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Annex II

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ANNEX II

| CALCULATION OF FEES | Reference date | | NAME |

| TOTAL ASSETS | Submission date | | MFI Code |

| | | | LEI code |

| | | | |

Item | | Type of institution | Confirmation of auditor’s verification or of management letter for fee-paying branches (Yes/No) | Total assets | Comments

| | 010 | 020 | 030 | 040

010 | TOTAL ASSETS in accordance with Article 51(2) or (4) of Regulation (EU) No 468/2014 (ECB/2014/17) | (3) | | |

020 | TOTAL ASSETS in accordance with Article 2, point (12)(b) or (c) of Regulation (EU) No 1163/2014 (ECB/2014/41) | (4) | (Yes)/(No) | |

030 | TOTAL ASSETS in accordance with Article 3(2)(b) of this Decision: Item 030 is equal to 031 minus 032 plus 033 minus 034 | (2) or (5) | (Yes)/(No) | |

031 | Total assets of all group entities established in participating Member States —obligatory | | | |

032 | Intragroup positions among supervised entities established in participating Member States (from reporting packages used for the elimination of balances for group reporting purposes) —optional | | | |

033 | Goodwill included in the consolidated financial statements of the parent undertaking of a supervised group —obligatory | | | |

034 | Goodwill allocated to subsidiaries established in non-participating Member States and third countries —optional | | | |

Please ensure that this template is completed in accordance with the instructions provided separately.

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