ANNEX I

Request for cooperation or information exchange

Reference number: FROM:	Date: TO:
Member State:	Member State:
Competent authority:	Competent authority:
Address:	Address:
Name:	Name:
Telephone:	Telephone:
Email:	Email:

Dear [name],

Under Article 29 of Directive (EU) 2015/2366 on payment services in the internal market, we are seeking your input on the matter(s) detailed below.

I would be grateful to receive a response to this request by [insert indicative date for the reply] or, if that is not possible, for an indication of your estimated date of response.

Type of request

Please tick the appropriate box(es):

Provision of information	☐
On-site inspection	☐
Delegation of inspection	☐
Other – please provide details below	☐

Please provide the main reasons for the request:

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Please provide a detailed description of the information sought:

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Please provide any additional information that could be of interest and could help the authority concerned provide a swift reply:

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If the request is urgent, please explain why it is urgent and why the deadline is short:

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Please add any further comments on data confidentiality and how you expect to use the information provided:

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Yours sincerely,

[signature]