Reference number:

Date:

From:

Name of the applicant:

Address:

Legal Entity Identifier(where applicable):

(Contact details of the designated contact person at the applicant)

Full Name:

Telephone:

Email:

To:

Member State:

Competent authority:

Address:

(Contact details of the designated contact point at the competent authority)

Address:

Telephone:

Email:

Dear [insert appropriate name]

In accordance with Article 2 of Commission Implementing Regulation (EU) 2017/1110 (1) please find attached the authorisation application.

— Person at the applicant in charge of preparing the application:

Full Name:

Status/position:

Telephone:

Email:

Date:

Signature:

— Nature of the application (tick the relevant box(es)):

Authorisation – Approved Publication Arrangement (APA)

Authorisation – Consolidated Tape Provider (CTP)

Authorisation – Approved Reporting Mechanism (ARM)

Content

Please insert the information referred to under Commission Delegated Regulation (EU) 2017/571 (2). Please set out that information under the appropriate section or make reference to the relevant annexes containing the information.

Information on the organisation (Article 2 of Delegated Regulation (EU) 2017/571)

Information on corporate governance (Article 3 of Delegated Regulation (EU) 2017/571)

Information on conflicts of interest (Article 5 of Delegated Regulation (EU) 2017/571)

Information on organisational requirements regarding outsourcing (Article 6 of Delegated Regulation (EU) 2017/571)

Information on business continuity and back-up facilities (Article 7 of Delegated Regulation (EU) 2017/571)

Information on testing and capacity (Article 8 of Delegated Regulation (EU) 2017/571)

Information on security (Article 9 of Delegated Regulation (EU) 2017/571)

Information on management of incomplete or potentially erroneous information by APAs and CTPs (Article 10 of Delegated Regulation (EU) 2017/571)

Information on management of incomplete or potentially erroneous information by ARMs (Article 11 of Delegated Regulation (EU) 2017/571)

Information on connectivity of ARMs (Article 12 of Delegated Regulation (EU) 2017/571)

Information on other services provided by CTPs (Article 13 of Delegated Regulation (EU) 2017/571)

Information on publication arrangements (Chapter 3 of Delegated Regulation (EU) 2017/571)

Notes:

(1) Commission Implementing Regulation (EU) 2017/1110 of 22 June 2017 laying down implementing technical standards with regard to standard forms, templates and procedures for the authorisation of data reporting services providers and related notifications pursuant to Directive 2014/65/EU of the European Parliament and of the Council on markets in financial instruments (OJ L 162, 23.6.2017, p. 3).

(2) Commission Delegated Regulation (EU) 2017/571 of 2 June 2016 supplementing Directive 2014/65/EU of the European Parliament and of the Council with regard to regulatory technical standards on the authorisation, organisational requirements and the publication of transactions for data reporting services providers (OJ L 87, 31.3.2017, p. 126).