ANNEX VI
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Reference number:
Date:
From:
Name of the CTP:
Address:
Legal Entity Identifier (where applicable): Full name:
Telephone:
Email:
To:
ESMA:
Address: Address:
Telephone:
Email:
Dear [
insert appropriate name
],
In accordance with Article 11 of Commission Implementing Regulation (EU) 2025/1157 please find attached the notification on changes to the membership of the management body.
—
Person at the CTP 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:
Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:
Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:
Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP:
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 2014:
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:
Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:
Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:
Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP:
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 2014:
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:
Name
Position
Effective date
Name:
Position:
Effective date:# Table 1 in anx_I
| 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:ESMA/National Competent Authority:Address:(Contact details of the designated contact point at ESMA/National Competent Authority)Address:Telephone:Email:Dear [insert appropriate name],In accordance with Article 2 of Commission Implementing Regulation (EU) 2025/1157 please find 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 – Approved Reporting Mechanism (ARM)CONTENTPlease insert the information referred to under Commission Delegated Regulation (EU) 2025/1143. 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) 2025/1143):Information on the ownership (Article 3 of Delegated Regulation (EU) 2025/1143):Information on corporate governance (Article 4 of Delegated Regulation (EU) 2025/1143):Information on the members of the management body (Article 5 of Delegated Regulation (EU) 2025/1143):Information on internal controls (Article 6 of Delegated Regulation (EU) 2025/1143):Information on digital operational resilience (Article 7 of Delegated Regulation (EU) 2025/1143):Information on conflicts of interest (Article 8 of Delegated Regulation (EU) 2025/1143):Information on organisational requirements regarding outsourcing (Article 9 of Delegated Regulation (EU) 2025/1143):Information on management of incomplete or potentially erroneous information by APAs (Article 10 of Delegated Regulation (EU) 2025/1143):Information on management of incomplete or potentially erroneous information by ARMs (Article 11 of Delegated Regulation (EU) 2025/1143):Information on connectivity of ARMs (Article 12 of Delegated Regulation (EU) 2025/1143):Information on machine readability (Article 13 of Delegated Regulation (EU) 2025/1143):Information on the details to be published by the APA (Article 14 of Delegated Regulation (EU) 2025/1143):Notes: | — | 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 – Approved Reporting Mechanism (ARM) | ☐ | Authorisation – Approved Publication Arrangement (APA) | ☐ | Authorisation – Approved Reporting Mechanism (ARM) |
|---|---|---|---|---|---|---|---|---|
| — | 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 – Approved Reporting Mechanism (ARM) | ☐ | Authorisation – Approved Publication Arrangement (APA) | ☐ | Authorisation – Approved Reporting Mechanism (ARM) | |||
| ☐ | Authorisation – Approved Publication Arrangement (APA) | |||||||
| ☐ | Authorisation – Approved Reporting Mechanism (ARM) |
Table 2 in anx_I
| — | Person at the applicant in charge of preparing the application:Full name:Status/position:Telephone:Email:Date:Signature: |
|---|
Table 3 in anx_I
| — | Nature of the application [tick the relevant box(es)]:☐Authorisation – Approved Publication Arrangement (APA)☐Authorisation – Approved Reporting Mechanism (ARM) | ☐ | Authorisation – Approved Publication Arrangement (APA) | ☐ | Authorisation – Approved Reporting Mechanism (ARM) |
|---|---|---|---|---|---|
| ☐ | Authorisation – Approved Publication Arrangement (APA) | ||||
| ☐ | Authorisation – Approved Reporting Mechanism (ARM) |
Table 4 in anx_I
| ☐ | Authorisation – Approved Publication Arrangement (APA) |
|---|
Table 5 in anx_I
| ☐ | Authorisation – Approved Reporting Mechanism (ARM) |
|---|
Table 1 in anx_II
| 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:ESMA/National Competent Authority:Address:(Contact details of the designated contact point at ESMA/National Competent Authority)Address:Telephone:Email:Dear [insert appropriate name],In accordance with Article 2 of Commission Implementing Regulation (EU) 2025/1157 please find attached the notification relating to the members of the management body.—Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature:—List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 5(1)(e) of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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] | — | Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature: | — | List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 5(1)(e) of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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] |
|---|---|---|---|---|
| — | Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature: | |||
| — | List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 5(1)(e) of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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] |
Table 2 in anx_II
| — | Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature: |
|---|
Table 3 in anx_II
| — | List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 5(1)(e) of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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] |
|---|
Table 1 in anx_III
| Reference number:Date:From:Name of the APA or ARM:Address:Legal Entity Identifier (where applicable):(Contact details of the designated contact person at the APA or ARM)Full name:Telephone:Email:To:ESMA/National Competent Authority:Address:(Contact details of the designated contact point at ESMA/National Competent Authority)Address:Telephone:Email:Dear [insert appropriate name],In accordance with Article 5 of Commission Implementing Regulation (EU) 2025/1157 please find attached the notification on changes to the membership of the management body.—Person at the APA or ARM in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed:—Information on member(s) leaving the management body:Member 1Full 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 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:Personal national identification number or equivalent thereof:Private address:Position:Curriculum vitae attached to application: Yes/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:NamePositionEffective dateName:Position:Effective date: | — | Person at the APA or ARM in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed: | — | Information on member(s) leaving the management body:Member 1Full 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 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:Personal national identification number or equivalent thereof:Private address:Position:Curriculum vitae attached to application: Yes/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:NamePositionEffective dateName:Position:Effective date: | Name | Position | Effective date | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| — | Person at the APA or ARM in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed: | ||||||||||||||||||||||||||||
| — | Information on member(s) leaving the management body:Member 1Full 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 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:Personal national identification number or equivalent thereof:Private address:Position:Curriculum vitae attached to application: Yes/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:NamePositionEffective dateName:Position:Effective date: | Name | Position | Effective date | |||||||||||||||||||||||||
| Name | Position | Effective date | |||||||||||||||||||||||||||
Table 2 in anx_III
| — | Person at the APA or ARM in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed: |
|---|
Table 3 in anx_III
| — | Information on member(s) leaving the management body:Member 1Full 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: |
|---|
Table 4 in anx_III
| — | Information on new member(s) of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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:Personal national identification number or equivalent thereof:Private address:Position:Curriculum vitae attached to application: Yes/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to the competent authority to request information under Article 5(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the APA or ARM: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 27f(3) of Regulation (EU) No 600/2014: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] |
|---|
Table 5 in anx_III
| — | Complete updated list of members of the management body:NamePositionEffective dateName:Position:Effective date: | Name | Position | Effective date | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Name | Position | Effective date | ||||||||||||||||||||
Table 6 in anx_III
| Name | Position | Effective date |
|---|---|---|
Table 1 in anx_IV
| 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:ESMA:Address:(Contact details of the designated contact point at ESMA)Address:Telephone:Email:Dear [insert appropriate name],In accordance with Article 8 of Commission Implementing Regulation (EU) 2025/1157 please find 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:☐Authorisation – Consolidated Tape Provider (CTP)CONTENTPlease insert the information referred to under Commission Delegated Regulation (EU) 2025/1143. Please set out that information under the appropriate section or make reference to the relevant annexes containing the information.Information on the ownership (Article 16 of Delegated Regulation (EU) 2025/1143):Information on the organisation (Article 17 of Delegated Regulation (EU) 2025/1143):Information on corporate governance (Article 18 of Delegated Regulation (EU) 2025/1143):Information on the members of the management body (Article 19 of Delegated Regulation (EU) 2025/1143):Information on internal controls (Article 20 of Delegated Regulation (EU) 2025/1143):Information on conflicts of interest (Article 21 of Delegated Regulation (EU) 2025/1143):Information on business operativity (Article 22 of Delegated Regulation (EU) 2025/1143):Information on outsourcing (Article 23 of Delegated Regulation (EU) 2025/1143):Information on market data fees and licensing models (Article 24 of Delegated Regulation (EU) 2025/1143):Information on digital operational resilience (Article 25 of Delegated Regulation (EU) 2025/1143):Information on energy efficiency (Article 26 of Delegated Regulation (EU) 2025/1143):Information on record keeping arrangements (Article 27 of Delegated Regulation (EU) 2025/1143):Information on organisational requirements (Article 28 of Delegated Regulation (EU) 2025/1143):Information on reception, consolidation and dissemination of data and data quality (Article 29 of Delegated Regulation (EU) 2025/1143):Information from joint applicants (Article 30 of Delegated Regulation (EU) 2025/1143):Notes: | — | Person at the applicant in charge of preparing the application:Full name:Status/position:Telephone:Email:Date:Signature: | — | Nature of the application:☐Authorisation – Consolidated Tape Provider (CTP) | ☐ | Authorisation – Consolidated Tape Provider (CTP) |
|---|---|---|---|---|---|---|
| — | Person at the applicant in charge of preparing the application:Full name:Status/position:Telephone:Email:Date:Signature: | |||||
| — | Nature of the application:☐Authorisation – Consolidated Tape Provider (CTP) | ☐ | Authorisation – Consolidated Tape Provider (CTP) | |||
| ☐ | Authorisation – Consolidated Tape Provider (CTP) |
Table 2 in anx_IV
| — | Person at the applicant in charge of preparing the application:Full name:Status/position:Telephone:Email:Date:Signature: |
|---|
Table 3 in anx_IV
| — | Nature of the application:☐Authorisation – Consolidated Tape Provider (CTP) | ☐ | Authorisation – Consolidated Tape Provider (CTP) |
|---|---|---|---|
| ☐ | Authorisation – Consolidated Tape Provider (CTP) |
Table 4 in anx_IV
| ☐ | Authorisation – Consolidated Tape Provider (CTP) |
|---|
Table 1 in anx_V
| 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:ESMA:Address:(Contact details of the designated contact point at ESMA)Address:Telephone:Email:Dear [insert appropriate name],In accordance with Article 8 of Commission Implementing Regulation (EU) 2025/1157 please find attached the notification relating to the members of the management body.—Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature:—List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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] | — | Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature: | — | List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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] |
|---|---|---|---|---|
| — | Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature: | |||
| — | List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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] |
Table 2 in anx_V
| — | Person at the applicant in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signature: |
|---|
Table 3 in anx_V
| — | List of members of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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] |
|---|
Table 1 in anx_VI
| Reference number:Date:From:Name of the CTP:Address:Legal Entity Identifier (where applicable):(Contact details of the designated contact person at the CTP)Full name:Telephone:Email:To:ESMA:Address:(Contact details of the designated contact point at ESMA)Address:Telephone:Email:Dear [insert appropriate name],In accordance with Article 11 of Commission Implementing Regulation (EU) 2025/1157 please find attached the notification on changes to the membership of the management body.—Person at the CTP in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed:—Information on member(s) leaving the management body:Member 1Full 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 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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:NamePositionEffective dateName:Position:Effective date: | — | Person at the CTP in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed: | — | Information on member(s) leaving the management body:Member 1Full 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 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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:NamePositionEffective dateName:Position:Effective date: | Name | Position | Effective date | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| — | Person at the CTP in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed: | ||||||||||||||||||||||||||||
| — | Information on member(s) leaving the management body:Member 1Full 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 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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:NamePositionEffective dateName:Position:Effective date: | Name | Position | Effective date | |||||||||||||||||||||||||
| Name | Position | Effective date | |||||||||||||||||||||||||||
Table 2 in anx_VI
| — | Person at the CTP in charge of preparing the notification:Full name:Status/position:Telephone:Email:Date:Signed: |
|---|
Table 3 in anx_VI
| — | Information on member(s) leaving the management body:Member 1Full 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: |
|---|
Table 4 in anx_VI
| — | Information on new member(s) of the management body:Member 1Full 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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Commission Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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/NoProfessional experience and other relevant experience:Educational qualification and relevant training:Confirmation, where possible via an official certificate, of the absence of criminal records relating to money laundering, terrorist financing, financial or data services, acts of fraud or embezzlement OR self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (d), of Delegated Regulation (EU) 2025/1143:Self-declaration of good repute and authorisation to ESMA to request information under Article 19(1), point (e), of Delegated Regulation (EU) 2025/1143:Minimum time (approximate) that will be devoted to the performance of the person’s functions within the CTP: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 27f(3) of Regulation (EU) No 600/2014: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] |
|---|
Table 5 in anx_VI
| — | Complete updated list of members of the management body:NamePositionEffective dateName:Position:Effective date: | Name | Position | Effective date | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Name | Position | Effective date | ||||||||||||||||||||
Table 6 in anx_VI
| Name | Position | Effective date |
|---|---|---|