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ANNEX FORMAT OF APPLICATION

FORMAT OF APPLICATION

GENERAL INFORMATION

Date of application

Corporate name of trade repository

Legal address

The classes of derivatives for which the trade repository is applying to be registered

Name of the person assuming the responsibility of the application

Contact details of the person assuming the responsibility of the application

Name of other person responsible for the trade repository compliance

Contact details of the person(s) responsible for the trade repository compliance

Identification of any parent company

DOCUMENT REFERENCES (Article 1(3))

Article of the delegated act with regard to regulatory technical standards specifying the details of the application for registration of trade repositories adopted pursuant to Article 56(3) of Regulation (EU) No 648/2012

Unique reference number of document

Title of the document

Chapter or section or page of the document where the information is provided or reason why the information is not provided