Date and time (creation): [yyyy-mm-dd, hh:mm UTC (Coordinated Universal Time)]
Date of transmission to the competent 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 competent authority) |
Personal telephone numbers (home and personal mobile telephone numbers) (If available at the time of the request by the competent authority) |
|
[Text] |
[Text] |
[Text] |
[N |