Reference number:

Date:

From:

Name of the applicant:

Address:

Legal Entity Identifier (where applicable):

(Contact details of the designated contact person at the applicant)

Full name:

Telephone:

Email:

To:

ESMA/National Competent Authority:

Address:

(Contact details of the designated contact point at ESMA/National Competent Authority)

Address:

Telephone:

Email:

Dear [insert appropriate name],

In accordance with Article 2 of Commission Implementing Regulation (EU) 2025/1157 please find the authorisation application.

— Person at the applicant in charge of preparing the application: Full name: Status/position: Telephone: Email: Date: Signature:

— Nature of the application [ tick the relevant box(es) ]: ☐ Authorisation – Approved Publication Arrangement (APA) ☐ Authorisation – Approved Reporting Mechanism (ARM)

CONTENT

Please insert the information referred to under Commission Delegated Regulation (EU) 2025/1143. Please set out that information under the appropriate section or make reference to the relevant annexes containing the information.

Information on the organisation (Article 2 of Delegated Regulation (EU) 2025/1143):

Information on the ownership (Article 3 of Delegated Regulation (EU) 2025/1143):

Information on corporate governance (Article 4 of Delegated Regulation (EU) 2025/1143):

Information on the members of the management body (Article 5 of Delegated Regulation (EU) 2025/1143):

Information on internal controls (Article 6 of Delegated Regulation (EU) 2025/1143):

Information on digital operational resilience (Article 7 of Delegated Regulation (EU) 2025/1143):

Information on conflicts of interest (Article 8 of Delegated Regulation (EU) 2025/1143):

Information on organisational requirements regarding outsourcing (Article 9 of Delegated Regulation (EU) 2025/1143):

Information on management of incomplete or potentially erroneous information by APAs (Article 10 of Delegated Regulation (EU) 2025/1143):

Information on management of incomplete or potentially erroneous information by ARMs (Article 11 of Delegated Regulation (EU) 2025/1143):

Information on connectivity of ARMs (Article 12 of Delegated Regulation (EU) 2025/1143):

Information on machine readability (Article 13 of Delegated Regulation (EU) 2025/1143):

Information on the details to be published by the APA (Article 14 of Delegated Regulation (EU) 2025/1143):

Notes: