一法第十一条第一項第二号から第六号までに掲げる事項

(i)the information set forth in Article 11, paragraph (1), items (ii) through (vi) of the Act;

二次条第一項各号に掲げる事項（当該事項を公告することが困難である場合には、その旨及びその理由）

(ii)the information set forth in the items of paragraph (1) of the following Article (if it is difficult to give public notice of that information, a statement to that effect and the reason therefor);

三法第十一条第一項の規定による公告を希望する年月日

(iii)the date on which the financial institution wants the public notice under the provisions of Article 11, paragraph (1) of the Act to be given; and

四次条第二項第二号から第六号までに掲げる事項

(iv)the information set forth in paragraph (2), items (ii) through (vi) of the following Article.

一振込利用犯罪行為による被害を受けたことが疑われる者から対象預金口座等（対象預金口座等が法第二条第四項第二号に掲げる預金口座等である場合における当該対象預金口座等に係る資金の移転元となった同項第一号に掲げる預金口座等を含む。次項第三号において同じ。）への振込みが行われた時期

(i)the timing at which funds were transferred to the subject deposit account, etc. (this includes a deposit account, etc. as set forth in Article 2, paragraph (4), item (i) of the Act from which the funds in the subject deposit account, etc. have been moved, if the subject deposit account, etc. is a deposit account, etc. as set forth in item (ii) of that paragraph; the same applies in item (iii) of the following paragraph) by the person who is suspected of having suffered damage due to criminal conduct by means of transfer;

二対象預金口座等が法第二条第四項第二号に掲げる預金口座等である場合においては、その旨及び当該対象預金口座等に係る資金の移転元となった同項第一号に掲げる預金口座等に関する情報（法第十一条第一項第二号及び第三号並びに次項第五号に掲げる事項を除く。）

(ii)if the subject deposit account, etc. is a deposit account, etc. as set forth in Article 2, paragraph (4), item (ii) of the Act, a statement to that effect and the information concerning the deposit account, etc. set forth in item (i) of that paragraph from which the funds in the subject deposit account, etc. have been moved (excluding information as set forth in Article 11, paragraph (1), items (ii) and (iii) of the Act and in item (v) of the following paragraph); and

三その他参考となるべき事項

(iii)any other information that should serve as a reference.

一法第十一条第一項の規定による公告の年月日

(i)the date of the public notice under the provisions of Article 11, paragraph (1) of the Act;

二消滅預金等債権に係る法第七条の規定による公告の年月日

(ii)the date of the public notice under the provisions of Article 7 of the Act regarding the expired claim on deposits, etc.;

三対象預金口座等を利用して行われた振込利用犯罪行為の概要

(iii)an outline of the criminal conduct by means of transfer committed using the subject deposit account, etc.;

四対象預金口座等に係る金融機関が他の金融機関に対して法第四条第三項の規定による通知を行ったときは、その旨及び当該他の金融機関の預金口座等に関する情報

(iv)if the financial institution at which the subject deposit account, etc. is held has given notice under the provisions of Article 4, paragraph (3) of the Act to another financial institution, a statement to that effect and information concerning the deposit account, etc. held with the other financial institution;

五対象預金口座等に係る金融機関が他の金融機関より法第四条第三項の規定による通知を受けたときは、その旨及び当該他の金融機関の預金口座等に関する情報

(v)if the financial institution at which the subject deposit account, etc. is held has been given notice under the provisions of Article 4, paragraph (3) of the Act by another financial institution, a statement to that effect and the information concerning the deposit account, etc. held with the other financial institution; and

六その他必要な事項

(vi)any other necessary information.

一申請人が自然人であるときは、その氏名、生年月日及び住所

(i)if the applicant is a natural person, the applicant's name, date of birth, and address of the applicant;

二申請人が法人又は法人でない団体で代表者若しくは管理人の定めがあるもの（以下「法人等」という。）であるときは、その名称及び住所並びに代表者又は管理人の氏名、生年月日及び住所

(ii)if the applicant is a corporation or an organization without legal personality for which a representative or administrator is appointed (hereinafter referred to as a "corporation, etc."), the applicant's name and address, and the name, date of birth, and address of its representative or administrator;

三申請人が対象被害者の一般承継人であるときは、一般承継の理由及びその年月日並びに当該対象被害者との関係

(iii)if the applicant is the general successor of the subject victim, the reason for and date of the general succession, and the applicant's relationship to the subject victim;

四代理人によって申請をするときは、当該代理人の氏名及び生年月日又は名称並びに住所（代理人に事務所があるときは当該代理人の氏名並びに事務所の名称及び所在地、代理人が法人であるときは当該法人の名称及び所在地並びにその業務を担当する者の氏名。第二十七条第二項第三号及び第二十九条第一項第四号において同じ。）

(iv)if the application is filed by an agent, the agent's name and date of birth or organizational name and address (if the agent has an office, the name of the agent and the name and locality of the agent's office; and if the agent is a corporation, the name and locality of the corporation, and the name of the person in charge of its business; the same applies in Article 27, paragraph (2), item (iii) and Article 29, paragraph (1), item (iv));

五申請人又は代理人の郵便番号、電話番号（ファクシミリの番号を含む。以下同じ。）その他これらの者が法及びこの規則の規定による通知又は書面の送付を受けるために必要な事項

(v)the postal code and telephone number (including a facsimile number; the same applies hereinafter) of the applicant or the agent, and any other information that is needed in order for these persons to be given notice or sent documents under the provisions of the Act and this Regulation;

六控除対象額があるときは、当該てん補又は賠償があった年月日、当該てん補若しくは賠償をした者の氏名又は名称及びその者と対象預金口座等に係る振込利用犯罪行為の加害者と疑われる者との関係、当該てん補若しくは賠償を受けた者の氏名又は名称及びその者と対象被害者又はその一般承継人との関係並びに当該てん補又は賠償の額の内訳

(vi)if there is any amount subject to deduction, the date on which the relevant damage has been covered or compensated for, the name of the person that has covered or compensated for the relevant damage and that person's relationship to the person who is suspected of having engaged in criminal conduct by means of transfer involving the subject deposit account, etc., the name of the person that has received the payment to cover or compensate for the relevant damage and that person's relationship to the subject victim or general successor thereof, and the breakdown of the amount covered or compensated for;

七他の申請人又は申請人となるべき者（以下「他の申請人等」という。）との間で各人が支払を受けるべき被害回復分配金の額の割合について合意があるときは、当該他の申請人等の氏名又は名称、住所、郵便番号及び電話番号並びに当該合意の内容

(vii)if there is an agreement between the applicant and another applicant or person that is eligible to be an applicant (hereinafter referred to as "another applicant, etc.") regarding the ratio of the amount of damage recovery benefits to be received by each of them, the name, address, postal code, and telephone number of that other applicant, etc., and the details of the agreement; and

八被害回復分配金の支払を受ける金融機関の名称及び口座番号その他支払を受けるために必要な事項

(viii)the name of the financial institution and the account number to be used to receive damage recovery benefits, and any other information that is needed in order for the applicant to receive the benefits.

一申請書に記載されている申請人（申請人が法人等である場合にあっては、その代表者又は管理人）及び申請人の代理人（弁護士及び弁護士法人並びに司法書士法（昭和二十五年法律第百九十七号）第三条第二項に規定する司法書士及び同項に規定する簡裁訴訟代理等関係業務を行うことを目的とする司法書士法人を除く。）の氏名、生年月日及び住所と同一の氏名、生年月日及び住所が記載されている運転免許証等（運転免許証、出入国管理及び難民認定法（昭和二十六年政令第三百十九号）第十九条の三に規定する在留カード、日本国との平和条約に基づき日本の国籍を離脱した者等の出入国管理に関する特例法（平成三年法律第七十一号）第七条第一項に規定する特別永住者証明書又は行政手続における特定の個人を識別するための番号の利用等に関する法律（平成二十五年法律第二十七号）第二条第七項に規定する個人番号カードをいう。以下同じ。）で申請の日において有効なものの写しその他これらの者が本人であることを確認するに足りる書類（以下「自然人に係る本人確認書類」という。）

(i)copies of a driver's license, etc. (meaning a driver's license, residence card prescribed in Article 19-3 of the Immigration Control and Refugee Recognition Act (Cabinet Order No. 319 of 1951), special permanent resident certificate prescribed in Article 7, paragraph (1) of the Special Act on the Immigration Control of, Inter Alia, Those Who Have Lost Japanese Nationality Pursuant to the Treaty of Peace with Japan (Act No. 71 of 1991), or individual number card prescribed in Article 2, paragraph (7) of the Act on the Use of Numbers to Identify a Specific Individual in Administrative Procedures (Act No. 27 of 2013); the same applies hereinafter) that is valid as of the date of the request, giving the same name, date of birth, and address as the name, date of birth, and address of the applicant (or of its representative or administrator, if the applicant is a corporation, etc.) and of the applicant's agent (other than an attorney or legal professional corporation, a judicial scrivener as prescribed in Article 3, paragraph (2) of the Judicial Scriveners Act (Act No. 197 of 1950), or a judicial scrivener corporation formed for the purpose of providing the summary court legal representation services, etc. prescribed in that paragraph) that are written in the application form, and which are valid as of the date of application, or any other documents sufficient for use in verifying their identities (hereinafter referred to as an "identity verification document associated with a natural person");

二申請人が法人等であるときは、申請書に記載されている当該法人等の名称及び住所並びに代表者又は管理人の氏名と同一の名称及び住所並びに氏名が記載されている登記事項証明書又は印鑑登録証明書で申請日前六月以内に作成されたものその他その者が本人であることを確認するに足りる書類（以下「法人等に係る本人確認書類」という。）

(ii)if the applicant is a corporation, etc., a certificate of registered information or certificate of seal registration, prepared within six months prior to the date of application, giving the same name and address and representative or administrator name as the name and address of the corporation, etc. and the name of its representative or administrator that is written on the application form, or any other documents sufficient for use in verifying its identity (hereinafter referred to as an "identity verification document associated with a corporation, etc.");

三金融機関が作成した振込みの明細書の写しその他の申請人（申請人が対象被害者の一般承継人である場合にあっては、その被承継人）が対象被害者であることの基礎となる事実を疎明するに足りる資料

(iii)materials that make a prima facie showing of the facts fundamental to show that the applicant (or the predecessor thereof, if the applicant is the general successor of the subject victim) is the subject victim, such as a copy of the transfer statement prepared by the financial institution;

四申請人が対象被害者の一般承継人であるときは、一般承継の理由及びその年月日並びに対象被害者との関係を明らかにする戸籍の謄本若しくは抄本又は法人の登記事項証明書で申請日前六月以内に作成されたものその他申請人が一般承継人であることの基礎となる事実を疎明するに足りる資料

(iv)if the applicant is the general successor of the subject victim, a certified copy or extract of the family register or certificate of registered information of the corporation that shows the reason for and date of the general succession and the applicant's relationship to the subject victim and that has been prepared within six months prior to the date of application, and any other materials that make a prima facie showing of the facts fundamental to show that the applicant is the general successor;

五代理人によって申請をするときは、代理権を証する資料

(v)if the application is filed by an agent, materials evidencing the authority to represent;

六法第十二条第一項第二号に掲げる事項を疎明するに足りる資料

(vi)materials that make a prima facie showing of the information set forth in Article 12, paragraph (1), item (ii) of the Act;

七控除対象額があるときは、前条第一項第六号に掲げる事項を明らかにする資料

(vii)if there is any amount subject to deduction, materials that show the information set forth in paragraph (1), item (vi) of the preceding Article; and

八他の申請人等との間で各人が支払を受けるべき被害回復分配金の額の割合について合意があるときは、前条第一項第七号に掲げる事項を明らかにする資料

(viii)if there is an agreement between the applicant and another applicant, etc. on the ratio of the amount of damage recovery benefits to be received by each of them, materials that show the information set forth in paragraph (1), item (vii) of the preceding Article.

一申請人の氏名又は名称及び住所

(i)the name and address of the applicant;

二申請人が法人等であるときは、その法人等の代表者又は管理人の氏名及び住所

(ii)if the applicant is a corporation, etc., the name and address of its representative or administrator;

三代理人があるときは、その代理人の氏名又は名称及び住所（代理人に事務所があるときは当該代理人の氏名並びに事務所の名称及び所在地、代理人が法人であるときは当該法人の名称及び所在地並びにその業務を担当する者の氏名）

(iii)if the applicant has an agent, the agent's name and address (if the agent has an office, the name of the agent and the name and locality of the agent's office; if the agent is a corporation, the name and locality of the corporation and the name of the person in charge of its business);

四法第十三条の規定による決定の年月日

(iv)the date of the determination under the provisions of Article 13 of the Act; and

五法第十三条の規定による決定の結果及びその理由

(v)the result of and reason for the determination under the provisions of Article 13 of the Act.

一法第十一条第一項第二号から第四号までに掲げる事項

(i)the information set forth in Article 11, paragraph (1), items (ii) through (iv) of the Act;

二本店又は主たる営業所若しくは事務所（銀行法（昭和五十六年法律第五十九号）第十条第二項第八号に規定する外国銀行にあっては、同法第四十七条第一項に規定する主たる外国銀行支店。以下「本店等」という。）に決定書を保管し、いつでも申請人に交付する旨

(ii)an indication that the financial institution has retained the written determination at its head office, principal business office, or principal office (or at the principal foreign bank branch prescribed in Article 47, paragraph (1) of the Banking Act (Act No. 59 of 1981), in the case of a foreign bank prescribed in Article 10, paragraph (2), item (viii) of that Act; hereinafter referred to as the "head office, etc.") and will deliver it to the applicant at any time; and

三その他必要な事項

(iii)any other necessary information.

一決定書を申請人に送付することができない旨

(i)that the financial institution is unable to send the written determination to the applicant;

二法第十一条第一項第二号から第四号までに掲げる事項

(ii)the information set forth in Article 11, paragraph (1), items (ii) through (iv);

三金融機関がその本店等に決定書を保管し、いつでも申請人に交付する旨

(iii)that the financial institution has retained the written determination at its head office, etc. and will deliver it to the applicant at any time;

四公告の日から起算して二週間を経過した日に決定書が申請人に到達したものとみなされる旨

(iv)that the written determination is deemed to have arrived at the applicant as of the day that marks two weeks' time since the date of the public notice; and

五その他必要な事項

(v)any other necessary information.

一支払該当者決定の年月日（支払該当者決定を受けた者がないときは、法第十三条第一項の規定による決定の年月日）

(i)the date of the determination of eligible recipient (if no person is subject to a determination of eligible recipient, the date of the determination under the provisions of Article 13 of the Act); and

二各人が支払を受けるべき被害回復分配金の額

(ii)the amount of damage recovery benefits that each person subject to a determination of eligible recipient is to be paid.

一申請人が自然人である場合において当該申請人が請求人であるときは、その氏名、生年月日及び住所

(i)if the applicant is a natural person and that applicant is the person making the request, the name, date of birth, and address of the applicant;

二申請人が法人等である場合において当該申請人が請求人であるときは、その名称及び住所並びに代表者又は管理人の氏名、生年月日及び住所

(ii)if the applicant is a corporation, etc. and that applicant is the person making the request, the name and address of the applicant and the name, date of birth, and address of its representative or administrator;

三申請人の代理人が請求人であるときは、当該申請人の氏名又は名称及び住所並びに当該代理人の氏名及び生年月日又は名称並びに住所

(iii)if the request is made by the applicant's agent, the name and address of the applicant and the name and date of birth or organizational name and address of the agent;

四閲覧を請求する事項

(iv)the information that the person is requesting to inspect;

五閲覧の目的

(v)the purpose of inspecting it;

六閲覧を希望する日時

(vi)the date and time that the person wishes to inspect it; and

七閲覧を希望する場所

(vii)the place at which the person wishes to inspect it.

一対象預金口座等に係る金融機関及びその店舗並びに預金等の種別及び口座番号

(i)the financial institution and its branch at which the subject deposit account, etc. is held, as well as the type of deposits, etc. and the account number of the subject deposit account, etc.;

二対象預金口座等の名義人の氏名又は名称

(ii)the name of the registered holder of the subject deposit account, etc.;

三消滅預金等債権の額

(iii)the amount of the expired claim on deposits, etc.;

四消滅預金等債権に係る法第七条の規定による公告の年月日

(iv)the date of the public notice under the provisions of Article 7 of the Act regarding the expired claim on deposits, etc.; and

五その他必要な事項

(v)any other necessary information.

一届出人が自然人であるときは、その氏名、生年月日及び住所

(i)if the notifier is a natural person, the name, date of birth, and address of the notifier;

二届出人が法人等であるときは、その名称及び住所並びに代表者又は管理人の氏名、生年月日及び住所

(ii)if the notifier is a corporation, etc., the name and address of the notifier, and the name, date of birth, and address of its representative or administrator;

三一般承継の理由及びその年月日並びに支払該当者決定を受けた者との関係

(iii)the reason for and date of general succession, and the notifier's relationship to the person subject to the determination of eligible recipient;

四代理人によって届出をするときは、当該代理人の氏名及び生年月日又は名称並びに住所

(iv)if the notification is made by an agent, the agent's name and date of birth or organizational name and address;

五届出人又は代理人の郵便番号、電話番号その他これらの者が法及びこの規則の規定による通知又は書面の送付を受けるために必要な事項

(v)the postal code and telephone number of the notifier or the agent, and any other information that is needed in order for these persons to be given notice or sent documents under the provisions of the Act and this Regulation;

六他の届出人又は届出人となるべき者（以下「他の届出人等」という。）との間で各人が支払を受けるべき被害回復分配金の額の割合について合意があるときは、当該他の届出人等の氏名又は名称、住所、郵便番号及び電話番号並びに当該合意の内容

(vi)if there is an agreement between the notifier and another notifier or person eligible to be a notifier (hereinafter referred to as the "other notifier, etc.") on the ratio of the amount of damage recovery benefits to be received by each of them, the name, address, postal code, and telephone number of that other notifier, etc., and the details of the agreement; and

七被害回復分配金の支払を受ける金融機関の名称及び口座番号その他支払を受けるために必要な事項

(vii)the name of the financial institution and the account number to be used to receive damage recovery benefits and any other information that is needed in order for the notifier to receive the benefits.

一届出書に記載されている届出人（届出人が法人等である場合にあっては、その代表者又は管理人）及び届出人の代理人（弁護士及び弁護士法人並びに司法書士法第三条第二項に規定する司法書士及び同項に規定する簡裁訴訟代理等関係業務を行うことを目的とする司法書士法人を除く。）の氏名、生年月日及び住所と同一の氏名、生年月日及び住所が記載されている自然人に係る本人確認書類

(i)identity verification documents associated with a natural person giving the same names, dates of birth, and addresses as the names, dates of birth, and addresses of the notifier (or its representative or administrator, if the notifier is a corporation, etc.) and the notifier's agent (excluding an attorney or legal professional corporation, a judicial scrivener as prescribed in Article 3, paragraph (2) of the Judicial Scriveners Act, or a judicial scrivener corporation formed for the purpose of providing summary court legal representation services, etc. as prescribed in that paragraph) that are written in the written notification;

二届出人が法人等であるときは、届出書に記載されている当該法人等の名称及び住所並びに代表者又は管理人の氏名と同一の名称及び住所並びに氏名が記載されている法人等に係る本人確認書類

(ii)if the notifier is a corporation, etc., an identity verification document associated with a corporation, etc. giving the same name and address and representative or administrator name as the name and address of the corporation, etc. and the name of its representative or administrator that is written in the written notification;

三一般承継の理由及びその年月日並びに支払該当者決定を受けた者との関係を明らかにする戸籍の謄本若しくは抄本又は法人の登記事項証明書で届出日前六月以内に作成されたものその他届出人が一般承継人であることの基礎となる事実を疎明するに足りる資料

(iii)a certified copy or extract of the family register or certificate of registered information of the corporation, prepared within six months prior to the date of notification, showing the reason for and date of the general succession and the notifier's relationship to the person subject to the determination of eligible recipient, or other materials sufficient to make a prima facie showing of factual circumstances fundamental to establish that the notifier is a general successor;

四代理人によって届出をするときは、代理権を証する資料

(iv)if the notification is made by an agent, materials evidencing the authority to represent; and

五他の届出人等との間で各人が支払を受けるべき被害回復分配金の額の割合について合意があるときは、第一項第六号に掲げる事項を明らかにする資料

(v)if there is an agreement between the notifier and another notifier, etc. on the ratio of the amount of damage recovery benefits to be received by each of them, materials that show the information set forth in paragraph (1), item (vi).

一法第十八条第一項各号のいずれに該当するかの別

(i)which one of the items of Article 18, paragraph (1) of the Act applies;

二消滅預金等債権の額（法第十八条第一項第四号に該当する場合を除く。）

(ii)the amount of the expired claim on deposits, etc. (excluding a case falling under Article 18, paragraph (1), item (iv) of the Act);

三支払該当者決定を受けた者に対する支払額の総額（法第十八条第一項第三号に該当する場合に限る。）

(iii)the total amount to be paid to the person subject to the determination of eligible recipient (limited to a case falling under Article 18, paragraph (1), item (iii) of the Act);

四法第十九条の規定による預金保険機構への納付予定額

(iv)the scheduled amount of payment to the Deposit Insurance Corporation under the provisions of Article 19 of the Act; and

五その他必要な事項

(v)any other necessary information.

一預金等に係る債権の消滅手続に関して金融機関が行った調査の内容を記載した書面（次号の判断の基礎とした資料を含む。）

(i)a document describing the details of an investigation conducted by the financial institution in connection with the procedure for expiry of the claim on deposits, etc. (including materials used as the basis for the assessment referred to in the following item);

二預金等に係る債権の消滅手続を行った預金口座等について犯罪利用預金口座等であると疑うに足りる相当な理由を記載した書面

(ii)a document describing the probable cause to suspect that the deposit account, etc. for which the procedure for expiry of the claim on deposits, etc. has been implemented is a deposit account, etc. used for crime;

三被害回復分配金の支払手続に関して金融機関が行った手続の内容を記載した書面

(iii)a document describing the details of the procedure implemented by the financial institution in connection with the procedure for payment of damage recovery benefits;

四支払該当者決定並びに犯罪被害額及び被害回復分配金の額の決定の内容並びにその理由を記載した書面

(iv)a document describing the details of and reason for a determination of eligible recipient and a determination of the amount of criminal damages and the amount of damage recovery benefits;

五法第二十五条第一項又は第二項の規定による名義人等への支払に関して金融機関が行った調査の内容を記載した書面（次号の判断の基礎とした資料を含む。）

(v)a document describing the details of an investigation conducted by the financial institution with regard to making a payment to the registered holder, etc. under the provisions of Article 25, paragraph (1) or (2) of the Act (including materials used as the basis for the assessment referred to in the following item);

六名義人等が法第二十五条第一項又は第二項に基づく支払を請求することができると判断した理由を記載した書面

(vi)a document describing its reason for judging that the registered holder, etc. is eligible to request payment under the provisions of Article 25, paragraph (1) or (2) of the Act;

七次項各号に掲げる要件に該当すると判断した理由を記載した書面

(vii)a document describing its reason for judging that the requirements set forth in the items of the following paragraph are satisfied; and

八その他参考となるべき事項を記載した書面

(viii)a document containing any other information that should serve as a reference.

一法令等に基づき当該手続を実施したと認められること。

(i)it is found that the financial institution has implemented the relevant procedures based on laws and regulations, etc.; and

二預金等に係る債権の消滅手続を行った預金口座等が犯罪利用預金口座等でないこと及び申請人が被害回復分配金の支払を受けることができる者でないことについて相当な注意を用いたにもかかわらず知ることができなかったと認められること。

(ii)it is found that, in spite of the financial institution having exercised reasonable care, it was not possible for it to know that the deposit account, etc. for which it implemented the procedures for expiry of the claim on deposits, etc. was not a deposit account, etc. used for crime, and that the applicant was not a person eligible to receive payment of damage recovery benefits.