Annex II Template for the insider list to be submitted by issuers of financial instruments admitted to trading on SME growth markets

United Kingdom

Date and time (creation): [ yyyy-mm-dd, hh:mm UTC (Coordinated Universal Time) ]

Date of transmission to the competent authority: [ yyyy-mm-dd ]

First name(s) of the insider	Surname(s) of the insider	Birth surname(s) of the insider (if different)	Professional telephone number(s) (work direct telephone line and work mobile numbers)	Company name and address	Function and reason for being insider	Obtained (the date and time at which a person obtained access to inside information)	Ceased (the date and time at which a person ceased to have access to inside information)	National Identification Number (if applicable)Or otherwise date of birth	Personal full home address (street name; street number; city; post/zip code; country)(If available at the time of the request by the competent authority)	Personal telephone numbers (home and personal mobile telephone numbers)(If available at the time of the request by the competent authority)
[Text]	[Text]	[Text]	[Numbers (no space)]	[Address of issuer or third party of insider]	[Text describing role, function and reason for being on this list]	[yyyy-mm-dd, hh:mm UTC]	[yyyy-mm-dd, hh:mm UTC]	[Number and/or text or yyyy-mm-dd for the date of birth]	[Text: detailed personal address of the insider Street name and number City Post/zip code Country]	[Numbers (no space)]

First name(s) of the insider

Surname(s) of the insider

Birth surname(s) of the insider (if different)

Professional telephone number(s) (work direct telephone line and work mobile numbers)

Company name and address

Function and reason for being insider

Obtained (the date and time at which a person obtained access to inside information)

Ceased (the date and time at which a person ceased to have access to inside information)

National Identification Number (if applicable)Or otherwise date of birth

Personal full home address (street name; street number; city; post/zip code; country)(If available at the time of the request by the competent authority)

Personal telephone numbers (home and personal mobile telephone numbers)(If available at the time of the request by the competent authority)

[Text]

[Numbers (no space)]

[Address of issuer or third party of insider]

[Text describing role, function and reason for being on this list]

[yyyy-mm-dd, hh:mm UTC]

[Number and/or text or yyyy-mm-dd for the date of birth]

[Text: detailed personal address of the insider

Street name and number
City
Post/zip code
Country]

[Numbers (no space)]