ANNEX III

Notification of intention to carry out an on-site inspection in the host Member State

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, I intend to carry out an on-site inspection in your country, as detailed below.

Information on the payment institution to be inspected:

…

…

…

…

Information on the scope of and plan for the on-site inspection, if possible:

…

…

…

…

Planned dates of the on-site inspection:

…

…

Yours sincerely,

[signature]