{
  "url": "https://openlegislation.uk/eu-regulation-2017-2055/annex-IV",
  "json_url": "https://openlegislation.uk/eu-regulation-2017-2055/annex-IV.json",
  "legislation": "eur/2017/2055",
  "legislation_title": "Commission Delegated Regulation (EU) 2017/2055 of 23 June 2017 supplementing Directive (EU) 2015/2366 of the European Parliament and of the Council with regard to regulatory technical standards for the cooperation and exchange of information between competent authorities relating to the exercise of the right of establishment and the freedom to provide services of payment institutions (Text with EEA relevance)",
  "legislation_url": "https://openlegislation.uk/eu-regulation-2017-2055",
  "path": "annex/IV",
  "kind": "annex",
  "number": "IV",
  "heading": "Notification template for the exchange of information in relation to passport applications by e-money institutions using distributors",
  "text": "1)\nHome Member State\n2)\nHost Member State in which e-money services are to be provided\n3)\nName of the competent authority of the home Member State\n4)\nDate of receipt by the competent authority of the home Member State of the complete and accurate application from the e-money institution\nDD/MM/YY\n5)\nType of application\n☐ First application\n☐ Change to previous application\n☐ Additional distributors\n☐ Distributor deactivation\n6)\nNature of the application (assessment of the competent authority of the home Member State)\n☐ Right of establishment\n☐ Freedom to provide services, based on the following circumstances:\n…\n…\n…\n7)\nName of the e-money institution\n8)\nHead office address of the e-money institution\n9)\nUnique identification number of the e-money institution in the format of the home Member State as specified in Annex I (where applicable)\n10)\nLegal Entity Identifier (LEI) of the e-money institution (where available)\n11)\nHome Member State authorisation number of the e-money institution (where applicable)\n12)\nContact person within the e-money institution\n13)\nEmail of the contact person within the e-money institution\n14)\nTelephone number of the contact person within the e-money institution\n15)\nDistributor details:\na.. If legal person:\ni.. Name\nii.. Registered Address(es)\niii.. Unique identification number in the format of the Member State where the distributor is located as specified in Annex I (where applicable)\niv.. Legal Entity Identifier (LEI) of the distributor (where available)\nv.. Telephone number\nvi.. Email\nvii.. Name, place and date of birth of legal representatives\nb.. If natural person:\ni.. Name, date and place of birth\nii.. Registered Business address(es)\niii.. Unique identification number in the format of the Member State where the distributor is located as specified in Annex I (where applicable)\niv.. Telephone number\nv.. Email\n16)\nElectronic money services to be provided by the distributor\n☐ Distribution\n☐ Redemption of electronic money\n17)\nDescription of the internal control mechanisms that will be used by the e-money institution/distributor in order to comply with the obligations in relation to the prevention of money laundering and terrorist financing under Directive (EU) 2015/849.\n18)\nIn case of outsourcing of operational functions of e-money services:\na.. Name and address of the entity to which operational functions are to be outsourced\nb.. Contact details (email and telephone number) of a contact person within the entity to which operational functions are to be outsourced\nc.. Type and exhaustive description of the operational functions outsourced",
  "extent": "E+W+S+N.I.",
  "status": null,
  "version": "current",
  "annotations": [],
  "outstanding_effects": [],
  "provenance": {
    "source": "legislation.gov.uk",
    "source_url": "https://www.legislation.gov.uk/eur/2017/2055/annex/IV",
    "retrieved_at": "2026-11-01T14:44:28.249510+00:00"
  },
  "licence": "Open Government Licence v3.0",
  "licence_url": "https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/",
  "attribution": "Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives."
}