleted):

Authoritymentionedunderpoint(b)

Canbecontactedforquestionsconcerning:

Authoritymentionedunderpoint(c)

Canbecontactedforquestionsconcerning:

Authoritymentionedunderpoint(d)

Canbecontactedforquestionsconcerning:

(f)WheretheconfiscationorderisafollowuptoafreezingordertransmittedtotheexecutingStatepursuanttoCouncil

Framework Decision2003/577/JHAof22July2003ontheexecutionintheEuropeanUnionofordersfreezingproperty orevidence('),provide relevantinformationtoidentifythefreezingorder(thedatesofissueandtransmissionofthefreezingorder,theauthoritytowhichitwas transmitted,referencenumber,ifavailable):

(g) Wheretheconfiscationorder hasbeentransmittedtomorethanone executing State,providethefollowinginformation:

1. Theconfiscationorder hasbeentransmittedtothefollowingotherexecutingState(s) (countryandauthority):

2. Theconfiscationorder hasbeentransmittedtomorethanone executing Statefor thefollowingreason(ticktherelevant

box):

2.1 Wherethe confiscationorderconcernsoneor more specificitemsof property:

Differentspecificitemsofpropertycoveredbytheconfiscationorderarebelievedtobelocatedindifferent

executing States.

Theconfiscationof aspecificitemof propertyinvolvesactionin morethanone executingState.

Aspecificitemofpropertycoveredbytheconfiscationorderisbelievedtobelocatedinoneoftwoormore

specified executingStates.

2.2 Wherethe confiscationorderconcernsanamountof money:

ThepropertyconcernedhasnotbeenfrozenunderFrameworkDecision2003/577/JHAof22July2003ontheexecutionin

theEuropeanUnionof ordersfreezingpropertyor evidence.

ThevalueofthepropertywhichmaybeconfiscatedintheissuingStateandanyoneexecutingStateisnotlikelytobe

sufficientfor theexecutionofthefull amountcoveredbytheconfiscationorder.

Otherreason(s)(tobespecified):

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(h) Informationregarding thenaturalor legalperson againstwhomtheconfiscationorder hasbeenissued:

1. Inthecaseofanaturalperson:

Name:

Forename(s):

Maiden name,(where applicable):

Aliases,(where applicable):

Sex:

Nationality:

Identitynumberorsocialsecuritynumber (whenpossible):

Dateofbirth:

Placeofbirth:

Lastknown address:

Language(s)whichthepersonunderstands(ifknown):

1.1.Iftheconfiscationorderconcernsanamountof money:

Theconfiscationorder istransmittedto theexecuting Statebecause(ticktherelevantbox):

(a) TheissuingStatehasreasonablegroundstobelievethatthepersonagainstwhomtheconfiscationorderhasbeen

issuedhaspropertyor incomeintheexecuting State.Addthefollowinginformation:

Groundsforbelieving thatthepersonhasproperty/income:

Descriptionofthepropertyoftheperson/sourceof income:

Locationofthepropertyoftheperson/sourceofincome(ifnotknown,thelastknown location):

(b) Therearenoreasonablegrounds,asreferredtounder(a),whichwouldallowtheissuingStatetodeterminethe

MemberState towhichtheconfiscationordermaybesent,buttheperson againstwhom the confiscationorder has

beenissued isnormallyresidentintheexecuting State.Addthefollowinginformation:

Normalresidence intheexecutingState:

1.2.Iftheconfiscation orderconcerns specificitem(s)ofproperty:

Theconfiscationorderistransmittedtotheexecuting Statebecause(ticktherelevant box):

(a)Thespecificitem(s)ofpropertyis(are)locatedintheexecuting State.(Seepoint(i))

(b)The issuing State has reasonable grounds to believe that all or part of the specific item(s) of property covered by the

confiscation order is (are) located in the executing State. Add the following information:

Grounds for believing that the specific item(s) of property is located in the executing State:

(c)Thereare no reasonablegrounds, as referred to in (b), which would allow the issuing State to determine the

MemberState to which the confiscation order may be transmitted, but the person against whom the confiscation

order has been issued is normally resident in the executing State. Add the following information:

Normal residence in the executing State:

2. Inthecaseofalegalperson:

Name:

Formoflegalperson:

Registrationnumber(ifavailable}([1]):

Registered seat(ifavailable)(¹):

Addressofthelegalperson:

1.3.Iftheconfiscation orderconcernsanamountofmoney:

The confiscation order is transmitted to the executing State because (tick the relevant box):

(a) The issuing State has reasonable grounds to believe that the legal person against whom the confiscation

order has been issued has property or income in the executing State. Add the following information:

Grounds for believing that the person has property/income:

Description of the property of the person/source of income:

Location of the property of the person/source of income (if not known, the last known location):

(b) There are no reasonable grounds, as referred to in (a), which would allow the issuing State to determine the

Member State to which the confiscation order may be sent but the legal person against whom the confiscation order has

been issued has its registered seat in the executing State. Add the following information:

Registered Seat in the executing State:

2.2. If the confiscation order concerns specific item(s) of property:

The confiscation order is transmitted to the executing State because (tick the relevant box):

(a) The specific item(s) of property is (are) located in the executing State. (See point (i)).

(b) The issuing State has reasonable grounds to believe that all or part of the specific item(s) of property covered by

the confiscation order is (are) located in the executing State. Add the following information:

Grounds for believing that the specific item(s) of property is (are) located in the executing State:

(c) There are no reasonable grounds, as referred to in (b), which would allow the issuing State to determine the

Member State to which the confiscation order may be transmitted but the legal person against whom the

confiscationorder has been issued has its registered seat in the executing State. Add the following information:

Registered seat in the executing State:

(i)The confiscation order

The confiscation order was issued on (date):

The confiscation order became final on (date):

Reference number of the confiscation order (if available):

1. Informationonthenatureoftheconfiscationorder

1.1.Indicate(by tickingintherelevantbox(es))iftheconfiscationorderconcerns:

An amount of money

TheamountforexecutionintheexecutingStatewithindicationofcurrency(infiguresandwords):

Thetotalamount coveredbytheconfiscationorderwithindicationofcurrency(infiguresandwords):

Specific item(s) of property

Description of the specific item(s) of property:

Location of the specific item(s) of property (if not known, the last known location):

Where the confiscation of the specific item(s) of property involves action in more than one executing State, description of the

action to be taken:

1.2.TheCourthasdecidedthattheproperty(ticktherelevantbox(es)):

(i)Istheproceedsofanoffence,or isequivalenttoeitherthefullvalueor partofthe valueof suchproceeds,

(ii)Constitutestheinstrumentalitiesofsuchanoffence,

(iii) IsliabletoconfiscationresultingfromtheapplicationintheissuingStateofextendedpowersofconfiscationas

specifiedin(a),(b)and(c).ThebasisforthedecisionisthattheCourt,basedonspecificfacts,isfullyconvincedthat the

propertyinquestionhasbeenderivedfrom:

(a) Criminalactivitiesoftheconvictedpersonduringaperiodpriortoconvictionfortheoffenceconcerned

whichisdeemedtobereasonable bytheCourtinthecircumstancesoftheparticular case,

(b) Similarcriminalactivitiesoftheconvictedpersonduringaperiodpriortoconvictionfortheoffence

concernedwhichisdeemedtobereasonablebytheCourtinthecircumstancesoftheparticularcase, or

(c) Thecriminalactivityoftheconvictedperson, andit hasbeenestablishedthatthevalueofthepropertyis

disproportionatetothelawfulincomeofthatperson.

(iv)Isliabletoconfiscationunderanyotherprovisionrelatingtoextendedpowersofconfiscationunderthelawofthe

issuingState.

Iftwoormorecategoriesofconfiscationareinvolved,providedetailsonwhichpropertyisconfiscatedinrelationto

which category:

  1. Informationontheoffence(s)resultingintheconfiscationorder

2.1. Asummaryoffactsand adescriptionofthecircumstancesinwhichtheoffence(s)resultingintheconfiscationorder

has(have)beencommitted,including timeand place:

2.2. Natureandlegal classificationoftheoffence(s)resultingintheconfiscationorder andtheapplicablestatutoryprovision/code

on basisof whichthedecisionwasmade:

2.3. Ifapplicable,indicateoneormoreofthefollowingoffencestowhichtheoffence(s) identifiedunderpoint2.2relate(s),if the

offence(s)arepunishableintheissuingStatebyacustodialsentenceofamaximumofatleast3years(ticktherelevant

box(es)):

participation in a criminal organisation;

terrorism;

trafficking in human beings;

sexual exploitation of children and child pornography;

illicit trafficking in narcotic drugs and psychotropic substances;

illicit trafficking in weapons, munitions and explosives;

corruption;

fraud, including that affecting the financial interests of the European Communities within the meaning of

the Convention of 26 July 1995 on the Protection of the European Communities' Financial Interests;

laundering of the proceeds of crime;

counterfeiting currency, including of the euro;

computer-related crime;

environmental crime, including illicit trafficking in endangered animal species and in endangered plant

Speciesand varieties;

facilitation of unauthorised entry and residence;

murder, grievous bodily injury;

illicit trade in human organs and tissue;

kidnapping, illegal restraint and hostage-taking;

racism and xenophobia;

organised or armed robbery;

illicit trafficking in cultural goods, including antiques and works of art;

swindling;

racketeering and extortion;

counterfeiting and piracy of products;

forgery of administrative documents and trafficking therein;

forgery of means of payment;

illicit trafficking in hormonal substances and other growth promoters;

illicit trafficking in nuclear or radioactive materials;

trafficking in stolen vehicles;

rape;

arson;

crimes within the jurisdiction of the International Criminal Court;

unlawful seizure of aircraft/ships;

sabotage.

2.4. Totheextentthattheoffence(s)resultingintheconfiscationorderidentifiedunderpoint2.2is(are)notcovered

bypoint2.3.give afulldescriptionoftheoffence(s) concerned (thisshouldcovertheactualcriminal activity

involved asopposed forinstanceto legalclassifications):

j)Proceedingsresultingintheconfiscationorder

Indicatethefollowingconcerning theproceedingsresultingintheconfiscation order(ticktherelevantbox(es)):

(a) Thepersonconcerned appeared personallyintheproceedings.

(b) Thepersonconcerned didnotappearpersonally intheproceedings,butwasrepresented byalegal

counsellor.

(c) Theperson concerneddidnotappearintheproceedingsandwasnotrepresentedbyalegalcounsellor. Itis

confirmed that:

Thepersonwasinformedpersonally,orviaarepresentativecompetentaccordingtonationallaw,ofthe

proceedings inaccordancewiththelawoftheissuingState,or

Thepersonhasindicatedthatheorshedoesnotcontestthe confiscationorder.

(k) Conversionandtransferofproperty

  1. Iftheconfiscationorderconcernsaspecificitemofproperty,statewhethertheissuingStateallowsfortheconfiscationinthe executingStatetotaketheformofarequirementtopayasumofmoneycorrespondingtothevalueoftheproperty.

Yes

No

  1. Iftheconfiscationorderconcernsanamountofmoney,statewhetherproperty,otherthanmoneyobtainedfromtheexecutionof theconfiscationorder,maybetransferredtotheissuingState:

Yes

No

(I)Alternativemeasures,includingcustodialsanctions

  1. Statewhethertheissuing Stateallows for theapplicationbytheexecutingStateofalternativemeasureswhere it isnotpossible toexecutetheconfiscationorder,eithertotallyor inpart:

Yes

No

  1. Ifyes,statewhichsanctionsmaybeapplied(natureand maximumlevelofthesanctions):

Custody(maximumperiod):

Communityservice(or equivalent)(maximumperiod):

Othersanctions(description):

(m) Othercircumstancesrelevantto thecase(optionalinformation):

(n) Theconfiscationorderisattachedtothecertificate.

Signatureoftheauthorityissuingthecertificateand/oritsrepresentativecertifyingthecontentofthecertificateasaccurate:

Name:

Postheld(title/grade):

Date:

Officialstamp(ifavailable):

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[1]Where a confiscation order is transmitted to the executing State because the legal person against whom the confiscation order has been issued has its registered seat in that State, Registration number and Registered seat must be completed.