ࡱ> 13./0 R_bjbj$$IzF|F|=<<8L96IJh~j~j~j~j~j~j~$S*~5II~T h~ h~ szua`vFT~<v/+/zz/z" ~~9 L/<+ g: Application Form for Initial Listing of a Security(Foreign ETN Trust Beneficiary Certificate)Date of Submission: DD/MM/YYYYTo President and CEO,Tokyo Stock Exchange, Inc. Name of Issuer000000000000Name and Title of00000000000Representative0000000000000We hereby apply to list the following security:1. Security for which listing application is madeIssueNo. of Units of Beneficiary RightsNo. of Units per Trading UnitAmount of Trust PrincipalMaximum Amount of Trust PrincipalunitsunitsJPY(000000000 )JPY[Trust Assets (Entrusted Securities)]Name of Foreign ETNTotal Redemption Value of Foreign ETNRedemption Value per Security of Foreign ETN Maximum Issuance Value of Foreign ETN JPY(000000000 )JPY(000000000 )JPY(000000000 )(Note) Rate applied:(1) State of Security for which Listing Application is made`$ Specific indicator which the security tracksName of IndicatorName of Providera$ Outstanding beneficiary certificates as of application date (initial creation date) Application (Initial Creation) DateNo. of Units of Beneficiary Rights Amount of Trust Principal No. of UnitsunitsJPY(000000000 )units(Note) Rate applied:b$ Summary of trust assets, etc.[Trust agreement]Period of Trust Agreement[Security for which listing application is made] Response to Acquisition Requests Recipient of acquisition requestsFrequency of accepting acquisition requestsDaily000/000Other (0000business days)Unit for accepting acquisition requestsJPY / units[Trust assets (entrusted securities)]Response to Redemption RequestsFrequency of accepting redemption requestsDaily000/000Other (0000business days)Unit for accepting redemption requestsLocal currency / quantityFinal Redemption DeadlineDD/MM/YYYYDate of Deciding Final Redemption Value, etc.Decision date: 000000000 DD/MM/YYYYDecision method:Listed on Foreign Financial Instruments Exchange, etc.Main foreign financial instruments exchange where it is listed (*):Other foreign financial instruments exchange where it is listed:* Book-entry transfer and settlement institution:Trading Currency Unit on Main Foreign Financial Instruments Exchange, etc.Name of Law pertaining to Foreign ETNc$ Handling of security for which listing application was made by book-entry transfer institutionHandled00/00To be handled in future(2) Status of Issuer, etc.`$ Overview of issuer, etc. [Issuer]Trade Name or Company NameAddress of Head OfficeDate of Establishment(commenced business on)000000000DD/MM/YYYY00000(DD/MM/YYYY)Content of BusinessStatus of Registration as Registered Financial Institution, etc.Registered Financial InstitutionApplicable /000Not applicableFinancial Instruments Business OperatorApplicable /000Not applicableParty equivalent to any of the aboveApplicable /000Not applicableHolding company of a financial firm (*)Applicable /000Not applicable* Name of subsidiary(s):0000000000000000000(Shareholding ratio:0000%)Name of Supervisory Authority, etc.[Guarantor] Trade Name or Company NameAddress of Head OfficeDate of Establishment(commenced business on)000000000DD/MM/YYYY00000(DD/MM/YYYY)Content of BusinessStatus of Guarantor's Registration as Registered Financial Institution, etc.Registered Financial InstitutionApplicable /000Not applicableFinancial Instruments Business OperatorApplicable /000Not applicableParty equivalent to any of the aboveApplicable /000Not applicableHolding company of financial firm(s) (*)Applicable /000Not applicable* Name of subsidiary(s):0000000000000000000(Shareholding ratio:0000%)Name of Supervisory Authority, etc.Appropriate GuaranteeApplicable /000Not applicable[Trustor]Trade Name or Company NameAddress of Head Office[Trustee]Trade Name or Company NameAddress of Head Officea$ Financial condition of issuer, etc. [Issuer]Net Worth00000000000000000JPY00000000000000000000000000000 Capital Adequacy Ratio%Credit RatingRatingDate obtainedRatings agencyRegistered Credit Ratings AgencyApplicable /000Not applicableStatus of Guarantee for Foreign ETN(s) Issued by the Company or Other Company(s)Amount of guarantee for security(s) issued by the company (*):00000000000000000JPY* Issue name:Amount of guarantee for security(s) issued by other company(s) (*):000000000JPY* Name of issuer:[Guarantor]Net Worth00000000000000000JPY00000000000000000000000000000 Capital Adequacy Ratio%Credit RatingRatingDate obtainedRatings agencyRegistered Credit Ratings AgencyApplicable /000Not applicableStatus of Guarantee for Foreign ETN(s) Issued by the Company or Other Company(s)Amount of guarantee for security(s) issued by the company (*):00000000000000000JPYAmount of guarantee for security(s) issued by other company(s) (*):000000000JPY* Name of issuer:(Note) Rate applied:(3) Matters Concerning Alteration ListingThe total number of units of beneficiary rights for which the listing application was made may change due to additional issuance within the number of beneficiary right units which is derived by dividing the above maximum amount of trust principal by the value per unit. As long as the total amount from additional issuance remains below the limit, this Application Form will suffice as an alteration application for a change in the number of listed.2. Other(1) Scheduled Trend of Number of Investment Units from Listing Application to Listing DateDateNo. of Additional Investment Units (Quantity)No. of Investment Unitsafter AdditionRemarksunits units (2) Auditor Opinion (Financial Statements, etc. of Issuer/Guarantor)[Issuer]Name of Current Certified Public Accountant or Audit Firm 000000000000000000000 Quarter0(DD/MM/YYYY^D/MM/YYYY)Quarter0(DD/MM/YYYY^D/MM/YYYY)Quarter0(DD/MM/YYYY^D/MM/YYYY)Quarter0(DD/MM/YYYY^D/MM/YYYY)Name of Certified Public Accountant or Audit FirmAudit Opinion pertaining to Financial Statements and Interim Financial Statements based on the Financial Instruments and Exchange Act[Guarantor]Name of Current Certified Public Accountant or Audit Firm 00000000000000000 0000Quarter0(DD/MM/YYYY^D/MM/YYYY)Quarter0(DD/MM/YYYY^D/MM/YYYY)Quarter0(DD/MM/YYYY^D/MM/YYYY)Quarter0(DD/MM/YYYY^D/MM/YYYY)Name of Certified Public Accountant or Audit FirmAudit Opinion pertaining to Financial Statements and Interim Financial Statements based on the Financial Instruments and Exchange Act (Notes on description)This "Application Form for Initial Listing of a Security" is used for foreign ETN trust beneficiary certificates. Foreign ETN trust beneficiary certificates mean foreign ETN trust beneficiary certificates prescribed in Rule 2, Item 13-3 of the Securities Listing Regulations, a foreign ETN means a foreign ETN prescribed in Rule 13-2 of the same rule in the same regulations, an issuer means an issuer prescribed in Rule 941, Paragraph 1 of the Securities Listing Regulations.If an issuer applies for the listing of multiple issues at the same time, please use the "Appendix" (Excel file) for "1. Securities for which listing application were made" and "(1) Status of securities for which listing application were made". (Please attach the Appendix to this application form.)1. Security for which listing application is made(a) If an issuer applies for the listing of multiple issues at the same time, please use the "Appendix" (Excel file) and state "Refer to appendix" in the "Issue" column. Please attach the Appendix to this application form. In this case, please leave the items in "1. Security for which listing application is made" and "(1) Status of security for which listing application is made" in this application form blank and state these items in the Appendix.(b) Please state the expected numerical values of the following as of the listing date: number of units of beneficiary rights, amount of trust principal, and total redemption value of foreign ETN trust beneficiary certificates.(c) Please state in parentheses the cash amount in local currency of the following: amount of trust principal, total redemption value of foreign ETN trust beneficiary certificates, redemption value per security of foreign ETN, maximum issuance value of foreign ETN.(d) Please submit the "Notice of Fixing Securities for which Listing Application was Made" predetermined by TSE immediately after the number of units of beneficiary rights and amount of trust principal at listing have been fixed.(1) Status of security for which listing application is madea$ Outstanding beneficiary 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h{tCJOJPJQJhJsCJOJPJQJo(hthhasCJOJPJQJh"hasCJOJQJhthhTCJOJQJhthhasCJOJQJhJsCJOJQJo(hthhthCJOJQJhthhasCJOJQJaJhJsCJOJPJQJaJo( hthhthCJOJPJQJaJ hthhasCJOJPJQJaJDDEFENEhEjEEEEEEEF,b,p,r,V-h---...6.J.b.d.l.......&/,/\/n///00"0>0@0N0P0b0d0z0|0000˿࣬hKCJOJo(h"h[CJOJQJo(h0CJOJo(h CJOJUhtCJOJo(h/*2h CJOJo(h/*2h/*2CJOJo(h/*2CJOJo(h CJOJo(h"h[CJOJQJhJsCJOJo(6ciary certificates. In "Recipient of acquisition requests", please state the person or party which will receive and respond to acquisition requests. Please also state the frequency of responding to acquisition requests and the unit for accepting acquisition requests.[Trust assets (entrusted securities)](b) "Response to Redemption Requests" refers to redemption requests to the issuer of the foreign ETN. Please also state the frequency of responding to redemption requests and the unit for accepting redemption requests.(c) In "Listed on Foreign Financial Instruments Exchange, etc.", please state the foreign financial instruments exchanges (those prescribed in the provisions of Rule 2, Item 13 of the Securities Listing Regulations) where the foreign ETN which is the entrusted security of the security for which a listing application was made, is or expected to be listed or continuously traded. Please state the foreign financial instruments exchange, etc. where it has the highest liquidity, and also state other foreign financial instruments exchanges, etc. for other markets on which it is listed. For the main foreign financial instruments exchange where it is listed, please state the corresponding book-entry transfer and settlement institution in "* Book-entry transfer and settlement institution".(d) In " Name of Law pertaining to Foreign ETN ", please state the name of the law, pertaining to the security for which listing application is made, on the foreign financial instruments exchange, etc. where such security is listed.c$ Handling of security for which listing application was made by book-entry transfer institutionIf the security is already listed on another exchange, etc. and is being handled in the book-entry transfer operations of the designated book-entry transfer institution (Japan Securities Depository Center, Inc.), please indicate "Handled". If the security is expected to be handled in the book-entry transfer operations of the designated transfer institution before listing, please indicate "To be handled in future".(2) Status of issuer, etc.`$ Overview of issuer, etc.[Issuer](a) For "Registered Financial Institution", please indicate registration status in accordance with Registered Financial Institution prescribed in the provisions of Article 2, Paragraph 11 of the Financial Instruments and Exchange Act.(b) For "Financial Instruments Business Operator", please indicate registration status in accordance with Financial Instruments Business Operator prescribed in the provisions of Article 2, Paragraph 9 of the Financial Instruments and Exchange Act. (c) "Party equivalent any of the above" refers to foreign financial institutions equivalent to a Registered Financial Institution or Financial Instruments Business Operator. Please indicate such status accordingly.(d) "Holding company of financial firm(s)" refers to a company prescribed in the provisions of Rule 939, Paragraph 1 of the Enforcement Rules for Securities Listing Regulations. If it is a holding company of financial firm(s), for subsidiary(s), please state Registered Financial Institutions and Financial Instruments Business Operators or equivalent parties for which it conducts business management as subsidiaries, their trade names or company names, and the shareholding ratios in such subsidiaries.(e) In "Name of Supervisory Authority, etc.", please state the name of the supervisory authority or equivalent institution pertaining to the issuer according to the address of the head office of such issuer.[Guarantor](f) Please state the items for guarantor only if there is a party other than the issuer providing an appropriate guarantee.(g) Please state according to the above (a) through (e) for issuer. "Issuer" in the above (e) shall be read as "guarantor".(h) "Appropriate Guarantee" refers to an appropriate guarantee prescribed in the provisions of Rule 935, Paragraph 1 of the Enforcement Rules for Securities Listing Regulations. Please indicate such status accordingly.a$ Financial condition of issuer, etc. [Issuer](a) Please state the status as of the end of the last business year.(b) For "Net Worth", in the case of a Financial Instruments Business Operator, please state amount of net assets. Please state in parentheses the cash amount in local currency.(c) For "Capital Adequacy Ratio", in the case of an insurance company, please state the solvency margin ratio; in the case of a Financial Instruments Business Operator, please state net capital regulation ratio.(d) If several credit ratings were obtained, please state the best credit rating.(e) In "Registered Credit Ratings Agency", please indicate status as Registered Credit Ratings Agency prescribed in the provisions of Article 2, Paragraph 36 of the Financial Instruments and Exchange Act, or Specified Related Corporation prescribed in the provisions of Article 116-3, Paragraph 2 of the Cabinet Office Ordinance on Financial Instruments Business, etc.(f) In "Amount of guarantee for security(s) issued by the company", please state the amount guaranteed by the company for foreign ETNS issued by the company. In addition, if there are foreign ETNS other than the security for which listing application was made, please state the names of such issues in "* Name of issuer ".(g) In "Amount of guarantee for security(s) issued by other company(s)", please state the amount guaranteed by the company for foreign ETNS issued by another company. If it does so, in "* Name of issuer", please state such other company.[Guarantor](h) Please state the items for a guarantor only if there is a party other than the issuer providing an appropriate guarantee.(i) Please state according to the above (a) through (g) for an issuer.2. Other(2) Audit opinion (financial statements, etc. of issuer/guarantor)(a) In "Name of Current Certified Public Accountant or Audit Firm", please state the name of the certified public account or audit firm with which an audit contract was concluded as of the listing application date.(b) If the last two (2) business years or consolidated accounting fiscal years prior to the listing application date were subject to audit pursuant to the Financial Instruments and Exchange Act, please state the audit opinion described in such audit report, and interim audit report (in the case of a company which submits quarterly financial statements or a company which submits consolidated quarterly financial statements, a quarterly review report).(c) If an audit opinion prescribed in (a) is not available, please state such fact and the reason in place of the statement.FE.d.0H6888"<$<Z<<}}xm WDd`gd[gd;I;VDWDd^;`gd3V:VDdWD^:`gd3V VDWD^ `gdM+ VDWDs^ `gd  VDWDs^ `gdkeVDWDQ^e`gd WD`gd :VDWDj^:`gd 0000 1101112222"2$242D3V3F6H6P6X6Z666667侲䚏wj`RGh0JsCJOJaJo(hfhfCJOJaJo(htCJOJaJh5MhfCJOJaJhfhfCJOJaJhCJOJaJo(hJsCJOJaJo(h"h[CJOJQJaJh[-CJOJo(h[-h[-CJOJo(h[-hkCJOJo(htCJOJo(hs[CJOJo(hkCJOJhkCJOJo(hKCJOJo(hA\CJOJo(78888 888:::<< <"<$<X<Z<\<^<<ĵwj[N?h;Ih;ICJOJPJQJh;ICJOJPJQJo(hthh[CJOJPJQJh"h[CJOJQJh"h3VCJOJQJo(hTCJOJo(h;ICJOJh;ICJOJo(hERCJOJo(h"h3VCJOJQJhERh0JsCJOJPJQJh0JsCJOJPJQJo(hthh3VCJOJPJQJhM+CJOJaJo(h0JsCJOJaJo(h0JsCJOJaJ<<<<<<<<h===v>x>>>>>>>>,?@?L??????8@f@h@j@t@~@@@@,A2AlAtAAAԻ˲ꦙtkԻh0CJOJo(h[hPCJOJo(h[h0CJOJo(h[hasCJOJQJh[h;ICJOJQJh[h;ICJOJo(hCJOJo(hPCJOJh;ICJOJhW=CJOJo(hPCJOJo(h"hasCJOJQJh;ICJOJo(h;IhasCJOJQJ*<<x>j@B FGGGHIjKlKKw:VDdWD^:`gdas1VDdWD^`1gdas VDWD^ `gdVDWD1^`gd;I8VDWDj^8`gd0 VDWD^ `gdTIGVDWDc^G`gd;I9VDWD^9`gd;IABB BdBjBBBBDDF FF*F,FBFDFFFGGGGGGHHtHHHIIIII2JFJhKlKnKpKΎvih;ICJOJPJQJo(hthh[CJOJPJQJhnH:CJOJo(hCJOJo(hbuCJOJo(h;ICJOJh}hasCJOJQJh0CJOJhCJOJo(h/OFCJOJhs[CJOJo(h/OFCJOJo(h;ICJOJo(h"hasCJOJQJh0CJOJo((pKKKKKKTLVL^LfLjLpLrLzL|LLLMMMMMMMMMMNN^O`OhOPP PPTPPPQ׸׸w׸׸lh7CJOJaJo(huhuCJOJo(h7CJOJo(h`jCJOJo(h@dCJOJh}CJOJo(huCJOJo(h@dCJOJo(hbuCJOJo(h"h;ICJOJQJh;ICJOJo(h"hasCJOJQJhbuh;ICJOJQJhbuh;ICJOJPJQJ'KKVLM`OPRlUHWJWbW^XXXYgdasVDWD1^`gd;I VDWD^ `gdV9* VDWD^ `gdC}2 VDWD^ `gdu VDWD^ `gd@dVDWD1^`gdbu 9VD^9gd;IQQQQQQQQQRRRRRRRRSSfTnTTTTUDURUZUdUfUjUlUtUxVǾ~pcZhV9*CJOJo(h"hasCJOJQJhnH:hnH:CJOJaJo(hnH:CJOJPJQJaJo( h5hnH:CJOJPJQJaJhC}2CJOJaJh7CJOJaJo(hC}2CJOJaJo(hC}2CJOJo(hbuCJOJo(huCJOJo(hO(CJOJo(h`jCJOJo(h7Sh7SCJOJh7SCJOJo(!xVzVVVVVWFWHWJW`WbWWWWWW\X^XXXXXXYYYYYYYYYYYYYʻ۲sfs]]]]]hnH:CJOJo(h[hasCJOJQJh[hICJOJo(h[hbuCJOJo(hbuCJOJhbuCJOJo(h;ICJOJo(h"hasCJOJQJhV9*CJOJo(hnH:CJOJPJQJaJo( h5hnH:CJOJPJQJaJhV9*CJOJaJo(h7CJOJaJo(hV9*hV9*CJOJaJo($YY4[^_________________FZUDVDdWD2]F^`ZgdItVDWDJ^t`gdV9* VDWD^ `gdV9*VD9WD^`gdV9*YZZ(Z.Z[[[[[(\\]]^^^________________________hi-hdjhdUhIhnH:CJOJo(hs[CJOJo(h"hasCJOJQJh|CJOJh|CJOJo(hV9*CJOJhnH:CJOJo(hV9*CJOJo((_______FZUDVDdWD2]F^`ZgdIG0P&P 1h2P:pJ,. 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