2. (As of mm/dd/yyyy) *Enter the same date of Page (No.1) □ 3. Officers and employees specified under a Cabinet Order □ *Enter the name of executing person, etc. if the corporate officer is a juridical person. Personal or company name * Enter FURIGANA if the name is written in Japanese characters. □ ① Organizational position □ ② Type of the employee specified by a Cabinet Order □ ③ 4. Status of the branch or business office where SPBQII is operated □ Name ① *Enter also the "Registered address of the head office" if the "Principal business office" is not located at such □ address. Location * Be sure to include the building name and floor. □ ② Phone □ ③ 5. Status of Representative in Japan or Agents in Japan □ Name or name of business ① □ *Enter "Not applicable" if the applicant is a Japanese corporation or an individual who has residency in Japan. Location or address Be sure to include the building name and floor. □ ② □ ③
□ 2. (As of mm/dd/yyyy) *Enter the same date of Page (No.1) □ 3. Officers and employees specified under a Cabinet Order *Enter the name of executing person, etc. if the corporate officer is a juridical person. □ ① Personal or company name * Enter FURIGANA if the name is written in Japanese characters. □ ② Organizational position □ ③ Type of the employee specified by a Cabinet Order □ 4. Status of the branch or business office where SPBQII is operated □ ① Name *Enter also the "Registered address of the head office" if the "Principal business office" is not located at such address. □ ② Location * Be sure to include the building name and floor. □ ③ Phone □ 5. Status of Representative in Japan or Agents in Japan □ ① Name or name of business *Enter "Not applicable" if the applicant is a Japanese corporation or an individual who has residency in Japan. □ ② Location or address Be sure to include the building name and floor. □ ③
000188950.docx