ANNEX XIII

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 by the competent authority of the home Member State to the competentauthority of the host Member State on the termination of the operation of a branch or of the cessationof the use of a tied agent established in a Member State outside its home Member State (Articles 19(2) and 20(2) of Commission Implementing Regulation (EU) 2017/2382) Reference number: Date: Communication in accordance with Article 35(10) of Directive 2014/65/EU regarding thetermination of the operation of a branch/the use of a tied agent established in a Member Stateoutside its home Member State (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 notified us the intention to terminate the operation of the branch/the use of the tied agent established in your territory with effect [date of termination]. Please find attached a copy of the notification regarding the termination of the operation of [name of the branch]/the cessation of the use of the [name of the tied agent]. If you have any queries, please do not hesitate to contact us. Yours sincerely, [Signature] (1) Please amend accordingly.