Annex

FORMAT 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 REFERENCES