ANNEX VISupplementary provisions
ANNEX VI Form for the branch passport notification and change of branch particulars notification (1) (Articles 12, 17 and 19 of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Part 1 — Contact Information Type of notification: Branch passport notification/change of branch particulars notification Member State in which the investment firm intends to establish a branch (2): Name of the investment firm: Address of the investment firm: Telephone number of the investment firm: Email of the investment firm: Name of the contact person at the investment firm: Name of the branch: Address of the branch: Telephone number of the branch: Email of the branch: Name(s) of those responsible for the management of the branch: Home Member State: Authorisation Status: Authorised by [Home Member State Competent Authority] Authorisation Date: (1) For the purposes of a changes of branch particulars notification please complete only the parts of the forms which are relevant to the notified changes. When the investment firm intends to make changes to the investment services, activities, ancillary services or financial instruments provided by the branch, the firm shall list all investment services, activities ancillary services or financial instruments the branch will provide. (2) Please note that national corporate law may require the previous registration to a commercial registry prior to the commencement of operations by the branch. Part 2 — Programme of operations Intended investment services, activities and ancillary services provided by the branch (*) Investment Services and activities Ancillary services A1 A2 A3 A4 A5 A6 A7 A8 A9 B1 B2 B3 B4 B5 B6 B7 Financial Instruments C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 (*) Please place an (x) in the appropriate box(es). Business Plan and structural organisation of the branch Business plan 1. How will the branch contribute to the strategy of the firm/group? 2. What will the main functions of the branch be? 3. Describe the main objectives of the branch; Commercial Strategy 1. Describe the types of clients/counterparties the branch will be dealing with; 2. Describe how the firm will obtain and deal with these clients; Organisational structure 1. Briefly describe how the branch fits into the corporate structure of the firm/group? (This may be facilitated by attaching an organisational chart) 2. Set out the organisational structure of the branch, showing functional, geographical and legal reporting lines; 3. Identify who will be responsible for the branch operations on a day to day basis? Provide details of professional experience of the persons responsible for the management of the branch (Please attach CV); 4. Identify who will be responsible for the internal control functions at the branch? 5. Identify who will be responsible for dealing with complaints in relation to the branch? 6. Explain how will the branch report to the head office? 7. Detail any critical outsourcing arrangements Tied Agents (*) 1. Will the branch use tied agent? 2. What is the identity of the tied agent? Name Address Telephone Email Contact point reference or hyperlink to the public register where the tied agent is registered Systems & Controls Provide a brief summary of arrangements for: 1. safeguarding client money and assets; 4. compliance with the conduct of business and other obligations that fall under the responsibility of the Competent Authority of the host Member State according to Art 35(8) and record keeping under Art 16(6); 5. staff code of Conduct, including personal account dealing; 6. anti-money laundering; 7. monitoring and control of critical outsourcing arrangements (if applicable); 8. the name, address and contact details of the accredited compensation scheme of which the investment firm is a member; Financial forecast Attach a forecast statement for profit and loss and cash flow, both over an initial period of thirty six month period; (*) The investment firm shall submit a separate passport notification in respect of each tied agent the branch intends to use.