Annex VI - Form for the communication of services passport notification

Competent authorities of the home Member State:

Name of the relevant department:

General email address of the relevant department (if any):

Name of the contact person:

Telephone number:

Email:

Address of the competent authorities of the host Member State:

[Date]

Ref:

Communication of services passport notification

[The communication shall contain the following information:

— name and national reference code of the credit institution available in the credit institution register maintained by the EBA;

— LEI of the credit institution;

— competent authorities responsible for the authorisation and supervision of the credit institution;

— statement on the credit institution’s intention to carry out activities in the territory of the host Member State in the exercise of the freedom to provide services.]

[Contact details]