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 Institution ☐ 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) | |||||||||
11) | Type of passporting | ☐ Branch ☐ Agent ☐ Distributor | ||||||||
12) | For agents/distributors, | If legal person: Name
If natural person: Name, date and place of birth
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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 | ||||||||