Commission Delegated Regulation (EU) 2017/2055Show full title

ANNEX II U.K. Notification template for the exchange of information in relation to branch passport applications by payment institutions and e-money institutions

1)	Home Member State
2)	Name of the competent authorities of the home Member State
3)	Date of receipt by the competent authority of the home Member State of the complete and accurate application from the payment institution/e-money institution	DD/MM/YY
4)	Member State where the branch is to be established
5)	Type of application	☐ First application ☐ Change to previous application ☐ End of business activity/cessation
6)	Type of Institution	☐ Payment Institution ☐ E-Money Institution
7)	Name of the payment institution/e-money institution
8)	Head office address of the payment institution/e-money institution
9)	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)
10)	Legal Entity Identifier (LEI) of the payment institution/e-money institution (where available)
11)	Home Member State authorisation number of the payment institution/e-money institution (where applicable)
12)	Contact person within the payment institution/e-money institution
13)	Email of the contact person within the payment institution/e-money institution
14)	Telephone number of the contact person within the payment institution/e-money institution
15)	Branch address
16)	Identity of persons responsible for the management of the branch
17)	Email of the persons responsible for the management of the branch
18)	Telephone number of the persons responsible for the management of the branch
19)	Payment services to be provided	1. ☐ Services enabling cash to be placed on a payment account as well as all the operations required for operating a payment account 2. ☐ Services enabling cash withdrawals from a payment account as well as all the operations required for operating a payment account 3. Execution of payment transactions, including transfers of funds on a payment account with the user's payment provider or with another payment service provider: a) execution of direct debits, including one-off direct debits ☐ b) execution of payment transactions through a payment card or a similar device ☐ c) execution of credit transfers, including standing orders ☐ 4. Execution of payment transactions where the funds are covered by a credit line for a payment service user: a) execution of direct debits, including one-off direct debits ☐ b) execution of payment transactions through a payment card or a similar device ☐ c) execution of credit transfers, including standing orders ☐ Including granting of credit in accordance with Article 18(4) of Directive (EU) 2015/2366: ☐ yes ☐ no 5. ☐ Issuing of payment instruments ☐ Acquiring of payment transactions Including granting of credit in accordance with Article 18(4) of Directive (EU) 2015/2366: ☐ yes ☐ no 6. ☐ Money remittance 7. ☐ Payment initiation services 8. ☐ Account information services
20)	Electronic money services to be provided (applicable only to e-money institutions)	☐ Issuing of electronic money ☐ Distribution and/or Redemption of electronic money
21)	Description of the organisational structure of the branch
22)	Business plan, which demonstrates that the branch is able to employ the appropriate and proportionate systems, resources and procedures to operate soundly in the host Member State, comprising: a. main objectives and business strategy of the branch and an explanation of how the branch will contribute to the strategy of the institution and, where applicable, of its group; b. a forecast budget calculation for the first three complete financial years.
23)	Governance arrangements and internal control mechanisms, comprising the following items: a. description of the governance structure of the branch, including functional and legal reporting lines and the position and role of the branch within the corporate structure of the institution and, where applicable, of its group; b. description of internal control mechanisms of the branch, including the following items: i. internal risk control procedures of the branch, the link with the internal risk control procedure of the payment institution/e-money institution, and where applicable, of its group; ii. details of the internal audit arrangements of the branch; iii. details of the anti-money laundering procedures to be adopted by the branch in the host Member State, under Directive (EU) 2015/849.
24)	In case of outsourcing of operational functions of payment/e-money services: a. Name and address of the entity to which operational functions are to be outsourced; b. Contact details (email and telephone number) of a contact person within the entity to which operational functions are to be outsourced; c. Type and exhaustive description of the operational functions outsourced.