ANNEX III
Template for informing of potential risks
| 
                         Potential Risks  | 
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| 
                         Identification of the reporting competent authority  | 
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| 
                         
  | 
                     
                         C0010  | 
                  |
| 
                         Name of the competent authority  | 
                     
                         R0010  | 
                     
                         
  | 
                  
| 
                         Reporting timestamp  | 
                     
                         R0020  | 
                     
                         
  | 
                  
| 
                         Reporting period  | 
                     
                         R0030  | 
                     
                         
  | 
                  
| 
                         Name of the main liaison  | 
                     
                         R0040  | 
                     
                         
  | 
                  
| 
                         Function of the main liaison  | 
                     
                         R0050  | 
                     
                         
  | 
                  
| 
                         Phone number of the main liaison  | 
                     
                         R0060  | 
                     
                         
  | 
                  
| 
                         Email address of the main liaison  | 
                     
                         R0070  | 
                     
                         
  | 
                  
| 
                         Identification of any potential risks resulting from the internalised settlement activity in the jurisdiction  | 
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| 
                         Identification of any potential risks resulting from the internalised settlement activity in the jurisdiction  | 
                     
                         R0080  | 
                     
                         
  |