Source: OJ L, 2025/304, 20.2.2025

Current language: EN

Annex


Form for the notification of information to be provided by certain financial entities

  1. In accordance with Articles 2 and 4 of Commission Implementing Regulation (EU) 2025/304 of 31 October 2024, laying down implementing technical standards for the application of Regulation (EU) 2023/1114 of the European Parliament and of the Council with regard to standard forms, templates and procedures for the notification of certain financial entities of their intention to provide crypto-asset servicesmeans any of the following services and activities relating to any crypto-asset:providing custody and administration of crypto-assets on behalf of clients;operation of a trading platform for crypto-assets;exchange of crypto-assets for funds;exchange of crypto-assets for other crypto-assets;execution of orders for crypto-assets on behalf of clients;placing of crypto-assets;reception and transmission of orders for crypto-assets on behalf of clients;providing advice on crypto-assets;providing portfolio management on crypto-assets;providing transfer services for crypto-assets on behalf of clients;, kindly find attached our notification of our intention to provide crypto-asset servicesmeans any of the following services and activities relating to any crypto-asset:providing custody and administration of crypto-assets on behalf of clients;operation of a trading platform for crypto-assets;exchange of crypto-assets for funds;exchange of crypto-assets for other crypto-assets;execution of orders for crypto-assets on behalf of clients;placing of crypto-assets;reception and transmission of orders for crypto-assets on behalf of clients;providing advice on crypto-assets;providing portfolio management on crypto-assets;providing transfer services for crypto-assets on behalf of clients;(1)OJ L, 2025/304, 20.2.2025, ELI: http://data.europa.eu/eli/reg_impl/2025/304/oj..

    1. Reference number (to be completed by the competent authority):

    2. Date:

    3. FROM

    4. Name of the notifying entity:

    5. National reference number:

    6. Address of the notifying entity:

    7. Contact details of designated contact person:

    8. Name:

    9. Telephone:

    10. Email:

    11. TO

    12. Member State (if applicable):

    13. 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;:

    14. Address:

    15. Contact details of the designated contact point:

    16. Name:

    17. Telephone:

    18. Email:

    19. [We,] [notifying entity,] declare that the submitted information is accurate, complete and up-to-date. If some information relates only to a future date, it is explicitly identified in the notification and we undertake to notify the authority in writing without delay if any such information should turn out to be inaccurate, incomplete or misleading. Further, we undertake to inform the 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; of any change concerning the information provided in this form.

      1. Person in charge of preparing the notification:

    20. Name:

    21. Status/position:

    22. Telephone:

    23. Email:

    24. REQUIRED INFORMATION

    25. Programme of operations

    26. Please insert the information referred to in Article 1 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    27. Business continuity

    28. Please insert the information referred to in Article 2 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    29. Detection and prevention of money laundering and terrorist financing

    30. Please insert the information referred to in Article 3 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    31. ICT systems and related security arrangements

    32. Please insert the information referred to in Article 4 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    33. Segregation of clients’ crypto-assets and funds

    34. Please insert the information referred to in Article 5 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    35. Custody and administration policy

    36. Please insert the information referred to in Article 6 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    37. Operating rules of the trading platform and market abuse detection

    38. Please insert the information referred to in Article 7 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    39. Exchange of crypto-assets for funds or other crypto-assets

    40. Please insert the information referred to in Article 8 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    41. Execution policy

    42. Please insert the information referred to in Article 9 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    43. Provision of advice or portfolio management on crypto-assets

    44. Please insert the information referred to in Article 10 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    45. Transfer services

    46. Please insert the information referred to in Article 11 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

    47. [signature of legal representative]

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