ANNEX VISupplementary provisions
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, a. If legal person: i. Name ii. Unique identification number in the format of the Member State where the agent/distributor is located as specified in Annex I (where applicable) iii. Legal Entity Identifier (LEI) of the agent/distributor (where available) iv. Telephone number b. If natural person: i. Name, date and place of birth ii. Unique identification number in the format of the Member State where the agent/distributor is located as specified in Annex I (where applicable) 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