ANNEX II Template for the insider list to be submitted by issuers of financial instruments admitted to trading on SME growth markets
Date and time (creation): [ yyyy-mm-dd, hh:mm UTC (Coordinated Universal Time) ]
Date of transmission to the Financial Conduct Authority: [ yyyy-mm-dd ]
First name(s) of the insider |
Surname(s) of the insider |
Birth surname(s) of the insider (if different) |
Professional telephone number(s) (work direct telephone line and work mobile numbers) |
Company name and address |
Function and reason for being insider |
Obtained (the date and time at which a person obtained access to inside information) |
Ceased (the date and time at which a person ceased to have access to inside information) |
National Identification Number (if applicable) Or otherwise date of birth |
Personal full home address (street name; street number; city; post/zip code; country) (If available at the time of the request by the Financial Conduct Authority) |
Personal telephone numbers (home and personal mobile telephone numbers) (If available at the time of the request by the Financial Conduct Authority) |
[Text] |
[Text] |
[Text] |
[Numbers (no space)] |
[Address of issuer or third party of insider] |
[Text describing role, function and reason for being on this list] |
[yyyy-mm-dd, hh:mm UTC] |
[yyyy-mm-dd, hh:mm UTC] |
[Number and/or text or yyyy-mm-dd for the date of birth] |
[Text: detailed personal address of the insider
|
[Numbers (no space)] |