HCCH — Request for Access (Recommended Model Form)

Extrasele exacte din documentul la care trimit ghidurile, în forma indicată la fiecare extras.

1. p. 1, Important notice to the applicant, par. 1 · forma din 25 martie 2026 · textul original, în limba engleză

   Please note that this is an optional recommended model form. Before submitting your application, you should ensure that you complete the form of the Requested State or that the form is acceptable to the appropriate Central Authority. You may do so by consulting the relevant Country Profile on the HCCH website, by contacting the Central Authority in the Requested State or by consulting the website of the relevant Central Authority.

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2. p. 6, secțiunea VI · forma din 25 martie 2026 · textul original, în limba engleză

   SECTION VI – LEGAL GROUNDS FOR JUSTIFYING THE REQUEST Please indicate what is the applicant’s current situation as regards rights of access to the child: Applicant does not currently have rights of access and would like to establish them through this request. Applicant has rights of access by virtue of a decision by a judicial or administrative authority. Applicant has rights of access by operation of law (i.e., where there is no decision by a judicial or administrative authority or an enforceable agreement). Applicant has rights of access by virtue of a legally binding agreement (i.e., an agreement reached by the parties regarding rights of access and having legal effect under the law applicable in the State of the child's habitual residence). Other (please specify): Click or tap here to enter text.

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3. p. 8, secțiunea IX · forma din 25 martie 2026 · textul original, în limba engleză

   SECTION IX – PROPOSED ARRANGEMENTS FOR EXERCISING THE RIGHTS OF ACCESS Are there any arrangements that would facilitate the exercise of your rights of access that you would like to propose? (e.g., possible dates and place of the visits, means of transport, person responsible for picking up and dropping off the child, contribution towards travel costs, visa arrangements, practicalities of organising online contact) (If necessary, please provide further information on a separate sheet.) Click or tap here to enter text.

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4. p. 8, secțiunea X · forma din 25 martie 2026 · textul original, în limba engleză

   SECTION X – OTHER RELEVANT INFORMATION Please set out any further information relevant to the access application (e.g., immigration issues, travel limitations, medical / healthcare needs). (If necessary, please provide further information on a separate sheet.) Click or tap here to enter text.

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5. p. 9, secțiunea XI · forma din 25 martie 2026 · textul original, în limba engleză

   SECTION XI – LIST OF DOCUMENTS ATTACHED TO THIS FORM Please indicate the selected documents that are attached with this form by ticking the relevant box(es). Please consult the Central Authority in your State for information on whether any particular documents are required for the application. Concerning the child (a) Copy of the child’s identity card(s) / travel document(s) (b) Copy of the child’s birth certificate or equivalent document (c) Copy of relevant decision(s) and / or agreement(s) relating of the child (e.g., judicial decisions attributing rights of custody, access, designating a guardian or placing the child in alternative care) (d) Recent photograph of the child (please date the attached photograph) (e) Other: Click or tap here to enter text. Concerning the applicant (f) Copy of the applicant’s identity card(s) / travel document(s) (g) Legal aid form (if applicable) (h) Power of Attorney (if applicable) (i) Other: Click or tap here to enter text. Concerning the parents (j) Copy of the marriage or registered partnership certificate of the child’s parents (if applicable) (k) Copy of the divorce decree of the child’s parents or the official document stating the end of their registered partnership (if applicable) (l) Other: Click or tap here to enter text. Concerning the parent / person with whom the child is currently living (m) Recent photograph of the parent / person with whom the child is currently living (please date the attached photographs) (n) Copy of the identity card(s)/travel document(s) of the parent / person with whom the child is currently living (o) Other: Click or tap here to enter text. Others (please specify) (p) Click or tap here to enter text.

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6. p. 9, secțiunea XII · forma din 25 martie 2026 · textul original, în limba engleză

   SECTION XII – AUTHORISATION AND SIGNATURE I confirm that the information above is true and correct to the best of my knowledge. I understand that the personal data provided in this application may be processed and transmitted with the aim of furthering my application for the purposes of the 1980 Convention on the Civil Aspects of International Child Abduction. I hereby authorise the Central Authority of Click or tap here to enter text. (name of the requested State) to act on my behalf, where required, with respect to my application for access to the following child(ren): Click or tap here to enter text. . _______________________ (Signature of the applicant) Name: Click or tap here to enter text. Date: Click or tap here to enter text.

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