Template for the form for acceptance of participation in the simplified recovery procedure (Document template)

Attn. [the bailiff shall insert his name, mailing address and, where available, his fax number and e-mail address] :

I/ We (*) hereby notify you/ Notify you (*) my/ our (*) agreement to participate in the simplified procedure for the recovery of the claim for an amount of [total amount claimed] consisting of:

- [total principal amount]

- [total amount of interest]

invoked by [Madam, Sir or corporate name of the creditor] based on [basis of claim: date of the contract or obligation of a statutory nature] .

Signature of consignee(s) (only in case of notification of this form on paper).