Guidelines for Completing the Proof of Rehabilitation Claim* Please carefully read these guidelines as well as the instructions set forth in the
Proof of Rehabilitation Claim, and complete the form in accordance with theinstructions.
* Please do not fill in the form by hand except for the signature. Please fill in
the necessary information on computer and print it.
* Once you filled out the necessary information, please print all pages including
those on which you did not enter any information, affix your signature or seal
thereto, and send them to the Office of the Rehabilitation Trustee together withthe following documents by post:(i)
A copy of identity verification documents, such as your passport ,driver's license or any identity card, which contains your face photo andyour name written in English or Japanese, if any;(ii) Power of attorney, only if your agent is filing your proof of
rehabilitation claim on behalf of your own; and(iii) A document certifying the matters have changed, only if you are filing a
proof of rehabilitation claim that deviates from the proof of bankruptcy
claim that you filed.
* It has been observed that automatic calculation of the claim amounts may notwork properly when the function of PDF form provided by any other platform
than Adobe (e.g., Google Chrome, Safari or Microsoft Edge web browser) isused. In order to assure accurate filing, please make sure you use either
Adobe Acrobat Reader DC or Adobe Acrobat when filling out the form.

l Fields described as "Required field" must be filled in.
l Please enter the date on which you filled out the form.
l Country, zip/postcode and address:

Please enter the information of your own. Please enter the name even if signature
is affixed.
l Seal or signature
After this form is printed, the User must affix seal or signature thereto. The
instruction written in red will not appear when you print. Please affix seal orsignature in this field.

l If you are filing your rehabilitation claim through agent, please also enter theinformation regarding the agent.
l If you are filing your rehabilitation claim through agent, the agent must affix sealor signature after this form is printed.
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l Amount of claim

The amount of claim for return of cash must be entered by using Arabic numerals.
If you have the right to claim for return of cash in a currency other than Japaneseyen, please enter it as it is without converting into Japanese yen.

l For the right to claim for return of Bitcoin, please enter the quantity of Bitcoin byusing Arabic numerals.

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l Please enter the information regarding the relevant pending lawsuits, oradministrative proceedings only if your rehabilitation claim is subject to suchlawsuits or proceedings.

l Please enter the total number of the enforceable title of obligation only if you holdenforceable title of obligation in respect of the rehabilitation claim you filed under
the proof of claim.

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l Seal or signature

Please affix seal or signature also to this Statement.

l Please enter the information regarding the User , and the agent, if applicable.
l Contact e-mail address:

You must enter e-mail address at which you can receive e-mail notifications fromthe Rehabilitation Trustee hereafter.
If you can still use the e-mail address registered under the bankruptcy proceedings,
please enter such e-mail address.

l Only applicable to corporate creditors.

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l Only Bitcoin creditors are required to select the box.

l Please enter the User information registered with the MTGOX Bitcoin Exchange.

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l Please enter the User information registered with the MTGOX Bitcoin Exchange.

l Creditor Number in Bankruptcy Proceedings
Please enter the creditor number, if such number was assigned to you in thebankruptcy proceedings.

Address of the Office of the Rehabilitation Trustee
MTGOX Co., Ltd. Office of the Rehabilitation Trustee
Suite 202, Kojimachi 3-chome Building
3-4-1 Kojimachi, Chiyoda-ku,
Tokyo Japan 102-0083

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Notes to the users who selected the Offline Method to file a proof of rehabilitation claim- using Adobe It has been observed that automatic calculation of the claim amounts may not work properly when thefunction of PDF form provided by any other platform than Adobe (e.g., Google Chrome, Safari orMicrosoft Edge web browser) is used. In order to assure accurate filing, please make sure you use
either Adobe Acrobat Reader DC or Adobe Acrobat when filling out the form.
For your reference, we have put together, by taking Google Chrome user as an example, the steps todownload and open a PDF file of the Proof of Rehabilitation Claim Form or the Form of Amendment toProof of Rehabilitation Claim by using Adobe Acrobat Reader DC or Adobe Acrobat. Please complete
the filing by using Adobe Acrobat Reader DC or Adobe Acrobat by referring to these steps.
■ Steps to download and open a PDF file of the Proof of Rehabilitation Claim Form or the Form of Amendment to Proofof Rehabilitation Claim
1. Installing Adobe Acrobat Reader DC or Adobe Acrobat* If Adobe Acrobat Reader DC or Adobe Acrobat has not been installed in the system you are using, please install thesoftware as a preparation.
* Adobe Acrobat Reader DC is a free software. To install the latest version of Adobe Acrobat Reader DC, please
follow the following installation steps provided by Adobe.
・Installation steps（Windows version Acrobat Reader DC）
https://helpx.adobe.com/jp/acrobat/kb/cq101423182.html
・Installation steps（Mac OS version Acrobat Reader DC）
https://helpx.adobe.com/jp/acrobat/kb/cq1014231811.html
2. How to download the PDF file
2.1 Start Chrome.
2.2 Open MTGOX homepage（https://www.mtgox.com）.
2.3 Click the button indicated as “Please click here to file a rehabilitation claim in relation to MTGOX's civil
rehabilitation proceedings.”

2.4 “MTGOX Rehabilitation Claim Filing System” page will be opened.

If you want to download the Proof of Rehabilitation Claim Form
Click on the link for “Download” in the statement of “1. Download the Proof of Rehabilitation Claim Form (“Form(1)-1”).”

If you want to download the Form of Amendment to Proof of Rehabilitation Claim
Click on the link for “Download” in the statement of “1. Download the Form of Amendment to Proof ofRehabilitation Claim (“Form (1)-2”).”

2.5 After the download, the file name will be displayed at the bottom left but if the file name is clicked on, thePDF file will be opened on Chrome and automatic calculation may not properly function; therefore, please
do not click on the file name.
※ mtgox-offline-claim.pdf（Proof of Rehabilitation Claim Form）※ mtgox-offline-claim-amendment.pdf（Form of Amendment to Proof of Rehabilitation Claim）
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Example：Windows10

3. Start either Adobe Acrobat Reader DC or Adobe Acrobat• If you use Windows, open Adobe Acrobat Reader DC orAdobe Acrobat from Start Screen which is displayed byclicking on Windows icon shown at the bottom left of thescreen.

• If you use Mac, open Adobe Acrobat Reader DC, Adobe
Acrobat or Launchpad icon from the Dock. If there is no
Launchpad icon in the Dock, please open “Launchpad.app”
which is in the application folder. As a list of “applications”
will be displayed, double-click on the icon for either Adobe
Acrobat Reader DC or Adobe Acrobat.
4. Open the Proof of Rehabilitation Claim Form or the Form of Amendment to Proof of Rehabilitation Claim with Adobe
Acrobat Reader DC or Adobe Acrobat
4.1 Start Adobe Acrobat Reader DC or Adobe Acrobat.
4.2 Select “File”–“Open” menu.
Example: Windows Acrobat Reader DC
Example: Mac OS Acrobat Reader DC

4.3 Go to “Download” folder, select the following files that have been downloaded through Chrome, and click on“Open” button.
※ mtgox-offline-claim.pdf（Proof of Rehabilitation Claim Form）※ mtgox-offline-claim-amendment.pdf（Form of Amendment to Proof of Rehabilitation Claim）
4.4 As each form will be opened, fill out the PDF form with the required information.
If you cannot solve your problem by following the above-described steps, please contact the call center described below.
Phone number:
Reception hours:+81-3-4588-3922
Monday to Friday 1:00 p.m. to 10:00 p.m.(Japan time)

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