ANNEX I Template for the compliance statement referred to in Article 25(7) of Regulation (EU) 2016/1011

A. General Information

(1) Date of creation of this document and, where applicable, of the latest update to it

Created: [dd/mm/yy]

Last updated: [dd/mm/yy]

(2) Name of the administrator

[As it appears in the "Register of administrators and benchmarks" published by the FCA]

The following section:

• identifies the significant benchmark or significant benchmarks in respect of which provisions do not apply,
• identifies the provisions that the administrator has chosen not to apply, and
• explains why it is appropriate for the administrator not to comply with each such provision.

If this document relates to more than one significant benchmark provided by the administrator, a separate section must be completed for each set of benchmarks in respect of which:

• the provisions that the administrator chooses not to apply are the same for all those benchmarks, and
• for each provision, the explanation why it is appropriate for the administrator not to comply with the provision is the same for all those benchmarks.

B. [Insert name of the administrator as set out in item 2 of section A] chooses not to apply the following provisions of Regulation (EU) 2016/1011 with respect to the significant benchmark or significant benchmarks identified below

(1) The benchmark or benchmarks in respect of which the provision(s) do not apply

[Insert name of the benchmark, or each of the benchmarks, including its international securities identification number (ISIN) or, where no ISIN is available, any other identifier available]

(2) Indication of where the benchmark statement for the relevant benchmark or each of the relevant benchmarks is published

[e.g. webpage link]

(3)(i) The provision or provisions of Regulation (EU) 2016/1011 that do not apply

(3)(ii) For each provision, the reasons why it is appropriate for the administrator not to comply with that provision

[For each provision, insert the Article number, paragraph and, where applicable, specific point of Regulation (EU) 2016/1011, and the full text of the provision]

[For each provision, insert a specific, detailed and clear explanation of why it is appropriate for the administrator not to comply with the provision, taking into account the nature and impact of the benchmark or benchmarks and the size of the administrator.]