Reference number:

Date:

FROM:

Member State:

Requesting competent authority:

Address:

(Contact point details)

Name:

Telephone:

Email:

TO:

Member State:

Recipient:

Address:

(Contact point details)

Name:

Telephone:

Email:

Dear [insert appropriate name]

Following your request [insert reference to request], we hereby notify you that we refuse to act thereon due to exceptional circumstances in accordance with Article 31(2) of Regulation (EU) 2020/1503 of the European Parliament and of the Council (1).

We relied upon the following exceptional circumstance for this refusal to act on your request

…

[Insert description of the relevant circumstance in accordance with of Article 31(2), points (a), (b) and (c), of Regulation (EU) 2020/1503].

Our decision to refuse to act on your request relied upon the following reason(s)

…

…

[Insert full reasons for the recipient’s refusal to act on the requesting competent authority’s request for cooperation or request for information, having regard to the exceptional circumstance on which the refusal is based]

Any personal data provided shall be processed by ESMA in accordance with Regulation (EU) 2018/1725 of the European Parliament and of the Council and by the relevant competent authorities in accordance with Regulation (EU) 2016/679 of the European Parliament and of the Council. In particular, both ESMA and the relevant competent authorities shall ensure that all relevant information on the processing of personal data is provided to data subjects in accordance with Section 2 ‘Information and access to personal data’ of CHAPTER III ‘Rights of the data subject’ of these Regulations.

Yours sincerely,

[signature]