ANNEX V
Form for the submission of services passport notification
1. Contact information
Type of notification | Services passport notification
Host Member State in which the credit institution intends to carry out its activities: |
Name and national reference numbercode of the credit institution:institution as available in the credit institution register maintained by the EBA: |
LEI of the credit institution: |
Address of the head office of the credit institution: |
Name of contact person at the credit institution: |
Telephone number: |
E-mail:Email: |
2. List of the activities referred to in Annex I to Directive 2013/36/EU that the credit institution intends towill carry out in the host Member State with the indication of the activities that will constitute the core business of the credit institution in the host Member State, including the intended commencement date for each coreactivity service(as activityaccurate as possible)
NoNo. | Activity | Activities that the credit institution intends to carry out (fill in with ‘X’) | Activities that will constitute the core business | Intended start date for each core activity
1. | Taking deposits and other repayable funds | | |
2. | Lending including, inter alia: consumer credit, credit agreements relating to immovable property, factoring, with or without recourse, financing of commercial transactions (including forfeiting) | | |
3. | Financial leasing | | |
4. | Payment services as defined in Article 4(3)4, point (3) of Directive 2007/64/EC(EU) 2015/2366 of the European Parliament and of the Council (^{1}) | | |
4a | Services enabling cash to be placed on a payment account as well asand all the operations required for operating a payment account | | |
4b | Services enabling cash withdrawals from a payment account as well asand all the operations required for operating a payment account | | |
4c | Execution of payment transactions, including transfers of funds on a payment account with the user'suser’s payment service provider or with another payment service provider: — execution of direct debits, including one- off direct debits — execution of payment transactions through a payment card or a similar device — execution of credit transfers, including standing orders | | |
4d (^{}) | Execution of payment transactions where the funds are covered by a credit line for a payment service user: — execution of direct debits, including one- off direct debits — execution of payment transactions through a payment card or a similar device — execution of credit transfers, including standing orders | | |
4e (^{}) | — Issuing and/or acquiring of payment instruments — Acquiring of payment transactions | | |
4f | Money remittance | | |
4g | Execution of payment transactions where the consent of the payer to execute a payment transaction is given by means of any telecommunication, digital or IT device and the payment is made to the telecommunication, IT system or network operator, acting only as an intermediary between the payment service user and the supplier of the goods and services (*1) | | |
4g | Payment initiation services | | |
4h | Account information services | | |
5. | Issuing and administering other means of payment (e.g. travellers'travellers’ cheques and bankers'bankers’ drafts) insofar as such activity is not covered by point 4 | | |
6. | Guarantees and commitments | | |
7. | Trading for own account or for account of customers in any of the following: | | |
7a | | | |
7b | | | |
7c | | | |
7d | | | |
7e | | | |
7a | — money market instruments (e.g. cheques, bills, certificates of deposits) | | |
7b | — foreign exchange | | |
7c | — financial futures and options | | |
7d | — exchange and interest-rate instruments | | |
7e | — transferable securities | | |
8. | Participation in securities issues and the provision of services related to such issues | | |
9. | Advice to undertakings on capital structure, industrial strategy, and related questions and advice as well as services relating to mergers and the purchase of undertakings | | |
10. | Money broking | | |
11. | Portfolio management and advice | | |
12. | Safekeeping and administration of securities | | |
13. | Credit reference services | | |
14. | Safe custody services | | |
15. | Issuing electronic money | | |
(*1) Does the activity referred to in point 4g include the granting of credits in accordance with the conditions set out in Article 16(3) of Directive 2007/64/EC?
☐ yes ☐ no
(1) Directive (EU) 2015/2366 of the European Parliament and of the Council of 25 November 2015 on payment services in the internal market (OJ L 337, 23.12.2015, p. 35). (2) Does the activity referred to in point 4d include the granting of credit in accordance with Article 18(4) of Directive (EU) 2015/2366? □yes□no (3) Does the activity referred to in point 4e include the granting of credit in accordance with Article 18(4) of Directive (EU) 2015/2366? □yes□no
3. List of the services and activities that the credit institution intends to carry out in the host Member State, and which are provided for in Sections A and B of Annex I to Directive 2004/39/EC,2014/65/EU, when referring to the financial instruments provided for in Section C of Annex I of that DirectiveAnnex
Financial Instrumentsinstruments | Investment services and activities | | Ancillary services
| A 1 | A 2 | A 3 | A 4 | A 5 | A 6 | A 7 | A 8 | A9 | B 1 | B 2 | B 3 | B 4 | B 5 | B 6 | B 7
C1 | | | | | | | | | | | | | | | |
C2 | | | | | | | | | | | | | | | |
C3 | | | | | | | | | | | | | | | |
C4 | | | | | | | | | | | | | | | |
C5 | | | | | | | | | | | | | | | |
C6 | | | | | | | | | | | | | | | |
C7 | | | | | | | | | | | | | | | |
C8 | | | | | | | | | | | | | | | |
C9 | | | | | | | | | | | | | | | |
C10 | | | | | | | | | | | | | | | |
C11 | | | | | | | | | | | | | | | |
Note 1:
Note 1: Row and column headings are references to the relevant section and item numbernumbers in Annex I to Directive 2004/39/EC2014/65/EU (e.g. A1 refers to point 1 of Section A of Annex I).I)