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ANNEX IV - Statement on the authorisation of an AIFM under Article 32(3), second subparagraph, of Directive 2011/61/EU

ANNEX IV

Statement on the authorisation of an AIFM under Article 32(3), second subparagraph, of Directive 2011/61/EU

STATEMENT ESTABLISHED BY ______________________________________ (name of the competent authority of the AIFM home Member State)

Section 1.   Department responsible for the establishment of the statement within the competent authority of the AIFM home Member State

Department

 

Address of the NCA

 

Email address of the department establishing the statement

 

Section 2.   Identification of the authorised AIFM

AIFM

 

AIFM’s LEI

 

AIFM’s home Member State

 

Address and, where different from address, registered office/domicile

 

Section 3.   Scope of the authorisation of the AIFM

The authorisation of the AIFM is limited to the management of AIFs with the following investment strategy:

____________________________________________________________________________________________________

____________________________________________________________________________________________________

(The attestation shall be signed and dated by a representative of the competent authority of the AIFM home Member State. The signatory shall state his or her full name)

Date

 

Name and capacity of the signatory

 

Signature