All dates in this document
should be written in Westerncalendar. Amounts should berounded down to the nearest
indicated unit. Percentages
should be rounded off to thefirst decimal place.

Profile of Applicant Company
１．Company Profile①

Name of Applicant Company
Director-General of the②

Registration Number

If unregistered:・Formal Application(Kanto, dated [Month][Day])・Preliminary
consultation is inprogress.

Local

Financial Bureau (Kinsho) No.
(Registered on [Month] [Day], [Year])Type 1 / Type 2 / Investment Advisory andAgency Business / Investment ManagementBusiness③Business Category, etc.

Electronic Public Offering Services /Electronic-based Application Type Electronic
Public Offering Services
Act of Management of Specified Securities, etc.

④Location⑤

Date of Incorporation⑥Website URL[Month] [Day], [Year]https://[Month],

Please describe briefly.
Please be sure to enter theyear and month of registration
for the Real Estate Brokerageand the Money Lending
Business.

[Year][Month],⑦

History[Year][Month],[Year]
Chairman and Representative Director⑧Title and name of company
representative

President and Representative Director・Real Estate Brokerage⑨Businesses engaged in・・・Others

Please enter theregistration/permission number of theReal Estate Brokerage, Money Lending
Business, Specified Joint Real EstateVenture, and general real estate
investment advisory business.

1Please list all officers who
have the authority ofrepresentation.

・Real Estate
Brokerage: Tokyo( )・Permission on
Specified Joint Real
Estate Venture No.
(No. 1 and No. 2business)Please describe all the details of TypeII Financial Instruments Businessstipulated in the statement of businessmethods (e.g., purchase and sale,intermediation and agency of purchaseand sale, and handling of private
placement of beneficiary interest in real
property trust

Type II Financial Instruments⑩Business (FinancialInstruments) handled or tobe handled(a) Details of Specific Financial Instruments andscheme outline
e.g. Handling of private placement of foreign PE
funds
Purchase and sale, intermediation ofpurchase and sale, and handling of private
placements of beneficiary interest in real
property trust(b) Customer basee.g., Professional Investors only(c) Past handling of Type II Financial Instruments
Businesse.g., None(d) Plans for future sales and solicitation of funds
Fund name
Type
Investment Target
Amount offered
Total assets undermanagement
Time ofComposition
Operator
Period ofOperation
Assumedinvestment yield⑪

Listed or unlisted

Financial Instruments Firms⑫

Association, etc. to which
you are a member

Status of officers⑬(Number of part-time officers

Fund No.
Silent Partnershipfundbusiness
JPY

MillionJPY

MillionPlease enter only in the caseof a fund.

[Month], [Year]
Limited Liability Company
year
Approx.

%e.g., TSE Prime(Please state thesecurities code.)

・Listed ・Unlisted
・Japan Securities Dealers Association (planned)
・Financial Futures Association of Japan・The Investment Trusts Association, Japan・The Investment Advisers Association, Japan・Japan Security Token Offering Association
・Japan Virtual and Crypto assets Exchange
Association・FINMAC

See 5 below.

Number of officers(Number of part-time officers:)

among them)（

Number of full-time officers
and employees⑭(Number of officers andemployees engaged in Type II
Financial Instruments Businessamong them)）Business Execution System (Type II Business)（The following is an example of a fund businessdepartment that is a Type II business department）

・Fund Business Department:・Compliance Department:
・Risk Management Department:
・Internal Audit Department:

2If you are planning tojoin, please indicate:“planned”

In principle, the numberof officers and employees
engaged in the Type II
Financial Instruments
Business and the total
number of personnel inthe business execution
system (Type II Business)should be the same. If
there is a discrepancy,
please explain the reason
in the remarks column.
(e.g., the representative
director oversees theentire Type II Business,etc.)

Regular Member
Representative

Regular Member Representative
President and Representative Director

Regular Member
Representative’sdeputy:.
Title:Name

See Article 14 of the “Articles of Incorporation” and Article 2 of the“Rules Concerning Enforcement of the Articles of Incorporation.”
Regular Member Representative: A person who represents yourcompany in respect of the businesses of the Association (one person,an officer who holds registered representative authority or a person
holding the authority equivalent to that of such officer).
Regular Member Representative’s deputy: Appointment is optional(one person, a registered officer or a person holding the authority
equivalent to that of such officer). If you wish to appoint a deputy,
please submit a notification of appointment in Form 1 after becoming amember.

⑮

Please note that due to thenature of the duties, we do
not allow a person to serve
concurrently as Type II
Business Internal Control(Supervisory) Manager andType II Business BusinessManager.

Plans for the appointment⑯* (optional)

and placement of Type II
Business Internal Control

Type II Business Internal Control Supervisory
Managere.g., Managing Director
Title:
Name:
Type II Business Internal Control Managere.g., Administrative Manager
Title:Name:

A registered officer whois in charge of internal
control pertaining to
Self-Offering and OtherTransactions, etc. (withexceptions)Type II Business Business Managere.g., Sales Manager
Title:
Name:Supervisory Manager, etc.
Name
At least one
whoAt least one individual,
whoindividual,
is an officer
or is
anan
or an
employeeand
withemployee withofficer
sufficientknowledge
sufficientknowledge
andexperience regarding
Lawsand Regulations,regarding
Laws andetc., in each ofexperience
the positionsin accordancewithin each of thethe actual stateRegulations,of affairs of etc.,
the businesspositions
in relevant
accordancewith theactivities pertaining
to theSelf-Offering
actual stateof affairs of theand Other Transactions,etc.

See “Rules Concerning Type II Business Internal
Control Supervisory Manager, etc.”⑰

Employees specified byTitle:

Cabinet OrderName:

See 6 below.

(Only for those engaged in
Type II Financial Instruments
Business)[Month], [Year](Planned date of commencement of Type II Business)⑱

Preferred date of admission

3

・In the “last period” column, please enter the figures for the accounting period immediately
preceding the application for admission.
・In the “reference period” column, please enter the amount based on the monthly financial results
available at the time of the application for the business year beginning on the day after the end of
the immediately preceding period (i.e. the current period).

2. Financial Information(Millions of yen)

The period before

Last period

the last period(From: [Month] [Year](From: [Month] [Year]

To: [Month] [Year])

Reference period(From: [Month] [Year]

Remarks

To: [Month] [Year])

To: [Month] [Year])

Sales[Breakdown][Breakdown]

Please describe the breakdown indetail. Regarding consulting
services, please describe thespecific content of the consulting,such as real estate securitization,business restructuring, andfundraising support.

[Breakdown]

Operating income
Ordinary income
Net income
Total assets
Total liabilities

Stated Capital asof the date ofapplication()

Total net assets(Stated Capital)()(Whether or not)()If yes, name of
the audit firm

Yes ・ No

accounting audits(are conducted)

If the number of companies is large, list only those companies with which you have important
capital, personal, or business relationships, and enter the number of other companies as “othercompanies [number]”. (You will be asked to submit the status of the persons in specified
relationships later.)

3. List of Parent Corporations, etc. or Subsidiary Corporations, etc.
Company Name /StatedIncorporation

CapitalA Corporation(Incorporated in [Month] [Year])

Location

Type ofCapital ties

PersonalBusiness

Name ofBusiness(Investment Ratio)

Relations

Relationship

Representative

Ownership
percentage

Concurrent
Officers

JPYTokyo[number]

Borrowing offunds％

ThousandIf there is no major shareholder,please list the largest shareholder.

4-1. Status of Major Shareholders (as provided for in Article 29-4, Paragraph 2 of the FIEA) or
Largest Shareholder
Shareholder Name

Address or Location

Voting rights

Industry, occupation, etc.

ratio
B Corporation

In total ([number])-480%.

Holding company and investment business100.0%-

4-2. Substantial Controller*Substantial Controller means a person specified by an ordinance of the competent ministry provided for in Article
4, Paragraph 1, Item 4 of the Act for Prevention of Transfer of Criminal Proceeds and Article 12, Paragraph 3, Item
3 of the Order for Enforcement of the Act for Prevention of Transfer of Criminal Proceeds.
NameAddressorLocation of head office orprincipal office

Date of Birth

Relationships

occupation, etc.

(For individuals only)[Month] [Day], [Year]

Industry,e.g., Indirectly
holding 30% ofvoting rights

Officer of acompany(investmentbusiness)

Please list the officers supervising (i) the business division, (ii) the control division(compliance division, risk management division, etc.), and (iii) the internal audit division (thethree lines of defense) in charge of operations related to Type II Business under the businessexecution system of each company. Please be noted that after admission to the Association,
any changes to the officers in charge of Type II Business must be reported on each change.

As “Regular Member Representative” is “a person who represents therelevant Regular Member or Electronic Public Offering Member inrespect of the businesses of the Association (Article 14, Paragraph 1of the Articles of Incorporation),” it is assumed that the Regular
Member Representative is an officer in charge of Type II Business.

5. Status of Officers① Officers in charge of Type II Financial Instruments BusinessTitle(Full-time or parttime)President andRepresentativeDirector(Full-time)

Name(Age)
Name:
Age:

Career, concurrent occupations, etc.
[Month] [Year][Month] [Year][Month] [Year]

C Corporation, Deputy General Manager of Sales Department
D Corporation, General Manager of Sales Department
Corporation (we), Director and General Manager of SalesDepartment
Corporation (we), President and Representative Director[Month] [Year](Concurrent occupation)[Month] [Year]
Corporation, Director
Director andGeneral Manager ofSales Department(Full-time)

Name:
Age:

[Month] [Year][Month] [Year]

X Corporation, Deputy General Manager of Sales Department
Corporation (we), Director and General Manager of Sales
Department(Concurrent occupation)[Month] [Year]
Corporation, Director
Director andGeneral Manager ofLegal Department(Full-time)

Name:
Age:

[Month] [Year][Month] [Year][Month] [Year]

X Corporation, Deputy General Manager of Legal Department
Y Corporation, General Manager of Legal Department
Corporation (we), Director and General Manager of LegalDepartment(Concurrent occupation)[Month] [Year]
Corporation, Director5

② Officers other than ① above
Title(Full-time or parttime)
Chairman andRepresentative
Director(Part-time)

Name(Age)
Name:
Age:

Career, concurrent occupations, etc.
[Month] [Year][Month] [Year][Month] [Year]

X Corporation, Deputy General Manager of Sales Department
Y Corporation, General Manager of Sales Department
Corporation (we), Director and General Manager of SalesDepartment[Month] [Year]
Corporation (we), Chairman and Representative Director(Concurrent occupation)[Month] [Year]
Corporation, Director
Company Auditor(Full-time)

Name:
Age:

[Month] [Year][Month] [Year][Month] [Year]

X Corporation, Deputy General Manager of Sales Department
Y Corporation, General Manager of Sales Department
Corporation (we), Director and General Manager of SalesDepartment[Month] [Year]
Corporation (we), Company Auditor(Concurrent occupation)[Month] [Year] X Corporation, Company Auditor[Month] [Year] Y Corporation, Company Auditor

6. Important employees
Title
Manager ofComplianceDepartment

NameName:
Age:

Main career, previous occupation, and concurrent occupations, etc.
[Month] [Year] X Corporation, Legal Department[Month] [Year] Y Corporation, Legal Department[Month] [Year]Corporation (we), Manager of Compliance Department[End of Document]

6