Annex IV | FORM FOR UNSOLICITED PROVISION OF INFORMATION

Unsolicited provision of information

Reference number:

Date:

FROM

Member State:

Competent Authoritymeans one or more authorities:designated by each Member State in accordance with Article 93 concerning offerors, persons seeking admission to trading of crypto-assets other than asset-referenced tokens and e-money tokens, issuers of asset-referenced tokens, or crypto-asset service providers;designated by each Member State for the application of Directive 2009/110/EC concerning issuers of e-money tokens;:

Address:

(Contact details of the contact point)

Name:

Telephone:

Email:

Member State:

Address:

(Contact details of the contact point)

Name:

Telephone:

Email:

Dear [insert appropriate name],

In accordance with Article 10, we are providing the following information we believe may be of assistance in carrying out your duties.

Information provided

…

[Please set out the details of the information here, including if relevant a description of any supporting documents or material attached]

The information provided is confidential and is disclosed to [insert name of the competent authority receiving the information] pursuant to Article 95 of Regulation (EU) 2023/1114 of the European Parliament and of the Council(¹)Regulation (EU) 2023/1114 of the European Parliament and of the Council of 31 May 2023 on markets in crypto-assets, and amending Regulations (EU) No 1093/2010 and (EU) No 1095/2010 and Directives 2013/36/EU and (EU) 2019/1937 (OJ L 150, 9.6.2023, p. 40, ELI: http://data.europa.eu/eli/reg/2023/1114/oj). and on the basis that the information shall remain confidential in accordance with Article 11 of this Regulation and Article 100 of Regulation (EU) 2023/1114.

The [insert name of the competent authority receiving the information] shall observe the requirements of the Article 11 with respect to the permissible uses of that information, and of Article 101 of Regulation (EU) 2023/1114 with respect to personal datameans personal data as defined in Article 4, point (1), of Regulation (EU) 2016/679; processing and transfer. In particular, the relevant competent authoritiesmeans one or more authorities:designated by each Member State in accordance with Article 93 concerning offerors, persons seeking admission to trading of crypto-assets other than asset-referenced tokens and e-money tokens, issuers of asset-referenced tokens, or crypto-asset service providers;designated by each Member State for the application of Directive 2009/110/EC concerning issuers of e-money tokens; shall ensure that all relevant information on the processing of personal datameans personal data as defined in Article 4, point (1), of Regulation (EU) 2016/679; is provided to data subjects in accordance with Section 2 ‘Information and access to personal datameans personal data as defined in Article 4, point (1), of Regulation (EU) 2016/679;’ of Chapter III ‘Rights of the data subject’ of Regulation (EU) 2016/679 of the European Parliament and of the Council(²)Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (OJ L 119, 4.5.2016, p. 1, ELI: http://data.europa.eu/eli/reg/2016/679/oj).

Where the [insert name of the competent authority receiving the information] intends to use or disclose information provided in this reply for purposes different than those stated in Article 11(3), it shall notify [insert name of the competent authority providing the information] and, unless the exception referred to in Article 100(2) of Regulation (EU) 2023/1114 applies, shall obtain the prior consent of [insert name of the competent authority providing the information]. Where [insert name of the competent authority providing the information] consents to such use or disclosure of the information, it may subject it to certain conditions.

Yours sincerely,

[signature]