# 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), Annex VI: Notification template for the exchange of information in relation to start of branch/agent/distributor passport activities by payment institutions and e-money institutions

Extent: E+W+S+N.I.

Start of activities
1)
Home Member State
2)
Name of the competent authority of the home Member State
3)
Date of the initial application according to Annex II or III or IV.
4)
Member State where the branch/agent/distributor is to start activities
5)
Type of Institution
☐ Payment Institution
☐ E-Money Institution
6)
Name of the payment institution/e-money institution
7)
Head office address of the payment institution/e-money institution
8)
Unique identification number of the payment institution/e-money institution in the format of the home Member State as specified in Annex I (where applicable)
9)
Legal Entity Identifier (LEI) of the payment institution/e-money institution (where available)
10)
Home Member State authorisation number of the payment institution/e-money institution (where applicable)
11)
Type of passporting
☐ Branch
☐ Agent
☐ Distributor
12)
For agents/distributors,
a.. If legal person:
i.. Name
ii.. Unique identification number in the format of the Member State where the agent/distributor is located as specified in Annex I (where applicable)
iii.. Legal Entity Identifier (LEI) of the agent/distributor (where available)
iv.. Telephone number
b.. If natural person:
i.. Name, date and place of birth
ii.. Unique identification number in the format of the Member State where the agent/distributor is located as specified in Annex I (where applicable)
13)
For agents and branches, date of entry in the register of the competent authorities of the Home Member State
DD/MM/YYYY
14)
Start date of the branch/agent/distributor activities (for agents and branches, the date shall not precede the date of entry of the agent/branch in the register of the home Member State as referred to in Article 28(3) of Directive (EU) 2015/2366)
DD/MM/YYYY

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Source: https://www.legislation.gov.uk/eur/2017/2055/annex/VI (the official version)
Page: https://openlegislation.uk/eu-regulation-2017-2055/annex-VI
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.