Reference number (to be completed by the competent authority):

Date:

FROM

Name of the notifying entity:

National reference number:

Address of the notifying entity:

Contact details of designated contact person:

Name:

Telephone:

Email:

TO

Member State (if applicable):

Competent authority:

Address:

Contact details of the designated contact point:

Name:

Telephone:

Email:

[We,] [notifying entity,] declare that the submitted information is accurate, complete and up-to-date. If some information relates only to a future date, it is explicitly identified in the notification and we undertake to notify the authority in writing without delay if any such information should turn out to be inaccurate, incomplete or misleading. Further, we undertake to inform the competent authority of any change concerning the information provided in this form.

Name:

Status/position:

Telephone:

Email:

REQUIRED INFORMATION

Programme of operations

…

Please insert the information referred to in Article 1 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Business continuity

…

Please insert the information referred to in Article 2 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Detection and prevention of money laundering and terrorist financing

…

Please insert the information referred to in Article 3 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

ICT systems and related security arrangements

…

Please insert the information referred to in Article 4 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Segregation of clients’ crypto-assets and funds

…

Please insert the information referred to in Article 5 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Custody and administration policy

…

Please insert the information referred to in Article 6 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Operating rules of the trading platform and market abuse detection

…

Please insert the information referred to in Article 7 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Exchange of crypto-assets for funds or other crypto-assets

…

Please insert the information referred to in Article 8 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Execution policy

…

Please insert the information referred to in Article 9 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Provision of advice or portfolio management on crypto-assets

…

Please insert the information referred to in Article 10 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

Transfer services

…

Please insert the information referred to in Article 11 of Delegated Regulation (EU) 2025/303, by setting out that information here or making reference to the relevant sections of the notification.

[signature of legal representative]