# ANNEX XII **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 on a change of tied agent particulars notification by the competent authority of the home Member State to the competent authority of the host Member State (Article 20(1) of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Communication in accordance with Article 35(10) 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 35(10) of Directive 2014/65/EU, we wish to inform you that [Name of firm], an investment firm/credit institution authorised by [name of the competent authority of the home Member State], has: (a) amended the investment services and activities being provided by [name of the tied agent]. (b) changed its tied agent name from [add old name of the tied agent] to [add new name] with effect [date of change] (c) changed its tied agent’s other contact information to as follows [add any changes to the contact information notified under Part 1 of the form set out in Annex VII to Commission Implementing Regulation (EU) 2017/2382] with effect [date of change] (d) changed its own name/address/contact details from [old name/address/contact details of the investment firm/credit institution] to [new name/address/contact details of the investment firm/credit institution] with effect [date of change]. Please find attached a copy of the change of investment services and activities particulars notification with the relevant changes. If you have any queries, please do not hesitate to contact us. Yours sincerely, [Signature] (1) Please amend accordingly.