# ANNEX II **Commission Implementing Regulation (EU) 2017/2382 · binding · OJ L 340, 20.12.2017 · dated 14 Dec 2017 [in force]** *In force · Consolidated version of 7 September 2022 · Checked against EUR-Lex on 26 Oct 2026 · [Official source](https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:02017R2382-20220907)*  *The form’s text as printed in the original act (OJ L 340, 20.12.2017); the consolidated version prints the form only as an image, above.* Form for the communication regarding an investment services and activities passportnotification by the competent authority of the home Member State to the competent authorityof the host Member State (Article 5 of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Communication in accordance with Article 34(3) of Directive 2014/65/EU (1) FROM: Member State: Competent authority of the home Member State: Address: Designated contact point: Telephone number: Email: TO: Member State: Competent Authority of the host Member State: Address: Designated contact point: Telephone number: Email: In accordance with Article 34(3) of the Directive 2014/65/EU, we wish to inform you that [Name of firm], (1) an investment firm authorised by [name of the competent authority of the home Member State], intends to provide the investment services and/or investment activities as well as ancillary services listed in the attached passport notification for the first time in the exercise of the right of freedom to provide investment services or activities; or (2) a credit institution authorised by [name of the competent authority of the home Member State] intends to provide, through the use of a tied agent, the investment services or activities listed in the attached passport notification for the first time, in the exercise of the right of freedom to provide investment services and activities. If you have any queries, please do not hesitate to contact us. Yours sincerely, [Signature] (1) Please amend as appropriate.