Free Printable Fax Cover Sheets 43223 | Notification Form Freeprovisionofservices

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Sheet 1: Cover

	
	
	
	
	
	
	
	
	
	
	
	
		Notification Form 
		
		

	
	
		

		

		
 
		
		
 
		
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		
 
		
		

		

		

		

		

	
	
		

		

		Commission de Surveillance du Secteur Financier 
		
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		Postal address:
		
 
		
		

		

		

		

		

	
	
		

		

		

		Luxembourg
		

		

		

		

		

	
	
		

		

		Address of the head office: 
		
		283, route d’Arlon  
		
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		

		L-1150 Luxembourg
		

		

		

		

		

	
	
		

		

		

		Luxembourg
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		
 
		
		
 
		
		

		

		

		

		

	
	
		
 
		
		

		

		

		

		

	
	
		

		
 
		
		

		

		

		

		

	
	
		

		

		

		

		

		

	
	
		

		

		

		

		

		

	
	
		

		

		

		

		

	
	
		
 
		
		
 
		
		

		

	
	
		Article 33 of the Directive 2011/61/EU 
		
		luaifm33@cssf.lu 
		
		

		

	
	
		
 
		
		Article 18 of the Directive 2009/65/EC AND Article 33 of the Directive 2011/61/EU 
		
		lu_manco_ucits_notif@cssf.lu 
		
		AND
		luaifm33@cssf.lu 
		
		
 
		
		
 
	
	
	
		

		
 
		
		
 
		
		
 
		
		

		

		
	
		

		

		

		

		

		

		

	
	
		
 
		
		
 
		
		
 
		
		
 
		
		
 
		
		

		

		

		

		

	
	
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		v5.0 - 02/2022
		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		
 
		
		
 
		
		
 
		
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		

		

		

		

		

		

		

		

		

		

		

	
	
		
 
		
		
 
		
		
 
		
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

		

		

	
	
		
 
		
		
 
		
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		

		

		

		

		

	
	
		
 
		
		

		

		

		

		

	
	
		

		

		

		

		

	

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 




Sheet 2: General

	
	
	
		GENERAL
		
	
		

		

	
	
		1.1 TYPE OF NOTIFICATION
		

	
	
		Applicable Directive
		

	
	
		

		

	
	
		Type of notification
		

	
	
		

		

	
	
		1.2 GENERAL INFORMATION
		

	
	
		Manager full name
		

	
	
		

		

	
	
		Manager address - street
		

	
	
		Manager address - postcode & city
		

	
	
		

		

	
	
		Manager identification number 1
		

	
	
		

		

	
	
		Manager type (authorisation in your home Member State)
		

	
	
		

		

	
	
		Home Member State
		

	
	
		

		

	
	
		1.3 CONTACT DETAILS OF THE CONDUCTING OFFICER RESPONSIBLE FOR THE NOTIFICATION
		
	
		Contact name
		

	
	
		

		

	
	
		Contact title
		

	
	
		

		

	
	
		Telephone (direct dial)
		

	
	
		Email
		

	
	
		Fax
		

	
	
		

		

	
	
		Footnotes
		
	
		1 In case of notification pursuant to both directives please indicate both the UCITS management company identification number (ex.S000001) and the AIFM identification number  (ex. A0000001). The identification numbers are available on the published lists of the CSSF Internet web site.
		



Sheet 3: Activities

	
	
	
	
	
		

		ACTIVITIES NOTIFIED UNDER FREEDOM TO PROVIDE SERVICES
		

	
	
		

		

		

		

	
	
		

		2.1 GENERAL INFORMATION
		

	
	
		

		EEA State1 in which you wish to provide services
		

		

	
	
		

		

		

		

	
	
		

		2.2 ACTIVITIES TO BE CARRIED OUT - DIRECTIVE 2009/65/EC 2
		

	
	
		

		Article 6(2)
		

		

	
	
		

		Collective portfolio management
		

		

	
	
		

		Investment management
		

		

	
	
		

		Administration
		

		

	
	
		

		Marketing
		

		

	
	
		

		

		

		

	
	
		

		Article 6(3)
		

		

	
	
		

		Management of portfolios of investments, including those owned by pension funds, in accordance with mandates given by investors on a discretionary, client-by-client basis, where such portfolios include one or more of the instruments listed in Annex I, Section C to Directive 2004/39/EC 
		

		

	
	
		

		Investment advice
		

		

	
	
		

		Safe-keeping and administration in relation to units of UCIs
		

		

	
	
		

		

		

		

	
	
		

		2.3 ACTIVITIES TO BE CARRIED OUT - DIRECTIVE 2011/61/EU 2 and 3 
		

	
	
		

		Article 6(2)
		

		

	
	
		

		Investment management
		

		

	
	
		

		Portfolio management
		

		

	
	
		

		Risk management
		

		

	
	
		

		Other additional functions
		

		

	
	
		

		Administration
		

		

	
	
		

		Marketing
		

		

	
	
		

		Activities related to the assets of AIFs 4
		

		

	
	
		

		

		

		

	
	
		

		Article 6(4)
		

		

	
	
		

		Management of portfolios of investments, including those owned by pension funds and institutions for occupational retirement provision in accordance with Article 19(1) of Directive 2003/41/EC, in accordance with mandates given by investors on a discretionary, client-by-client basis
		

		

	
	
		

		Investment advice
		

		

	
	
		

		Safe-keeping and administration in relation to units of UCIs
		

		

	
	
		

		Reception and transmission of orders in relation to financial instruments
		

		

	
	
		

		

		

		

	
	
		

		2.4 Is the Manager member of the Système d'indemnisation des investisseurs au Luxembourg ("SIIL")?
		

		

	
	
		

		

		

		

	
	
		

		Footnotes
		

	
	
		

		1 "EEA State" stands for countries which are members of the European Economic Area 
		

	
	
		

		2 Please indicate ´Yes´ to the activities to be provided under freedom to provide services. Only the activities covered by the license in Luxembourg can be exercised in the host EEA state.
		

	
	
		

		3 Please provide the AIFM attestation as appendix 1
		

		

	
	
		

		4 Activities related to the assets of AIFs, namely services necessary to meet the fiduciary duties of the AIFM, facilities management, real estate administration activities, advice to undertakings on capital structure, industrial strategy and related matters, advice and services relating to mergers and the purchase of undertakings and other services connected to the management of the AIF and the companies and other assets in which it has invested

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...Sheet cover notification form commission de surveillance du secteur financier postal address luxembourg of the head office route d rsquo arlon l article directive eu luaifm cssflu ec and lu manco ucits notif v general type applicable information manager full name street postcode amp city identification number authorisation in your home member state contact details conducting officer responsible for title telephone direct dial email fax footnotes case pursuant to both directives please indicate management company exs aifm ex a numbers are available on published lists cssf internet web site activities notified under freedom provide services eea which you wish be carried out collective portfolio investment administration marketing portfolios investments including those owned by pension funds accordance with mandates given investors discretionary clientbyclient basis where such include one or more instruments listed annex i section c advice safekeeping relation units ucis risk other additi...

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GENERAL

1.1 TYPE OF NOTIFICATION
Applicable Directive

Type of notification

1.2 GENERAL INFORMATION
Manager full name

Manager address - street
Manager address - postcode & city

Manager identification number 1

Manager type (authorisation in your home Member State)

Home Member State

1.3 CONTACT DETAILS OF THE CONDUCTING OFFICER RESPONSIBLE FOR THE NOTIFICATION
Contact name

Contact title

Telephone (direct dial)
Email
Fax

*Footnotes*
1 In case of notification pursuant to both directives please indicate both the UCITS management company identification number (ex.S000001) and the AIFM identification number (ex. A0000001). The identification numbers are available on the published lists of the CSSF Internet web site.

	ACTIVITIES NOTIFIED UNDER FREEDOM TO PROVIDE SERVICES

	2.1 GENERAL INFORMATION
	EEA State1 in which you wish to provide services

	2.2 ACTIVITIES TO BE CARRIED OUT - DIRECTIVE 2009/65/EC 2
	*Article 6(2)*
	Collective portfolio management
	Investment management
	Administration
	Marketing

	*Article 6(3)*
	Management of portfolios of investments, including those owned by pension funds, in accordance with mandates given by investors on a discretionary, client-by-client basis, where such portfolios include one or more of the instruments listed in Annex I, Section C to Directive 2004/39/EC
	Investment advice
	Safe-keeping and administration in relation to units of UCIs

	2.3 ACTIVITIES TO BE CARRIED OUT - DIRECTIVE 2011/61/EU 2 and 3
	*Article 6(2)*
	Investment management
	Portfolio management
	Risk management
	Other additional functions
	Administration
	Marketing
	Activities related to the assets of AIFs 4

	*Article 6(4)*
	Management of portfolios of investments, including those owned by pension funds and institutions for occupational retirement provision in accordance with Article 19(1) of Directive 2003/41/EC, in accordance with mandates given by investors on a discretionary, client-by-client basis
	Investment advice
	Safe-keeping and administration in relation to units of UCIs
	Reception and transmission of orders in relation to financial instruments

	2.4 Is the Manager member of the Système d'indemnisation des investisseurs au Luxembourg ("SIIL")?

	*Footnotes*
	1 "EEA State" stands for countries which are members of the European Economic Area
	2 Please indicate ´Yes´ to the activities to be provided under freedom to provide services. Only the activities covered by the license in Luxembourg can be exercised in the host EEA state.
	3 Please provide the AIFM attestation as appendix 1
	4 Activities related to the assets of AIFs, namely services necessary to meet the fiduciary duties of the AIFM, facilities management, real estate administration activities, advice to undertakings on capital structure, industrial strategy and related matters, advice and services relating to mergers and the purchase of undertakings and other services connected to the management of the AIF and the companies and other assets in which it has invested

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