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In this act Annex III of 5

ANNEX III

Financial servicesLevel 2ITSMiCAIn forceOfficial source

REPORTING FOR CRYPTO-ASSET SERVICE PROVIDERS

CRYPTO-ASSET SERVICE PROVIDER TEMPLATES
Template numberTemplate codeAdresseesName of the template /group of templates
INFORMATION ON HOLDERS
6S 06.00Crypto-asset service providersINFORMATION ON HOLDERS
INFORMATION ON TRANSACTIONS
7S 07.01Crypto-asset service providersTRANSACTIONS DURING REPORTING PERIOD - TOTAL
7S 07.02Crypto-asset service providersTRANSACTIONS DURING REPORTING PERIOD - TOTAL_EU
7S 07.03Crypto-asset service providersTRANSACTIONS THAT ARE ASSOCIATED TO ITS USES AS A MEANS OF EXCHANGE WITHIN A SINGLE CURRENCY AREA - TOTAL
7S 07.04Crypto-asset service providersDISTRIBUTED LEDGER ADDRESSES FOR MAKING TRANSFERS ON BEHALF OF CLIENTS
INFORMATION ON TOKEN
8S 08.00Crypto-asset service providersTOKEN HELD BY CASP
S 06.00 - INFORMATION ON HOLDERS
Holders - at reference date
NameCodeType of codeRetail/Non-retailCountry
00100020003000400050
S 07.01 - TRANSACTIONS DURING REPORTING PERIOD - TOTAL
Country:
NumberAmount
00100020
Transactions during reporting period - total0010
of which made within the country0020
of which received transaction to the country0030
of which sent transaction from the country0040
S 07.02 - TRANSACTIONS DURING REPORTING PERIOD - TOTAL_EU
NumberAmount
00100020
Transactions during reporting period - total0010
of which made within the EU0020
of which received transaction to the EU0030
of which sent transaction from the EU0040
S 07.03 - TRANSACTIONS THAT ARE ASSOCIATED TO ITS USES AS A MEANS OF EXCHANGE WITHIN A SINGLE CURRENCY AREA - TOTAL
Single currency area:
NumberAmount
00100020
Transactions during reporting period - total0010
S 07.04 - DISTRIBUTED LEDGER ADDRESSES FOR MAKING TRANSFERS ON BEHALF OF CLIENTS
Distributed ledger address
0010
S 08.00 - TOKEN HELD BY CASP
NumberAmount
00100020
Token held by CASP0010
of which held via EU clients of the CASP0020