Suspicious Transaction and Order Report (STOR) Form

The European Union issued this form to mandate the reporting of suspicious orders and transactions under Article 92 of the Market in Crypto Asset Regulation. It requires entities and persons professionally arranging or executing crypto-asset transactions to provide detailed identity, transaction, and suspicion descriptions across six mandatory sections. The document specifies that all fields in Sections 1 through 4 are compulsory, requiring 'NA' and explanations where specific information cannot be provided.

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Suspicious Transaction and Order Report (STOR) [This form is for notification of suspicious orders and transactions under Article 92 of Regulation (EU) 2023/1114 of the European Parliament and of the Council of 31 May 2023 on market abuse (Market in Crypto Asset Regulation)] Please note that all fields in Sections 1-4 are mandatory. Where information cannot be provided for a specific field, please indicate ‘NA’ and briefly explain the reasons thereof. SECTION 1 – IDENTITY OF ENTITY/PERSON SUBMITTING the STOR Persons professionally arranging or executing transactions in crypto assets – Specify in each case: Name of the natural person Position within the reporting entity Name of the reporting entity Address of the reporting entity Acting capacity of entity with respect to the orders, transactions or behaviours related to the functioning of the DLT that could constitute market abuse Type of trading activity (market making, arbitrage etc.) and type of crypto-asset traded by the reporting entity Contact for additional request for information Have the facts already been reported to public authorities? SECTION 2 - TRANSACTION/ORDER/BEHAVIOUR AND OTHER ASPECTS RELATED TO THE FUNCTIONING OF THE DISTRIBUTED LEDGER TECHNOLOGY Description of the crypto-asset Name(s) of the distributed ledger(s) Trading platform where order was placed or the transaction was executed Location (country) Description of the order, transaction or suspicious behaviour related to the functioning of the DLT SECTION 3 - DESCRIPTION OF THE NATURE OF THE SUSPICION Nature of the suspicion Reasons for the suspicion SECTION 4 - IDENTIFICATION OF PERSON(S) RESPONSIBLE FOR THE ORDERS, TRANSACTIONS OR BEHAVIOUR RELATED TO THE FUNCTIONING OF THE DISTRIBUTED LEDGER TECHNOLOGY THAT COULD CONSTITUTE MARKET ABUSE (‘SUSPECTED PERSON’) Name National Identification Number Address Information about the employment: – Place – Position Account number(s) and wallet address(es Client identifier Relationship with the issuer of the crypto asset concerned SECTION 5 - ADDITIONAL INFORMATION Other information relevant to the report, depending on the activity SECTION 6 - DOCUMENTATION ATTACHED