Reference number:

Date:

From:

Name of the applicant:

Address:

Legal Entity Identifier(where applicable):

(Contact details of the designated contact person at the applicant)

Full Name:

Telephone:

Email:

To:

Member State:

Competent authority:

Address:

(Contact details of the designated contact point at the competent authority)

Address:

Telephone:

Email:

Dear [insert appropriate name]

In accordance with Article 2 of Commission Implementing Regulation (EU) 2017/1110 (1) please find attached the authorisation application.

— Person at the applicant in charge of preparing the application:

Full Name:

Status/position:

Telephone:

Email:

Date:

Signature:

— Nature of the application (tick the relevant box(es)):

Authorisation – Approved Publication Arrangement (APA)

Authorisation – Consolidated Tape Provider (CTP)

Authorisation – Approved Reporting Mechanism (ARM)

Content

Please insert the information referred to under Commission Delegated Regulation (EU) 2017/571 (2). Please set out that information under the appropriate section or make reference to the relevant annexes containing the information.

Information on the organisation (Article 2 of Delegated Regulation (EU) 2017/571)

Information on corporate governance (Article 3 of Delegated Regulation (EU) 2017/571)

Information on conflicts of interest (Article 5 of Delegated Regulation (EU) 2017/571)

Information on organisational requirements regarding outsourcing (Article 6 of Delegated Regulation (EU) 2017/571)

Information on business continuity and back-up facilities (Article 7 of Delegated Regulation (EU) 2017/571)

Information on testing and capacity (Article 8 of Delegated Regulation (EU) 2017/571)

Information on security (Article 9 of Delegated Regulation (EU) 2017/571)

Information on management of incomplete or potentially erroneous information by APAs and CTPs (Article 10 of Delegated Regulation (EU) 2017/571)

Information on management of incomplete or potentially erroneous information by ARMs (Article 11 of Delegated Regulation (EU) 2017/571)

Information on connectivity of ARMs (Article 12 of Delegated Regulation (EU) 2017/571)

Information on other services provided by CTPs (Article 13 of Delegated Regulation (EU) 2017/571)

Information on publication arrangements (Chapter 3 of Delegated Regulation (EU) 2017/571)

Notes:

(1) Commission Implementing Regulation (EU) 2017/1110 of 22 June 2017 laying down implementing technical standards with regard to standard forms, templates and procedures for the authorisation of data reporting services providers and related notifications pursuant to Directive 2014/65/EU of the European Parliament and of the Council on markets in financial instruments (OJ L 162, 23.6.2017, p. 3).

(2) Commission Delegated Regulation (EU) 2017/571 of 2 June 2016 supplementing Directive 2014/65/EU of the European Parliament and of the Council with regard to regulatory technical standards on the authorisation, organisational requirements and the publication of transactions for data reporting services providers (OJ L 87, 31.3.2017, p. 126).

Reference number:

Date:

From:

Name of the applicant:

Address:

Legal Entity Identifier (where applicable):

(Contact details of the designated contact person at the applicant)

Full Name:

Telephone:

Email:

To:

Member State:

Competent authority:

Address:

(Contact details of the designated contact point at the competent authority)

Address:

Telephone:

Email:

Dear [insert appropriate name]

In accordance with Article 2 of Commission Implementing Regulation (EU) 2017/1110 (1) please find attached the notification relating to the members of the management body.

— Person at the applicant in charge of preparing the application:

Full Name:

Status/position:

Telephone:

Email:

Date:

Signature:

— List of members of the management body:

Member 1

Full name

Date and place of birth

Personal national identification number or equivalent thereof

Private address:

Contact details (Telephone and email address)

Position

Curriculum vitae attached to application: Yes/No

Professional experience and other relevant experience

Educational qualification and relevant training

Criminal records attached to this application OR self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(d) of Commission Delegated Regulation (EU) 2017/571 (2)

Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(e) of Delegated Regulation (EU) 2017/571

Minimum time (approximate) that will be devoted to the performance of the person’s functions within the data reporting services provider

Declaration of any potential conflicts of interest that may exist or arise in performing the duties and how these conflicts are managed

Additional information relevant for the assessment whether the member is of sufficiently good repute, possesses sufficient knowledge, skills and experience and commits sufficient time to perform the duties pursuant to Article 63(3) of Directive 2014/65/EU of the European Parliament and of the Council (3)

Effective date

[Please set out that information here or provide an explanation of how it will be provided, or make reference to the relevant annexes containing the information]

Member [N]

Full name

Date and place of birth

Personal national identification number or equivalent thereof

Private address:

Contact details (Telephone and email address)

Position

Curriculum vitae attached to application: Yes/No

Professional experience and other relevant experience

Educational qualification and relevant training

Criminal records attached to application OR self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(d) of Delegated Regulation (EU) 2017/571

Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(e) of Commission Delegated Regulation (EU) 2017/571 (2)

Minimum time (approximate) that will be devoted to the performance of the person’s functions within the data reporting services provider

Declaration of any potential conflicts of interest that may exist or arise in performing the duties and how these conflicts are managed

Additional information relevant for the assessment that the member is of sufficiently good repute, possesses sufficient knowledge, skills and experience and commits sufficient time to perform the duties referred to in Article 63(3) of Directive 2014/65/EU

Effective date

Notes:

(1) Commission Implementing Regulation (EU) 2017/1110 of 22 June 2017 laying down implementing technical standards with regard to standard forms, templates and procedures for the authorisation of data reporting services providers and related notifications pursuant to Directive 2014/65/EU of the European Parliament and of the Council on markets in financial instruments (OJ L 162, 23.6.2017, p. 3).

(2) Commission Delegated Regulation (EU) 2017/571 of 2 June 2016 supplementing Directive 2014/65/EU of the European Parliament and of the Council with regard to regulatory technical standards on the authorisation, organisational requirements and the publication of transactions for data reporting services providers (OJ L 187, 31.3.2017, p. 126).

(3) Directive 2014/65/EU of the European Parliament and of the Council of 15 May 2014 on markets in financial instruments and amending Directive 2002/92/EC and Directive 2011/61/EU (OJ L 173, 12.6.2014, p. 349).

Reference number:

Date:

From:

Name of the data reporting services provider:

Address:

Legal Entity Identifier (where applicable):

(Contact details of the designated contact person at the data reporting services provider)

Full name:

Telephone:

Email:

To:

Member State:

Competent Authority:

Address:

(Contact details of the designated contact point at the competent authority)

Address:

Telephone:

Email:

Dear [insert appropriate name]

In accordance with Article 4 of the Commission Implementing Regulation (EU) 2017/1110 (1) please find attached the notification on changes to the membership of the management body.

— Person at the data reporting services provider in charge of preparing the notification:

Full Name:

Status/position:

Telephone:

Email:

Date:

Signed:

— Information on member(s) leaving the management body

Member 1

Full name

Contact details (Telephone and email address)

Position

Effective date of departure from management body

Reasons for the departure from management body

Member [N]

Full name

Contact details (Telephone and email address)

Position

Effective date of departure from management body

Reasons for the departure from management body

— Information on new member(s) of the management body

Member 1

Full name

Date and place of birth

Personal national identification number or equivalent thereof

Private address:

Contact details (telephone and email address)

Position

Curriculum vitae attached to application: Yes/No

Professional experience and other relevant experience

Educational qualification and relevant training

Criminal records attached to this application OR self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(d) of Commission Delegated Regulation (EU) 2017/571 (2)

Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(e) of Delegated Regulation (EU) 2017/571 (2)

Minimum time (approximate) that will be devoted to the performance of the person’s functions within the data reporting services provider

Declaration of any potential conflicts of interest that may exist or arise in performing the duties and how these conflicts are managed

Additional information relevant for the assessment that the member is of sufficiently good repute, possesses sufficient knowledge, skills and experience and commits sufficient time to perform the duties referred to in Article 63(3) of Directive 2014/65/EU of the European Parliament and of the Council (3)

Effective date

[Please set out that information here or provide an explanation of how it will be provided, or make reference to the relevant annexes containing the information]

Member [N]

Full name

Date and place of birth

Personal national identification number or equivalent thereof

Private address:

Position

Curriculum vitae attached to application: Yes/No

Professional experience and other relevant experience

Educational qualification and relevant training

Criminal records attached to this application OR self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(d) of Delegated Regulation (EU) 2017/571

Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(e) of Delegated Regulation (EU) 2017/571

Minimum time (approximate) that will be devoted to the performance of the person’s functions within the data reporting services provider

Declaration of any potential conflicts of interest that may exist or arise in performing the duties and how these conflicts are managed

Additional information relevant for the assessment that the member is of sufficiently good repute, possesses sufficient knowledge, skills and experience and commits sufficient time to perform the duties referred to in Article 63(3) of Directive 2014/65/EU.

Effective date

[Please set out that information here or provide an explanation of how it will be provided, or make reference to the relevant annexes containing the information]

— Complete updated list of members of the management body:

Notes:

(1) Commission Implementing Regulation (EU) 2017/1110 of 22 June 2017 laying down implementing technical standards with regard to standard forms, templates and procedures for the authorisation of data reporting services providers and related notifications pursuant to Directive 2014/65/EU of the European Parliament and of the Council on markets in financial instruments (OJ L 162, 23.6.2017, p. 3).

(2) Commission Delegated Regulation (EU) 2017/571 of 2 June 2016 supplementing Directive 2014/65/EU of the European Parliament and of the Council with regard to regulatory technical standards on the authorisation, organisational requirements and the publication of transactions for data reporting services providers (OJ L 187, 31.3.2017, p. 126).

(3) Directive 2014/65/EU of the European Parliament and of the Council of 15 May 2014 on markets in financial instruments and amending Directive 2002/92/EC and Directive 2011/61/EU (OJ L 173, 12.6.2014, p. 349).

Name

Position

Effective date