ANNEX FORMAT OF APPLICATION

ANNEX

1FORMAT FOR AN APPLICATION FOR REGISTRATION OR EXTENSION OF REGISTRATION AS A TRADE REPOSITORY

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 REFERENCES1

1Article of Commission Delegated Regulation 150/2013

Unique reference number of document

Title of the document

Chapter, section or page of the document where the information is provided or reason why the information is not provided1