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Implementing Regulation (EU) 2017/1110 · superseded — not in force · OJ L 162, 23.6.2017 · dated 22 Jun 2017 [no longer in force]","attribution":{"prepared_by":"European Commission","published_by":"Publications Office of the EU","published_in":"Official Journal of the European Union","document_type":"implementing_regulation","legal_nature":"binding_adopted","addressees":"not stated in the document","dates":{"document_date":"2017-06-22","entry_into_force":"2017-07-13","locators":{"document_date":"CELLAR 32017R1110 work_date_document","entry_into_force":"CELLAR 32017R1110 resource_legal_date_entry-into-force (earliest)"}},"adoption":null},"context":{"act":{"work_id":"spaces/mifid-ii/level-2/its/2017-1110-the-standard-forms-templates-and-procedures-for-the","path":"/mifid-ii/level-2/its/2017-1110-the-standard-forms-templates-and-procedures-for-the","name":"Commission Implementing Regulation (EU) 2017/1110","number":"2017/1110","celex":"32017R1110","title_official":"COMMISSION IMPLEMENTING REGULATION (EU) 2017/1110 of 22 June 2017 laying down implementing technical standards with regard to the standard forms, templates and procedures for the authorisation of data reporting services providers and related notifications pursuant to Directive 2014/65/EU of the European Parliament and of the Council on markets in financial instruments (Text with EEA relevance)","document_date":"2017-06-22"},"position":{"kind":"annex","key":"annex-iii","index":3,"articles":7,"annexes":3},"prev":{"path":"/mifid-ii/level-2/its/2017-1110-the-standard-forms-templates-and-procedures-for-the/annexes/annex-ii","key":"annex-ii","title":"ANNEX II"},"next":null,"act_anchor":"#annex-iii"}},"provenance":{"official_url":"https://eur-lex.europa.eu/eli/reg_impl/2017/1110/oj/eng","check":{"result":"matched","checked_at":"2026-10-26","against":"EUR-Lex"},"repo_path":"spaces/mifid-ii/level-2/its/2017-1110-the-standard-forms-templates-and-procedures-for-the.md","unit_text_sha256":"4ce79bb4be2df656a0a65656885eaa623bbcaab55be9e6659ace99f1ba025b8c","note":"the unit is a byte-exact part of the act page, whose check record covers it"},"unit":{"locator":"spaces/mifid-ii/level-2/its/2017-1110-the-standard-forms-templates-and-procedures-for-the/annex-iii","kind":"annex","key":"annex-iii","heading":"ANNEX III","text":"## ANNEX III\n\n<a id=\"annex-iii\"></a>Application form for changes to the membership of the management body\n\n![Figure printed as an image in the official text — Annex III](../../.gitbook/assets/mifid-ii-l2-32017R1110-image-6.jpg)\n\nReference number:\nDate:\nFrom:\nName of the data reporting services provider:\nAddress:\nLegal Entity Identifier (where applicable):\n(Contact details of the designated contact person at the data reporting services provider)\nFull name:\nTelephone:\nEmail:\nTo:\nMember State:\nCompetent Authority:\nAddress:\n(Contact details of the designated contact point at the competent authority)\nAddress:\nTelephone:\nEmail:\nDear [insert appropriate name]\nIn accordance with Article 4 of the Commission Implementing Regulation (EU) 2017/1110 (1) please find attached the notification on changes to the membership of the management body.\n— Person at the data reporting services provider in charge of preparing the notification:\nFull Name:\nStatus/position:\nTelephone:\nEmail:\nDate:\nSigned:\n\n![Figure printed as an image in the official text — Annex III](../../.gitbook/assets/mifid-ii-l2-32017R1110-image-7.jpg)\n\n— Information on member(s) leaving the management body\nMember 1\nFull name\nContact details (Telephone and email address)\nPosition\nEffective date of departure from management body\nReasons for the departure from management body\nMember [N]\nFull name\nContact details (Telephone and email address)\nPosition\nEffective date of departure from management body\nReasons for the departure from management body\n— Information on new member(s) of the management body\nMember 1\nFull name\nDate and place of birth\nPersonal national identification number or equivalent thereof\nPrivate address:\nContact details (telephone and email address)\nPosition\nCurriculum vitae attached to application: Yes/No\nProfessional experience and other relevant experience\nEducational qualification and relevant training\nCriminal records attached to this application OR self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(d) of Commission Delegated Regulation (EU) 2017/571 (2)\nSelf-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(e) of Delegated Regulation (EU) 2017/571 (2)\nMinimum time (approximate) that will be devoted to the performance of the person’s functions within the data reporting services provider\nDeclaration of any potential conflicts of interest that may exist or arise in performing the duties and how these conflicts are managed\nAdditional information relevant for the assessment that the member is of sufficiently good repute, possesses sufficient knowledge, skills and experience and commits sufficient time to perform the duties referred to in Article 63(3) of Directive 2014/65/EU of the European Parliament and of the Council (3)\nEffective date\n[Please set out that information here or provide an explanation of how it will be provided, or make reference to the relevant annexes containing the information]\n\n![Figure printed as an image in the official text — Annex III](../../.gitbook/assets/mifid-ii-l2-32017R1110-image-8.jpg)\n\nMember [N]\nFull name\nDate and place of birth\nPersonal national identification number or equivalent thereof\nPrivate address:\nPosition\nCurriculum vitae attached to application: Yes/No\nProfessional experience and other relevant experience\nEducational qualification and relevant training\nCriminal records attached to this application OR self-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(d) of Delegated Regulation (EU) 2017/571\nSelf-declaration of good repute and authorisation to the competent authority to make enquiries under Article 4(e) of Delegated Regulation (EU) 2017/571\nMinimum time (approximate) that will be devoted to the performance of the person’s functions within the data reporting services provider\nDeclaration of any potential conflicts of interest that may exist or arise in performing the duties and how these conflicts are managed\nAdditional information relevant for the assessment that the member is of sufficiently good repute, possesses sufficient knowledge, skills and experience and commits sufficient time to perform the duties referred to in Article 63(3) of Directive 2014/65/EU.\nEffective date\n[Please set out that information here or provide an explanation of how it will be provided, or make reference to the relevant annexes containing the information]\n— Complete updated list of members of the management body:\nNotes:\n(1) Commission Implementing Regulation (EU) 2017/1110 of 22 June 2017 laying down implementing technical standards with regard to standard forms, templates and procedures for the authorisation of data reporting services providers and related notifications pursuant to Directive 2014/65/EU of the European Parliament and of the Council on markets in financial instruments (OJ L 162, 23.6.2017, p. 3).\n(2) Commission Delegated Regulation (EU) 2017/571 of 2 June 2016 supplementing Directive 2014/65/EU of the European Parliament and of the Council with regard to regulatory technical standards on the authorisation, organisational requirements and the publication of transactions for data reporting services providers (OJ L 187, 31.3.2017, p. 126).\n(3) Directive 2014/65/EU of the European Parliament and of the Council of 15 May 2014 on markets in financial instruments and amending Directive 2002/92/EC and Directive 2011/61/EU (OJ L 173, 12.6.2014, p. 349).\nName\nPosition\nEffective date\n\n","marks":[],"text_hash":"4ce79bb4be2df656a0a65656885eaa623bbcaab55be9e6659ace99f1ba025b8c","revision":1}}