Reference number (to be completed by the competent authority):

Date:

FROM

Name of the applicant:

Address of the applicant / applicant’s registered office:

Contact details of the designated contact person

Name:

Telephone:

Email:

TO

Member State (if applicable):

Competent authority:

Address:

Contact details of the designated contact point

Name:

Telephone:

Email:

We, [insert applicant’s name] declare that the submitted information is true, accurate, complete, up to date, and not misleading. If some information relates only to a future date, it is explicitly identified in the application and we undertake to notify the authority in writing without delay if any such information should turn out to be inaccurate, incomplete or misleading. Further, we undertake to inform the competent authority of any change concerning the information provided in this form.

Person in charge of preparing the application

Name:

Status/position:

Telephone:

Email:

REQUIRED INFORMATION

General information according to Article 1 of Commission Delegated Regulation (EU) 2025/305 (2)

…

Programme of operations according to Article 2 of Delegated Regulation (EU) 2025/305

…

Prudential requirements

…

Please insert the information referred to in Article 3 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Information about governance arrangements and internal control mechanisms

…

Please insert the information referred to in Article 4 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Business continuity

…

Please insert the information referred to in Article 5 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Detection and prevention of money laundering and terrorist financing

…

Please insert the information referred to in Article 6 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Identity and proof of good repute, knowledge, skills, and experience and of sufficient time commitment of the members of the management body

…

Please insert the information referred to in Article 7 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Information relating to shareholders or members with qualifying holdings

…

Please insert the information referred to in Article 8 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

ICT systems and related security arrangements

…

Please insert the information referred to in Article 9 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Segregation of clients’ crypto-assets and funds

…

Please insert the information referred to in Article 10 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Complaints-handling

…

Please insert the information referred to in Article 11 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Custody and administration policy

…

Please insert the information referred to in Article 12 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Operating rules of the trading platform and market abuse detection

…

Please insert the information referred to in Article 13 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Exchange of crypto-assets for funds or other crypto-assets

…

Please insert the information referred to in Article 14 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Execution policy

…

Please insert the information referred to in Article 15 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Provision of advice or portfolio management on crypto-assets

…

Please insert the information referred to in Article 16 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

Transfer services

…

Please insert the information referred to in Article 17 of Delegated Regulation (EU) 2025/305, by setting out that information here or making reference to the relevant sections of the application.

[signature of legal representative]