ANNEX IV

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:

Address:

(Contact details of the designated contact point at ESMA)

Address:

Telephone:

Email:

Dear [insert appropriate name],

In accordance with Article 8 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: ☐ Authorisation – Consolidated Tape Provider (CTP)

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 ownership (Article 16 of Delegated Regulation (EU) 2025/1143):

Information on the organisation (Article 17 of Delegated Regulation (EU) 2025/1143):

Information on corporate governance (Article 18 of Delegated Regulation (EU) 2025/1143):

Information on the members of the management body (Article 19 of Delegated Regulation (EU) 2025/1143):

Information on internal controls (Article 20 of Delegated Regulation (EU) 2025/1143):

Information on conflicts of interest (Article 21 of Delegated Regulation (EU) 2025/1143):

Information on business operativity (Article 22 of Delegated Regulation (EU) 2025/1143):

Information on outsourcing (Article 23 of Delegated Regulation (EU) 2025/1143):

Information on market data fees and licensing models (Article 24 of Delegated Regulation (EU) 2025/1143):

Information on digital operational resilience (Article 25 of Delegated Regulation (EU) 2025/1143):

Information on energy efficiency (Article 26 of Delegated Regulation (EU) 2025/1143):

Information on record keeping arrangements (Article 27 of Delegated Regulation (EU) 2025/1143):

Information on organisational requirements (Article 28 of Delegated Regulation (EU) 2025/1143):

Information on reception, consolidation and dissemination of data and data quality (Article 29 of Delegated Regulation (EU) 2025/1143):

Information from joint applicants (Article 30 of Delegated Regulation (EU) 2025/1143):

Notes: