ANNEX IV

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 notification for the provision of arrangements to facilitate access to an MTF or OTF (Articles 8 and 10 of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Part 1 — Contact Information: Type of notification: Provision of arrangements to facilitate access to an MTF/OTF/changes to the particulars of the notification for the provision of arrangements to facilitate access to an MTF/OTF Member State(s) in which the investment firm/market operator intends to provide arrangements: Name of investment firm/market operator: Address: Telephone number: Email: Name of the contact person at the investment firm/market operator: Home Member State Authorisation Status (of the investment firm)/Applicable Law (of the market operator): Authorised/Licensed/Supervised by [Home Member State Competent Authority] Authorisation Date (for investment firms): Name of the MTF/OTF: Date from which the arrangements will be provided: With immediate effect Part 2 — Description of [name of the MTF/OTF] business model: [Please include at least the following information] Type of traded financial instruments: [to be completed by investment firm/market operator] Type of trading participants: [to be completed by investment firm/market operator] Type of appropriate arrangements: [to be completed by investment firm/market operator] Marketing: [to be completed by investment firm/market operator]