ANNEX VII

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 tied agent passport notification and change of tied agent particulars notification (1) (Articles 13, 14 and 18 of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Part 1 — Contact Information Type of notification: Tied agent passport notification/change of tied agent particulars notification Member State in which the investment firm/credit institution intends to use a tied agent established in the host Member State(s): Name of investment firm/credit institution: Address of the investment firm/credit institution: Name of the contact person at the investment firm/credit institution: Telephone number of the investment firm/credit institution Email of the investment firm/credit institution Name of the tied agent: Address of the tied agent: Telephone number of the tied agent: Email of the tied agent: Name(s) of those responsible for the management of the tied agent: Home Member State: Authorisation Status: Authorised by [Home Member State Competent Authority] Authorisation Date: Reference or hyperlink to the public register where the tied agent is registered (1) For the purposes of a change in the tied agent particulars notification, please complete only the parts of the forms relevant to the notified changes. Where changes have been made to the investment services, activities or financial instruments, the firm shall list all investment services, activities or financial instruments to be provided by the tied agent. Part 2 — Programme of operations Intended investment services or activities to be provided by the tied agent (): Investment services and activities Ancillary services A1 A2 A3 A4 A5 A6 A7 A8 A9 B1 B2 B3 B4 B5 B6 B7 Financial Instruments C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 () Please place an (x) in the appropriate box(es). Business plan and structural organisation of the tied agent Business plan

1. Explain how the tied agent will contribute to the strategy of the firm/group.
2. Describe what the main functions of the tied agent will be.
3. Describe the main objectives of the tied agent.

Commercial Strategy

1. Describe the types of clients/counterparties the tied agent will be dealing with.
2. Describe how the firm will obtain and deal with these clients.

Organisational structure

1. Briefly describe how the tied agent fits into the corporate structure of the firm/group. (This may be facilitated by attaching an organisational chart)
2. Set out the organisational structure of the tied agent, showing both functional and legal reporting lines.
3. Identify who will be responsible for the tied agent operations on a day to day basis? Provide details of professional experience of the persons responsible for the management of the tied agent (Please attach CV).
4. Identify who will be responsible for the internal control functions at the tied agent.
5. Identify who will be responsible for dealing with complaints in relation to the tied agent.
6. Identify how will the tied agent report to the head office.
7. Detail any critical outsourcing arrangements.

Systems & Controls

Provide a brief summary of arrangements for:

1. safeguarding client money and assets (where applicable);
2. compliance with the conduct of business and other obligations that fall under the responsibility of the Competent Authority of the host Member State according to Article 35(8) and record keeping under Article 16(6);
3. staff code of Conduct, including personal account dealing;
4. anti-money laundering;
5. monitoring and control of critical outsourcing arrangements (where applicable);
6. the name, address and contact details of the accredited compensation scheme of which the investment firm or credit institution is a member. Financial forecast Attach a forecast statement for profit and loss and cash flow, both over an initial period of thirty six month period.