(a)

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 form in Annex V;

(b)

the identity and contact details of the person responsible for the submission of the report;

(c)

the type of payment services and electronic money services provided, where applicable;

(d)

the number of places of business regarded as a single branch as defined in Article 4(39) of Directive (EU) 2015/2366, their addresses and the number of employees;

(e)

the number of agents enrolled within the reporting period and the total number of agents, broken down into number under the freedom to provide services and number under the right of establishment;

(f)

if applicable, the number of electronic money distributors enrolled within the reporting period and the total number of distributors, broken down into number under freedom to provide services and number under the right of establishment;

(g)

the names and addresses of the ten largest agents, and the ten largest distributors, if applicable, in the host Member State by transaction volumes;

(h)

the total volume of transactions carried out by the payment institution within the reporting period, broken down by type of payment service, distribution channel (branch, online, mobile, automated teller machine, telephone, etc.) and agent/branch (the volume of transactions coming in and out of the host Member State must also be specified);

(i)

the total value of transactions carried out by the payment institution within the reporting period, broken down by:

(j)

for electronic money institutions, the value of the electronic money distributed and redeemed in the host Member State;

(k)

the number of payment accounts, including accounts where electronic money is stored, opened or accessed in the host Member State within the reporting period, and the total number of payment accounts operated or maintained in the host Member State;

(l)

the number of card-based payment instruments issued in the host Member State within the reporting period, broken down by type of card-based payment instrument and stating the outstanding number of card-based payment instruments issued in the host Member State;

(m)

the number of automatic teller machines operated/managed by the payment institution in the host Member State, if applicable, and cash withdrawals from payment accounts and cash placed on payment accounts through those automated teller machines operated/managed by the payment institution in the host Member State;

(n)

the number of customers (framework contracts) and payment service users (single payment transactions) in the host Member State registered within the reporting period and the total number at the end of the period;

(o)

the aggregated number of complaints concerning the rights and obligations under Titles III and IV of Directive (EU) 2015/2366 and security-related customer complaints received from payment service users in the host Member State within the reporting period;

(p)

the volume of fraudulent payment transactions and the value of gross fraudulent payment transactions incurred in the host Member State within the reporting period; and

(q)

the number of suspicious transaction reports sent to the financial intelligence unit in the host Member State.