一主要株主（総株主の議決権（株主総会において決議をすることができる事項の全部につき議決権を行使することができない株式についての議決権を除き、会社法（平成十七年法律第八十六号）第八百七十九条第三項　の規定により議決権を有するものとみなされる株式についての議決権を含む。第十四条第二項第五号において同じ。）の百分の十以上の議決権を保有している株主をいう。）の氏名又は商号若しくは名称、住所又は所在地及びその保有する議決権の数を記載した書面

(i)a document stating the name or trade name of a Major Shareholder (meaning a shareholder that holds voting rights constituting ten percent or more of all shareholders' voting rights (excluding voting rights in respect of shares that do not allow voting rights to be exercised with regard to all matters that can be resolved at a shareholders meeting and including voting rights in respect of shares that are deemed to have voting rights pursuant to the provision of Article 879, paragraph (3) of the Companies Act (Act No. 86 of 2005); the same shall apply in Article 14, paragraph (2), item (v))), its address or location and the number of voting rights held by such a Major Shareholder;

二親法人（金融商品取引清算機関の総株主の議決権（前号に規定する議決権をいう。）の過半数を保有している法人その他の団体をいう。）及び子法人（金融商品取引清算機関が総株主、総社員又は総出資者の議決権（株式会社にあっては、株主総会において決議をすることができる事項の全部につき議決権を行使することができない株式についての議決権を除き、会社法第八百七十九条第三項　の規定により議決権を有するものとみなされる株式についての議決権を含む。）の過半数を保有している法人その他の団体をいう。）の概要を記載した書面

(ii)a document stating an outline of parent corporation(meaning a juridical person or other organization holding a majority of all shareholders' voting rights (meaning voting rights prescribed in the preceding item) of a Financial Instruments Clearing Organization) and subsidiary corporation (meaning a juridical person or other organization in which a majority of the voting rights of all shareholders, all members, or all equity investors (in the case of a stock company, excluding voting rights in respect of shares that do not allow voting rights to be exercised with regard to all matters that can be resolved at a shareholders meeting and including voting rights in respect of shares that are deemed to have voting rights pursuant to the provision of Article 879, paragraph (3) of the Companies Act) is held by a Financial Instruments Clearing Organization);

三取締役及び監査役（委員会設置会社にあっては、取締役及び執行役。以下この号において同じ。）の履歴書及び住民票の抄本（本籍の記載のあるものに限る。）又はこれに代わる書面並びに取締役及び監査役が法第二十九条の四第一項第二号イからトまでのいずれにも該当しない者であることを当該取締役及び監査役が誓約する書面

(iii)Resumes and extracts of residence certificate (limited to those stating the registered domicile) of directors and company auditors (or, in a Company with Committees, directors and executive officers; hereinafter the same shall apply in this item) or other documents in lieu thereof and documents in which said directors and company auditors pledge that they do not fall under any of the categories in Article 29-4, paragraph (1), item (ii), sub-items (a) to (g) inclusive of the Act;

四会計参与設置会社にあっては、会計参与の履歴書（会計参与が法人であるときは、当該会計参与の沿革を記載した書面）及び住民票の抄本（本籍の記載のあるものに限る。）又はこれに代わる書面（会計参与が法人であるときは、当該会計参与の登記事項証明書又はこれに代わる書面）並びに会計参与が法第二十九条の四第一項第二号イからトまでのいずれにも該当しない者であることを当該会計参与が誓約する書面

(iv)In a company with accounting advisors, resumes of accounting advisors (if the accounting advisor is a juridical person, a document stating the history of said accounting advisor) and extracts of residence certificate (limited to those stating the registered domicile) of accounting advisors or other documents in lieu thereof (if the accounting advisor is a juridical person, a certificate of registered information of said accounting advisor or other documents in lieu thereof) and a document in which said accounting advisors pledge that they do not fall under any of the categories in Article 29-4, paragraph (1), item (ii), sub-items (a) to (g) inclusive of the Act;

五取締役（委員会設置会社にあっては、執行役）の担当業務を記載した書面

(v)a document stating the business of which each of directors (or, in a Company with Committees, executive officers) is in charge;

六金融商品債務引受業に関する知識及び経験を有する従業員の確保の状況並びに当該従業員の配置の状況を記載した書面

(vi)a document stating the status of securing employees who have knowledge and experience related to Financial Instruments Debt Assumption Service and assignment status of said employees;

七金融商品取引清算機関の事務の機構及び分掌を記載した書面

(vii)a document stating the organization and division of business of Financial Instruments Clearing Organization;

八業務開始後三年間における収支の見込みを記載した書面

(viii)a document stating the expected income and expenditures for three years after the commencement of business; and

九その他法第百五十六条の四第一項　の規定による審査の参考となるべき事項を記載した書面

(ix)other documents stating matters that will be helpful for examination under the provision of Article 156-4, paragraph (1) of the Act.

一トラックフォーマットについては、日本工業規格Ｘ六二二五に規定する方式

(i)Track format: Method prescribed in JIS X6225

二ボリューム及びファイル構成については、日本工業規格Ｘ〇六〇五に規定する方式

(ii)Volume and file composition: Method prescribed in JIS X0605

一申請者の商号

(i)trade name of applicant; and

二申請年月日

(ii)application date.

一承認を受けようとする業務の種類

(i)type of business for which approval is to be obtained; and

二当該業務の開始予定年月日

(ii)scheduled date of commencement of said business.

一当該業務の内容及び方法を記載した書面

(i)a document stating the contents and methods of said business;

二当該業務を所掌する組織及び人員配置を記載した書面

(ii)a document stating the organization and assignment of personnel having jurisdiction over said business;

三当該業務の運営に関する社内規則

(iii)internal rules on operation of said business; and

四当該業務の開始後三年間における収支の見込みを記載した書面

(iv)a document stating the expected income and expenditures for three years after the commencement of said business.

一法第百五十六条の六第二項　の規定に基づき承認を受けた業務の種類

(i)type of business for which approval was obtained pursuant to the provision of Article 156-6, paragraph (2) of the Act;

二当該業務を廃止した年月日

(ii)date on which said business was discontinued; and

三当該業務を廃止した理由

(iii)reason for discontinuing said business.

一金融商品債務引受業に附帯する業務を行う場合にあっては、その旨

(i)In cases where a business incidental to Financial Instruments DebtAssumption Service is to be conducted, a statement to that effect

二金融商品債務引受業に関連する業務を行う場合にあっては、その旨

(ii)In cases where a business related to Financial Instruments Debt Assumption Service is to be conducted, a statement to that effect

三有価証券等清算取次ぎ（法第二条第二十七項第一号に係るものに限る。）に係る当該有価証券等清算取次ぎを行う清算参加者と顧客の間の基本契約においては、顧客が清算参加者を代理して対象取引を成立させようとするときは、当該顧客が有価証券等清算取次ぎの申込みをし、かつ、当該清算参加者が当該有価証券等清算取次ぎの受託をしたこととする旨

(iii)A statement to the effect that, in a basic contract pertaining to Brokerage for Clearing of Securities, etc. (limited to those pertaining to Article 2, paragraph (27), item (i) of the Act) between a Clearing Participant that provides said Brokerage for Clearing of Securities, etc. and a customer, if the customer intends to have the subject transaction effected on behalf of the Clearing Participant, it is deemed that the customer offered for Brokerage for Clearing of Securities, etc. and that the Clearing Participant accepted the entrustment of said Brokerage for Clearing of Securities, etc.

四市場デリバティブ取引について金融商品債務引受業を行う場合にあっては、取引証拠金に関する事項

(iv)In cases where a Financial Instruments Debt Assumption Service is to be provided for Market Transactions of Derivatives, matters relating to clearing margins

五法第百五十六条の十一　に規定する清算預託金を定める場合にあっては、次に掲げる事項

(v)In cases where provisions for a Clearing Deposit prescribed in Article 156-11 of the Act are made, the following matters:

一変更の内容及び理由

(i)contents of and reason for the amendment; and

二変更予定年月日

(ii)scheduled date of the amendment.

一定款又は業務方法書の新旧対照表

(i)a table that compares new articles of incorporation or business rules with old ones;

二株主総会（法第百五十六条の十九　の規定に基づく承認を受けた会員金融商品取引所（法第八十七条の六第一項　に規定する会員金融商品取引所をいう。以下同じ。）にあっては、総会）の議事録その他必要な手続があったことを証する書面

(ii)minutes of the shareholders meeting (or, in the case of a Membership-Type Financial Instruments Exchange (meaning a Membership-Type Financial Instruments Exchange prescribed in Article 87-6, paragraph (1) of the Act; the same shall apply hereinafter) that has obtained a approval based on the provisions of Article 156-19 of the Act, the general meeting) or other document proving that necessary procedures had been taken; and

三その他参考となる書類

(iii)other documents that will be helpful.

一変更の内容

(i)contents of change; and

二変更年月日

(ii)date of change.

一法第百五十六条の三第一項第二号　又は第三号　に掲げる事項の変更　同条第二項第三号　に掲げる書類

(i)Change of matters specified in Article 156-3, paragraph (1), item (ii) or (iii) of the Act: Documents specified in paragraph (2), item (iii) of that Article

二法第百五十六条の三第一項第四号　に掲げる事項の変更　同条第二項第三号　に掲げる書類及び第二条の二第三号　に掲げる書類

(ii)Change of matters specified in Article 156-3, paragraph (1), item (iv) of the Act: Documents specified in paragraph (2), item (iii) of that Article and documents specified in Article 2-2, item (iii)

三法第百五十六条の三第一項第五号に掲げる事項の変更同条第二項第三号に掲げる書類及び第二条の二第四号に掲げる書類

(iii)Change of matters specified in Article 156-3, paragraph (1), item (v) of the Act:Documents specified in paragraph (2), item (iii) of that Article and documents specified in Article 2-2, item (iv)

一金融商品債務引受業の廃止又は解散の理由を記載した書面

(i)a document stating the reason for abolition or dissolution of Financial Instruments Debt Assumption Service;

二株主総会（会員金融商品取引所にあっては、総会）の議事録（会社法第三百十九条第一項　の規定により株主総会の決議があったものとみなされる場合にあっては、当該場合に該当することを証する書面）

(ii)minutes of the shareholders meeting (or, in the case of a Membership-Type Financial Instruments Exchange, the general meeting) (in cases where a resolution of the shareholders meeting is deemed to have been made pursuant to the provisions of Article 319, paragraph (1) of the Companies Act, a document proving that said cases apply)

三最終事業年度に係る貸借対照表（関連する注記を含む。）及び損益計算書（関連する注記を含む。）並びに当該決議時における資産及び負債の内容を明らかにした書面

(iii)balance sheet (including related notes) and profit and loss statement (including related notes) for last business year as well as a document clarifying what assets and liabilities consisted of as at the time of said resolution;

四金融商品債務引受業の結了の方法を記載した書面

(iv)a document stating the method of completion of Financial Instruments Debt Assumption Service; and

五その他参考となるべき事項を記載した書面

(v)other documents stating matters that will be useful.

一承認を受けようとする業務の種類

(i)type of business for which approval is to be obtained; and

二当該業務の開始予定年月日

(ii)scheduled date of commencement of said business.

一業務方法書

(i)business rules;

二当該業務を所掌する組織及び人員配置を記載した書面

(ii)a document stating the organization and assignment of personnel having jurisdiction over said business; and

三当該業務の開始後三年間における収支の見込みを記載した書面

(iii)a document stating the expected income and expenditures for three years after the commencement of said business.

一会社法第四百三十五条第二項　の附属明細書

(i)annexed detailed statements referred to in Article 435, paragraph (2) of the Companies Act;

二清算預託金明細表

(ii)detailed statement of Clearing Deposit;

三取引証拠金明細表（市場デリバティブ取引について金融商品債務引受業を行う金融商品取引清算機関に限る。）

(iii)detailed statement of clearing margin (limited to Financial Instruments Clearing Organizations that provide Financial Instruments Debt Assumption Service for Market Transactions of Derivatives);

四その他諸勘定明細表

(iv)other detailed statements for various accounts; and

五主要株主の氏名又は商号若しくは名称、住所又は所在地及びその保有する議決権の数を記載した書面

(v)a document stating the name or trade name and address or location of Major Shareholder and the number of voting rights held by that shareholder.

一取締役、会計参与（会計参与が法人であるときは、職務を行うべき社員を含む。）、監査役、執行役又は使用人がその業務を執行するに際し、法令又は業務方法書に違反する行為をしたこと。

(i)violation of laws and regulations or business rules by a director, accounting advisor (or, if the accounting advisor is a juridical person, including the member who is supposed to conduct the duty), company auditor, executive officer or employee upon executing the operations; or

二電子情報処理組織の故障その他偶発的な事情による金融商品債務引受業の全部又は一部の停止

(ii)suspension of all or part of Financial Instruments Debt Assumption Service due to failure of the electronic data processing system or other unforeseeable circumstances.

一事故の詳細

(i)details of the Problematic Conduct;

二事故の改善策

(ii)improvement measures for the Problematic Conduct; and

三その他必要な事項

(iii)other necessary matters.

一当該申請を補正するために要する期間

(i)period required to make corrections to said application;

二当該申請をした者が当該申請の内容を変更するために要する期間

(ii)period required by the person who filed said application to change the content of said application; and

三当該申請をした者が当該申請に係る審査に必要と認められる資料を追加するために要する期間

(iii)period required by the person who filed said application to add materials deemed necessary for examination of said application.