1.1.  Contact persons for the purposes of the application (Article 1, points (a) and (b), of Delegated Regulation (EU) 2022/2580

Details of person to contact regarding the application

Title

Full name

Position

Telephone number

Mobile number

Facsimile (if available)

Email

Principal professional adviser involved in the preparation of the application (if any)

Title

Full name

Position

Telephone number

Mobile number

Facsimile (if available)

Email

1.2.  Identification of the applicant credit institution (Article 1, points (c) to (k), of Delegated Regulation (EU) 2022/2580)

Name of the applicant credit institution and any other trading name used or to be used by the applicant credit institution

Proposed plans (if any) to change the name of the applicant credit institution and an explanation of the proposed changes

Logo

Legal form of the applicant credit institution

Date of incorporation or formation

Jurisdiction of incorporation or formation

Address of the applicant credit institution’s registered office and, if different, its head office, and principal place of business

Contact details for the applicant credit institution if different from the details provided under Section 1.1 of this table: telephone, mobile number, facsimile (if available), and email

Where the applicant credit institution is registered in a central register, commercial register, companies register or similar public register, the name of that register and the registration number of the applicant credit institution or an equivalent means of identification in that register

The Legal Entity Identifier (LEI), if any, of the applicant credit institution

The date of the accounting year-end for the applicant credit institution

The website address, if any, of the applicant credit institution

1.3.  Constitutional documents (Article 1, point (l), of Delegated Regulation (EU) 2022/2580)

Annex under which is provided a copy of the articles of association of the applicant credit institution or equivalent constitutional documents and, where applicable, evidence of registration with the register designated by the law of the Member State concerned in accordance with Article 16 of Directive (EU) 2017/1132 of the European Parliament and of the Council (1)

1.4.  History of the applicant credit institution and its subsidiaries (Article 2, points (a) to (c), of Delegated Regulation (EU) 2022/2580)

Confirmation of whether the applicant credit institution has previously carried out commercial or other activities (yes/no) (if yes, complete the remaining fields in Section 1.4 of this table)

Details of licences, authorisations, registrations or other permissions of the applicant credit institution or of any of its subsidiaries to carry out activities in the financial services sector granted by a public authority or other entity performing public functions in any Member State or third country falling within the categories set out in Article 2, point (a)(i) to (iv), of Delegated Regulation (EU) 2022/2580

Details about any significant events relating to the applicant credit institution or to any of its subsidiaries which have taken place or are taking place which may be reasonably considered to be relevant for the authorisation, including any of the matters set out in Article 2, point (b), of Delegated Regulation (EU) 2022/2580

Information on any events set out in the declaration including the name and address of the relevant criminal or civil court, or civil or administrative authority, the date of the event, the amount involved, the outcome of the proceedings and an explanation of the circumstances of the event triggering the proceedings

1.5.  Applicable fees (Article 2, points (d) and (e), of Delegated Regulation (EU) 2022/2580

Elements necessary to calculate any applicable fees where, pursuant to Union or national law, any application fee or supervisory fee that is to be paid by the applicant credit institution is calculated on the basis of the activities or the characteristics of the applicant credit institution

Annex under which can be found evidence of the payment of any application fee, where applicable pursuant to Union or national law

Activities (Article 3 of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the programme of activities, including (a) the list of the activities that the applicant credit institution intends to carry out, including the activities listed in Annex I to Directive 2013/36/EU, and (b) the description of how the programme of operations aligns with the proposed activities

3.1.  Forecast information (Article 4, point (a), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found forecast information on the applicant credit institution at an individual level and, where applicable, at consolidated group and sub-consolidated levels as required by Article 4, point (a), of Delegated Regulation (EU) 2022/2580

3.2.  Statutory financial statements (Article 4, point (b), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the statutory financial statements of the applicant credit institution at an individual level and, where applicable, at a consolidated group and sub-consolidated levels as required by Article 4, point (b), of Delegated Regulation (EU) 2022/2580

3.3.  Indebtedness (Article 4, point (c), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the outline of any indebtedness incurred or expected to be incurred by the applicant credit institution prior to the commencement of its activities as a credit institution as required by Article 4, point (c), of Delegated Regulation (EU) 2022/2580

3.4.  Security interests, guarantees and indemnities (Article 4, point (d), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the outline of any security interests, guarantees or indemnities granted or expected to be granted by the applicant credit institution prior to the commencement of its activities as a credit institution

3.5.  Credit rating (Article 4, point (e), of Delegated Regulation (EU) 2022/2580)

Where available, the credit rating of the applicant credit institution and the overall rating of its group

3.6.  Consolidated supervision (Article 4, point (f), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found, where applicable, the analysis of the scope of consolidated supervision pursuant to the consolidation requirements as required by Article 4, point (f), of Delegated Regulation (EU) 2022/2580

3.7.  Frameworks and policies (Article 4, point (g)(i) to (x), of Delegated Regulation (EU) 2022/2580)

Outline of the risk management framework as required by Article 4, point (g), of Delegated Regulation (EU) 2022/2580

Outline of the liquidity risk management policy

Outline of the funding concentration and diversification policy

Outline of the collateral management policy

Outline of the deposit policy

Outline of the credit and lending policy

Outline of the concentration risk policy

Outline of the provisioning policy

Outline of the dividend distribution policy

Outline of the trading book policy

3.8.  Process for developing a recovery plan (Article 4, point (h), of Delegated Regulation (EU) 2022/2580)

Description of the applicant credit institution’s process for developing a recovery plan as defined in Article 2(1), point (32), of Directive 2014/59/EU of the European Parliament and of the Council (1), and, where applicable, a group recovery plan, as defined in Article 2(1), point (33), of that Directive

3.9  eposit guarantee scheme (Article 4, point (i), of Delegated Regulation (EU) 2022/2580)

A statement or confirmation that, before or at the latest on the date of authorisation, the applicant credit institution shall become a member of a deposit guarantee scheme officially recognised in the Member State where the application is submitted, as required by Article 4(3) of Directive 2014/49/EU

Name of the deposit guarantee scheme

3.10.  Institutional protection scheme (Article 4, point (j), of Delegated Regulation (EU) 2022/2580)

Name of any institutional protection scheme, as defined in Regulation (EU) No 575/2013 of the European Parliament and of the Council (2), that the applicant credit institution has entered into or proposes to enter into

4.1.  Programme of operations (Article 5(1), point (a), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the programme of operations as required by Article 5(1), point (a), of Delegated Regulation (EU) 2022/2580

4.2.  Organisation, structure and governance arrangements (Article 5(1), point (b), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the description of the organisation, structure and governance arrangements of the applicant credit institution as required by Article 5(1), point (b), of Delegated Regulation (EU) 2022/2580

4.3.  Internal control framework (Article 5(1), point (c), of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the overview of the internal organisation (including devoted budgetary and human resources) of the compliance function, risk management function and internal audit function as required by Article 5(1), point (c)(i), of Delegated Regulation (EU) 2022/2580

Outline of the whistleblowing policy

Outline of the conflicts of interest policy

Outline of the complaints handling policy

Outline of the market abuse policy

Outline of the policy promoting diversity in the management body

Outline of the remuneration policy for staff members whose professional activities have a material impact on the applicant credit institution’s risk profile

Outline of the systems and policies for assessing and managing the risks of money laundering and terrorist financing, including an overview of the key procedures that have been put in place to counter the risk that the applicant credit institution might be used to further financial crime

4.4.  Internal audit resources (Article 5(1), point (d) of Delegated Regulation (EU) 2022/2580)

Description of the internal audit resources and an outline of the methodology and internal audit plan for the next three years from authorisation, including the audit of externalised services

4.5.  Policies and plans (Article 5(1), point (e) of Delegated Regulation (EU) 2022/2580)

Outline of the internal audit policy

Outline of the product governance policy

Outline of the consumer protection policy

Outline of the business continuity plan and policy, including an overview of available back-up and recovery systems and of plans ensuring the availability of key staff in business continuity situations

4.6.  Structure of the applicant credit institution (Article 5(1), point (f) of Delegated Regulation (EU) 2022/2580)

Outline of external and intra-group outsourcing to support the applicant credit institution’s operations or internal control activities, including the information referred to in Article 5(1), point (f)(i), of Delegated Regulation (EU) 2022/2580

Outline of oversight responsibilities and arrangements, systems and controls for each outsourced function that is critical or important to the applicant credit institution’s management and operations

Outline of the service level agreements and arrangements for each outsourcing function that is critical or important to the applicant credit institution’s management and operations

Description of the applicant credit institution’s IT infrastructure, including the systems in use or to be used, its hosting arrangements, the organisation of its IT function, IT structure, IT strategy and IT governance, IT security policies and procedures, and any systems and controls in place or to be put in place for the provision of online banking facilities

4.7.  Statutory auditors or audit firm (Article 5(2) of Delegated Regulation (EU) 2022/2580)

Name

Address

Point of contact (name, telephone number, email address)

5.1.  Initial capital and own funds (Article 6(1) and (2) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found evidence of the applicant credit institution’s issued capital, paid-up capital and capital which is not yet paid-up

Description of the types and amounts of own funds that correspond to the initial capital

Where the initial capital has not been paid up in full at the time of submitting the application, the description of the plan and implementation deadline for ensuring that the initial capital is paid-up in full before the authorisation to commence the activity as a credit institution is effective

5.2.  Available funding sources for own funds (Article 6(3) of Delegated Regulation (EU) 2022/2580)

Explanation of the available funding sources for own funds and annex under which can be found evidence of the availability of those funding sources as required by Article 6(3) of Delegated Regulation (EU) 2022/2580

5.3.  Amounts, types and distribution of internal capital (Article 6(4) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the assessment of the amounts, types and distribution of internal capital considered by the applicant credit institution as adequate to cover the nature and level of the risks to which the applicant credit institution will or might be exposed, and the analysis as required by Article 6(4) of Delegated Regulation (EU) 2022/2580

6.1.  Members of the management body (complete a separate copy of this section of the table for each individual) (Article 7(1) of Delegated Regulation (EU) 2022/2580)

Name and, where different, any other previous names

Gender

Place of birth

Date of birth

Address

Telephone number

Mobile

Email address

Nationality

Personal identification number or annex under which a copy of the ID card or equivalent can be found

Details of the position held or to be held by the person, including whether the position is executive or non-executive, the start date or planned start date and duration of mandate, and a description of the person’s key duties and responsibilities

Annex under which can be found a curriculum vitae required by point 1(d) of Annex I to Delegated Regulation (EU) 2022/2580

Annex under which can be found a list of reference persons including contact information, preferably from employers in the banking or financial services sector, including full name, institution, position, telephone number, email, nature of the professional relationship and information if any non-professional relationship exists or existed with this individual

Annex under which can be found criminal records and relevant information on criminal investigations and proceedings, relevant civil and administrative cases, and disciplinary actions (including disqualification as a company director, bankruptcy, insolvency and similar procedures) notably through an official certificate or, in cases where such a certificate does not exist, any reliable source of information concerning the absence of criminal conviction, investigations and proceedings

Annex under which can be found a statement of whether criminal proceedings are pending or the person or any organisation managed by him or her has been involved as a debtor in insolvency proceedings or a comparable proceeding

Annex under which can be found information on matters set out in point 1(f)(iii), of Annex I to Delegated Regulation (EU) 2022/2580

Annex under which can be found a description of all financial and non-financial interests that could create potential conflicts of interest as required by point 1(g), of Annex I to Delegated Regulation (EU) 2022/2580

Annex under which details can be found to show that the individual has sufficient time to commit to the mandate as required by point 1(h), of Annex I to Delegated Regulation (EU) 2022/2580

Details of the result of any assessment of the suitability of the individual performed by the applicant credit institution as described in point 3 of Annex I to Commission Delegated Regulation (EU) 2022/2580

6.2.  Other information required in relation to members of the management body (Article 7(1) of, and points 2, 4 and 5 of Annex I to, Delegated Regulation (EU) 2022/2580)

Description of any committee of the management body that is planned at the time of the application, including its members and powers

Statement regarding the applicant credit institution’s overall assessment of the collective suitability of the management body, including relevant board minutes or suitability assessment report or documents

Description of how the diversity of qualities and competences was taken into account when selecting the members of the management body

6.3.  Heads of internal control function and chief financial officer who are not members of the management body (complete a separate copy of this section of the table for each individual) (Article 7(2) of Delegated Regulation (EU) 2022/2580)

Name and, where different, any other previous names

Gender

Place of birth

Date of birth

Address

Telephone number

Mobile

Email address

Nationality

Personal identification number or annex under which a copy of the ID card or equivalent can be found

Details of the position held or to be held by the person, including whether the position is executive or non-executive, the start date or planned start date and duration of mandate, and a description of the person’s key duties and responsibilities

Annex under which can be found a curriculum vitae as required by point 1(d), of Annex I to Delegated Regulation (EU) 2022/2580

Annex under which can be found a list of reference persons including contact information, preferably from employers in the banking or financial services sector, including full name, institution, position, telephone number, email, nature of the professional relationship and information if any non-professional relationship exists or existed with this individual

Annex under which can be found criminal records and relevant information on criminal investigations and proceedings, relevant civil and administrative cases, and disciplinary actions (including disqualification as a company director, bankruptcy, insolvency and similar procedures) notably through an official certificate or, in cases where such a certificate does not exist, any reliable source of information concerning the absence of criminal conviction, investigations and proceedings

Annex under which can be found a statement of whether criminal proceedings are pending or the person or any organisation managed by him or her has been involved as a debtor in insolvency proceedings or a comparable proceeding

Annex under which can be found information on matters set out in point 1(f)(iii), of Annex I to Delegated Regulation (EU) 2022/2580

Details of the result of any assessment of the suitability of the individual performed by the applicant credit institution as described in point 3 of Annex I to Delegated Regulation (EU) 2022/2580

6.4.  Powers, responsibilities and proxies conferred upon members of the applicant credit institution’s management body (Article 7(3) of Delegated Regulation (EU) 2022/2580)

Description of the powers, responsibilities and proxies conferred upon the members of the applicant credit institution’s management body and, where relevant in accordance with Article 7(2) of Delegated Regulation (EU) 2022/2580, conferred upon the heads of internal control functions and the chief financial officer who are not part of the management body

7.1.  Shareholders and members (legal and natural persons) (Article 8(1) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found in relation to each natural and legal person with a qualifying holding the information referred to in Article 8(1) of Delegated Regulation (EU) 2022/2580

7.2.  Further information in relation to natural persons (Article 8(2) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found in relation to each natural person with a qualifying holding the additional information referred to in Article 8(2) of Delegated Regulation (EU) 2022/2580

7.3.  Further information in relation to legal persons or entities which are not legal persons and which hold or will hold participations in their own name (Article 8(3) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found in relation to each legal person or entity which is not a legal person and which holds or shall hold participations in its own name the additional information referred to in Article 8(3) of Delegated Regulation (EU) 2022/2580

7.4.  Trusts (Article 8(4) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the information referred to in Article 8(4) of Delegated Regulation (EU) 2022/2580

7.5.  Members of an entity that is not a legal person where the holding in the applicant credit institution will be treated as an asset of the entity (Article 8(5) of Delegated Regulation (EU) 2022/2580)

Annex under which can be found the information referred to in Article 8(5) of Delegated Regulation (EU) 2022/2580

8.1.  Shareholder structure (Article 9 of Delegated Regulation (EU) 2022/2580)

Annex under which can be found a chart setting out the shareholder structure of the applicant credit institution, including the breakdown of the capital and voting rights

8.2.  List of names of all persons and other entities with a shareholding and other relevant details (Article 9 of Delegated Regulation (EU) 2022/2580)

Annex under which can be found a list of the names of all persons and other entities with a shareholding of a kind described in Article 9 of Delegated Regulation (EU) 2022/2580indicating in respect of each such person or entity:

Information required by the competent authority in accordance with Article 10(1) of Delegated Regulation (EU) 2022/2580 (complete as applicable presenting in the left column a description of the information required and in the right column the information)

10.1.  Information omitted in accordance with Article 11, point (a), of Delegated Regulation (EU) 2022/2580(complete with a list of the information as applicable)

10.2.  Information omitted in accordance with Article 11, point (b), of Delegated Regulation (EU) 2022/2580 (complete with a list of the information as applicable)