Statement on the authorisation of an AIFM under Article 32(3), second subparagraph, of Directive 2011/61/EU
ANNEX IVSupplementary provisions
ANNEX IV Statement on the authorisation of an AIFM under Article 32(3), second subparagraph, of Directive 2011/61/EU STATEMENT ESTABLISHED BY ______________________________________ ( name of the competent authority of the AIFM home Member State ) Section 1. Department responsible for the establishment of the statement within the competent authority of the AIFM home Member State Department Address of the NCA Email address of the department establishing the statement Section 2. Identification of the authorised AIFM AIFM AIFM’s LEI AIFM’s home Member State Address and, where different from address, registered office/domicile Section 3. Scope of the authorisation of the AIFM The authorisation of the AIFM is limited to the management of AIFs with the following investment strategy: ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ (The attestation shall be signed and dated by a representative of the competent authority of the AIFM home Member State. The signatory shall state his or her full name) Date Name and capacity of the signatory Signature