ANNEX II

Form for submitting aggregated information on all sanctions and measures imposed by competent authorities

Aggregated information on all sanctions and measures imposed by [name of the competent authority] in [year] under Article … of … FROM: Member State: Competent authority: Address: (Contact details of the designated contact person) Name: Telephone: Email: TO: ESMA (Contact details of the designated contact person) Name: Telephone: Email: Dear [insert appropriate name] In accordance with the first subparagraph of Article 71(4) of Directive 2014/65/EU I wish to provide you with aggregated information regarding all sanctions and measures imposed by [name of the competent authority] in [year]:

(1) Please insert value in euro or in national currency. If the relevant sanction refers not only to breaches relating to the relevant article of Directive 2014/65/EU or of Regulation (EU) No 600/2014, but also to other provisions, add the mention ‘AGGREGATED FIGURE’ to each value. (2) As sanctions/measures imposed may be based on more than one legislative provision, the sum of the different lines (number of sanctions or measures/value of fines) may not correspond to the total number of sanctions/measures or to the total value of fines imposed. Yours sincerely, [signature] Articles of Directive 2014/65/EU transposed by the national provisions, or of Regulation (EU) No 600/2014 of the European Parliament and of the Council (1), which were infringed Number of sanctions/measures imposed in the reporting period Value of administrative fines imposed in the reporting period [number of the article, paragraph, subparagraph] [number of sanctions/measures] [value of fines (1)] Total sanctions/measures [total number of sanctions/measures (2)] [total value of fines (1) (2)] (1) Regulation (EU) No 600/2014 of the European Parliament and of the Council of 15 May 2014 on markets in financial instruments and amending Regulation (EU) No 648/2012 (OJ L 173, 12.6.2014, p. 84).