(a)

the date of receipt of a complete and accurate passport application from the payment institution in accordance with Article 4;

(b)

the Member State in which the payment institution intends to operate by engaging an agent;

(c)

the type of the passport application;

(d)

the nature of the passport application and, where the use of the agent in the host Member State does not give rise to an establishment, a description of the circumstances taken into account by the competent authority in the home Member State in its assessment;

(e)

the name, the address and, where applicable, the authorisation number and the unique identification number of the payment institution in the home Member State in accordance with the formats set out in Annex I;

(f)

where available, the Legal Entity Identifier of the payment institution;

(g)

the identity and contact details of a contact person within the payment institution submitting the agent passport notification;

(h)

the identity and contact details of the agent engaged by the payment institution;

(i)

the unique identification number of the agent in the Member State where it is located, where applicable, in accordance with the formats provided in Annex I;

(j)

where applicable, the identity and contact details of the persons responsible for the central contact point, where this has been appointed in accordance with Article 29(4) of Directive (EU) 2015/2366;

(k)

the payment services to be provided in the host Member State by engaging the agent;

(l)

a description of the internal control mechanisms that will be applied by the agent in order to comply with requirements on anti-money laundering and terrorist financing under Directive (EU) 2015/849;

(m)

the identity and contact details of directors and persons responsible for the management of the agent to be used in the provision of payment services and, for agents other than payment service providers, evidence that they are fit and proper persons.