ANNEX IV

Notification of an infringement or suspected infringement

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, please find below information on [an infringement/a suspected infringement].

[Please provide all indispensable information on the infringement/suspected infringement, which must include the type of infringement and any action taken by your competent authority, including any precautionary measures or penalties]

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[Please provide any other information on the infringement/suspected infringement that could be of interest and benefit to the notified competent authority]

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[Please add any further comments on the confidentiality and potential use of the information provided]

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Yours sincerely,

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