{
  "url": "https://openlegislation.uk/eu-regulation-2017-2055/annex-V",
  "json_url": "https://openlegislation.uk/eu-regulation-2017-2055/annex-V.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/V",
  "kind": "annex",
  "number": "V",
  "heading": "Notification template for the exchange of information in relation to freedom to provide services applications with no agent or distributor",
  "text": "1)\nHome Member State\n2)\nName of the competent authority of the home Member State\n3)\nDate of receipt by the competent authority of the home Member State of the complete and accurate application from the payment institution/e-money institution\nDD/MM/YY\n4)\nMember State where the services are to be provided\n5)\nType of application\n☐ First application\n☐ Change to previous application\n☐ End of business activity/cessation\n6)\nType of Institution\n☐ Payment Institution\n☐ E-Money Institution\n7)\nName of the payment institution/e-money institution\n8)\nHead office address of the payment institution/e-money institution\n9)\nUnique identification number of the payment institution/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 payment institution/e-money institution (where available)\n11)\nHome Member State authorisation number of the payment institution/e-money institution (where applicable)\n12)\nContact person within the payment institution/e-money institution\n13)\nEmail of the contact person within the payment institution/e-money institution\n14)\nTelephone number of the contact person within the payment institution/e-money institution\n15)\nThe intended date of start of the provision of payment/e-money services (shall not precede the communication of the decision of the competent authority of the home Member State referred to in Article 28(3) of Directive (EU) 2015/2366\nDD/MM/YYYY\n16)\nPayment services to be provided\n1.\n☐ Services enabling cash to be placed on a payment account as well as all the operations required for operating a payment account\n2.\n☐ Services enabling cash withdrawals from a payment account as well as all the operations required for operating a payment account\n3.\nExecution of payment transactions, including transfers of funds on a payment account with the user's payment provider or with another payment service provider:\na)) execution of direct debits, including one-off direct debits ☐\nb)) execution of payment transactions through a payment card or a similar device ☐\nc)) execution of credit transfers, including standing orders ☐\n4.\nExecution of payment transactions where the funds are covered by a credit line for a payment service user:\na)) execution of direct debits, including one-off direct debits ☐\nb)) execution of payment transactions through a payment card or a similar device ☐\nc)) execution of credit transfers, including standing orders ☐\nIncluding granting of credit in accordance with Article 18(4) of Directive (EU) 2015/2366: ☐ yes ☐ no\n5.\n☐ Issuing of payment instruments\n☐ Acquiring of payment transactions\nIncluding granting of credit in accordance with Article 18(4) of Directive (EU) 2015/2366: ☐ yes ☐ no\n6.\n☐ Money remittance\n7.\n☐ Payment initiation services\n8.\n☐ Account information services\n17)\nE-money services to be provided (applicable only to e-money institutions)\n☐ Issuing of electronic money\n☐ Distribution and/or Redemption of electronic money\n18)\nIn case of outsourcing of operational functions of payment/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/V",
    "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."
}