ANNEX IIISupplementary provisions
ANNEX III Form for the communication of a change in the particulars of an investment services and activitiespassport notification or in a notification for the provision of arrangements to facilitate access to an MTF or OTF by the competent authority of the home Member State to the competent authority of the host Member State (Articles 7 and 8 of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Communication in accordance with Article 34(4) or Article 34(7) of Directive 2014/65/EU (1) FROM: Member State: Competent authority of the home Member State: Address: Designated contact point: Telephone number: Email: TO: Member State: Competent Authority of the host Member State: Address: Designated contact point: Telephone number: Email: In accordance with Article 34(4) of the Directive 2014/65/EU, we wish to inform you that [Name of firm], an investment firm/credit institution/market operator authorised/supervised by [name of the competent authority of the home Member State], has: (a) amended the investment services and activities/ancillary services/financial instruments that intends to carry on in your territory on a cross-border basis (b) changed its name from [old name] to [new name] with effect [date of change] (c) moved to the following address with effect [date of change] (d) changed its other contact information to as follows [add any changes made to the contact information of Part 1 in Annex I] with effect [date of change] (e) engaged an additional in [name of the home Member State] registered tied agent in providing its investment services and activities in your territory on a cross-border basis (f) amended the arrangements provided in [name of the host Member State] in order to facilitate the access to and trading of the [name of the MTF or OTF] (g) ceased to provide investment services and/or perform investment activities due to the withdrawal/cancellation of its authorisation with effect [date of withdrawal/cancellation]. Please find attached a copy of the change of [investment services and activities particulars notification/particulars for the provision of arrangements to facilitate access to an MTF or OTF notification] with the relevant changes. If you have any queries, please do not hesitate to contact us. Yours sincerely, [Signature] (1) Please amend as appropriate in accordance with the changes to be notified.