ANNEX IIISupplementary provisions
ANNEX III Notification of information on changes to the membership of the management body Text of image Reference number: Date: FROM: Name of the applicant: Address: (Contact details of the designated contact person) Name: Telephone: Email: TO: Competent Authority: Address: (Contact details of the designated contact point if relevant) Address: Telephone: Email: Dear [insert appropriate name] In accordance with Article 4 of the Commission Implementing Regulation (EU) 2017/1945 of 19 June 2017 laying down implementing technical standards with regard to standard forms, templates and procedures for notification or provision of information provided for in Article 7(5) of Directive 2014/65/EU to ensure uniform conditions of application of Article 9(5) of that Directive, kindly find attached the notification request. — Person in charge of preparing the application: Name: Status/position: Telephone: Fax (if available): Email: Text of image Information on member(s) leaving the management body Member 1 Name Contact details (Telephone, email, address) Position Effective date of departure from management body Reasons for the departure from management body Member 2 Name Contact details (Telephone, email, address) Position Effective date of departure from management body Reasons for the departure from management body Member n Name Contact details (Telephone, 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 Name Contact details (Telephone, email, address) Position Professional experience and other relevant experience Educational qualification and relevant training List of executive and non-executive directorships in other entities 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 Name Contact details (Telephone, email, address) Position Professional experience and other relevant experience Educational qualification and relevant training List of executive and non-executive directorships in other entities Text of image 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 Please provide: — Minutes of the general meeting acting the nomination of the new member of the management body. — Minutes of the general meeting of the management body acting the nomination of the new member. Name Position Effective date