ANNEX VI
Notification template for the exchange of information in relation to start of branch/agent/distributor passport activities by payment institutions and e-money institutions
Start of activities
1) | Home Member State |
2) | Name of the competent authority of the home Member State |
3) | Date of the initial application according to Annex II or III or IV. |
4) | Member State where the branch/agent/distributor is to start activities |
5) | Type of Institution | ☐ Payment□Payment Institution ☐ E-Money□E-Money Institution
6) | Name of the payment institution/e-money institution |
7) | Head office address of the payment institution/e-money institution |
8) | Unique identification number of the payment institution/e-money institution in the format of the home Member State as specified in Annex I (where applicable) |
9) | Legal Entity Identifier (LEI) of the payment institution/e-money institution (where available) |
10) | Home Member State authorisation number of the payment institution/e-money institution (where applicable) |
12) | For agents/distributors, |
11) | Type of passporting | ☐□Branch Branch□Agent ☐ Agent ☐ Distributor□Distributor
12) | For agents/distributors, | a. If legal person: i. Name ii. Unique identification number in the format of the Member State where the agent/distributor is located as specified in Annex I (where applicable) iii. Legal Entity Identifier (LEI) of the agent/distributor (where available) iv. Telephone number b. If natural person: i. Name, date and place of birth ii. Unique identification number in the format of the Member State where the agent/distributor is located as specified in Annex I (where applicable)
13) | For agents and branches, date of entry in the register of the competent authorities of the Home Member State | DD/MM/YYYY
14) | Start date of the branch/agent/distributor activities (for agents and branches, the date shall not precede the date of entry of the agent/branch in the register of the home Member State as referred to in Article 28(3) of Directive (EU) 2015/2366) | DD/MM/YYYY