I hereby confirm that at the time of signing this request for collection:
•The debt is not the subject of dispute and is certified as finally determined;•The writ of execution is not being contested;•The writ of execution has been enforced but has not led to (full) payment of the debt;•The tax claim concerns a tax covered by the Convention for which the requested State has not made a reservation to provide assistance in the recovery of tax claims;•The tax claim is enforceable under the laws of the applicant State;•The applicant state has pursued all measures available in its own territory to collect the claim, except where recourse to such measures would give rise to disproportionate difficulty;•The request is in conformity with the laws and administrative practices of the applicant State;•The information in the request and in the attached documents is correct.Dated:
.....
^name of competent authority^
Competent authority
XXXX
