Reference number: … Date: … General information FROM: Member State: Requesting competent authority: Address: (Contact point details) Name: Telephone: Email: TO: Member State: Recipient: Address: (Contact point details) Name: Telephone: Email: Dear [insert appropriate name] In accordance with Article 31 of Regulation (EU) 2020/1503 of the European Parliament and of the Council (1), your input is sought in relation to the matter(s) set out in further detail below. I would be grateful to receive a response to the above request by [insert indicative date for the reply and in case of an urgent request insert deadline for the information to be provided by] or, if that is not possible, for an indication as to when you anticipate being in a position to provide the assistance which is sought. Type of request Please tick the appropriate box(es) ☐ Supervisory activities (provision of information, taking of a statement, other) ☐ Investigation or on-site inspections ☐ Enforcement ☐ Authorisation procedure Reasons for the request … … … [Insert provision(s) of the sectoral legislation under which the requesting competent authority is competent to deal with the matter] The request concerns [cooperation] or [exchange of information] on … … … … … [Insert description of the subject matter of the request, the purpose for which the cooperation or exchange of information is sought, the facts underlying any investigation which form the basis of the request and an explanation of their helpfulness] Further to… … … … [If applicable, insert details of the previous request in order to enable it to be identified] Supervisory Activities (provision of information, taking of a statement) Provision of information (a) Please provide a detailed description of the specific information sought with reasons why that information will be of assistance and, if known, a list of the persons considered as possessing the information sought and/or the places where such information may be obtained. … … … … (b) If the request concerns cooperation or exchange of information relating to a specific transferable security, an admitted instrument for crowdfunding purposes or a loan of a crowdfunding offer, please provide the following information: Crowdfunding offer ID:… [Insert precise description of the crowdfunding offer, including the identifier referred to in Article 3 of Commission Delegated Regulation (EU) 2022/2119 ( 2 ) ] Personal ID:… [Insert the identity of any person connected with the crowdfunding offer and/or the relevant crowdfunding service provider] Date:… [Insert the date of when the crowdfunding offer was provided on the crowdfunding platform] (c) If the request concerns information relating to the business or activities of a person, please provide information as precise as possible to enable that person to be identified. … … … … (d) If there are special considerations on the sensitivity of the information sought (including due to investigatory considerations), please provide an indication of such sensitivity and any special precautions that have to be taken in collecting the information. … … … … (e) Please provide any additional information. … … … … [Specify whether the requesting competent authority has been or will be in contact with any other authority or law enforcement agency in its Member State in relation to the subject matter of the request or whether there is any other authority which the requesting authority is aware that has an active interest in the subject matter of the request] (f) In case of an urgent request and the setting of any deadline, please provide full explanation of the urgency of the request and an explanation of any deadline that the requesting competent authority has asked for the information to be provided by. Taking of a statement Please indicate: (a) Statement under: oath ☐/affirmation ☐ where permissible, neither ☐ (b) Need and purpose of the taking of the statement: … … … (c) Name of person(s) from whom the statement is to be obtained: … … … [Insert details of the persons from which the statement is to be taken to enable the requested competent authority to begin the summoning process where applicable] (d) Detailed description of the information sought, including a preliminary list of questions (if available at the time of the request). … … … … (e) Any additional information which may be useful: … … [Whether the requesting competent authority requests its staff to participate in the taking of the statement, insert details of the participating officials of the requesting competent authority, and, where appropriate, a description of any legal and procedural requirements that must be complied with to ensure the admissibility of the statement in the jurisdiction of the requesting’s competent authority] On-site inspection or investigation If the request concerns an on-site inspection or investigation, please provide information to enable the recipient to assess which of the actions set out in Article 31(4), second subparagraph, points (a) to (e), of Regulation (EU) 2020/1503 it may take and whether it may have an interest in entering into a joint on-site inspection or investigation. Please also provide information on the requesting competent authority’s proposal for the inspection or investigation, its reasoning and the benefits to the recipient. … [Include all relevant information to enable the recipient of the request to provide the necessary assistance, as appropriate] … Enforcement (a) Please provide a detailed description of the specific information sought with reasons why that information will be of assistance. … … … … (b) If the request concerns cooperation or exchange of information relating to a specific transferable security, an admitted instrument for crowdfunding purposes or a loan of a crowdfunding offer, please provide the following information Crowdfunding offer ID:…. [Insert precise description of the crowdfunding offer, including the identifier referred to in Article 3 of Delegated Regulation (EU) 2022/2119] Personal ID:… [Insert the identity of any person connected with the crowdfunding offer and/or the relevant crowdfunding service provider] Date:… [Insert the date of when the crowdfunding offer was provided on the crowdfunding platform] Authorisation procedure (a) Subject matter: … … … (b) Information on the authorisation procedure : … … … (c) Information on any other competent authority involved : … … … [Please provide information here or make reference to the annexed documentation containing the information] (d) Information sought: … … … [Please insert a specific description of the information sought, including any relevant documents requested with reasons why that information is necessary for the review of the application of authorisation] (e) Any additional information which may be useful: … … … [Insert any other relevant information. If there are special considerations on the sensitivity of the information sought, please provide an indication of such sensitivity and any special precautions that have to be taken in collecting the information.] Any personal data provided shall be processed by ESMA in accordance with Regulation (EU) 2018/1725 of the European Parliament and of the Council and by the relevant competent authorities in accordance with Regulation (EU) 2016/679 of the European Parliament and of the Council. In particular, both ESMA and the relevant competent authorities shall ensure that all relevant information on the processing of personal data is provided to data subjects in accordance with Section 2 ‘Information and access to personal data’ of CHAPTER III ‘Rights of the data subject’ of these Regulations. Yours sincerely, [signature]