Pursuant to the provisions of Cabinet Office Order, a person who intends to be registered referred to in the preceding Article must submit a written application for registration containing the following particulars to the Prime Minister:
前条の登録を受けようとする者は、内閣府令で定めるところにより、次に掲げる事項を記載した登録申請書を内閣総理大臣に提出しなければならない。
trade name, other name or name, and address;
商号、名称又は氏名及び住所
in cases of a corporation, the name or other name of its officers (including, in cases of a foreign corporation, persons treated in the same manner under laws and regulations of a foreign state and the representative person in Japan; the same applies hereinafter in this Chapter);
法人にあっては、その役員（外国法人にあっては、外国の法令上これと同様に取り扱われている者及び国内における代表者を含む。以下この章において同じ。）の氏名又は名称
name and location of business offices or offices pertaining to the electronic payment instruments and cryptoasset intermediary services;
電子決済手段・暗号資産サービス仲介業に係る営業所又は事務所の名称及び所在地
in cases of a corporation, the amount of capital or contribution;
法人にあっては、資本金又は出資の額
categories of electronic payment instruments and cryptoasset intermediary services (meaning the categories of business pertaining to the acts set forth in the items of Article 2, paragraph (18); the same applies in Article 63-22-6, paragraph (1), Article 63-22-24, paragraph (2) and Article 107, item (xiv));
電子決済手段・暗号資産サービス仲介業の業務の種別（第二条第十八項各号に掲げる行為に係る業務の種別をいう。第六十三条の二十二の六第一項、第六十三条の二十二の二十四第二項及び第百七条第十四号において同じ。）
the particulars specified in (a) or (b), depending on the category of cases set forth in (a) or (b):
次のイ又はロに掲げる場合の区分に応じ、当該イ又はロに定める事項
if the applicant carries out electronic payment instruments intermediary acts: the name of the electronic payment instrument handled and the trade name or name and address of the person that issues the electronic payment instrument;
電子決済手段仲介行為を行う場合 取り扱う電子決済手段の名称並びに当該電子決済手段を発行する者の商号又は名称及び住所
if the applicant carries out cryptoasset intermediary acts: the name of the cryptoasset handled;
the particulars specified in (a) or (b), depending on the category of cases set forth in (a) or (b):
次のイ又はロに掲げる場合の区分に応じ、当該イ又はロに定める事項
if the applicant carries out electronic payment instruments intermediary acts: the trade name of the electronic payment instruments service provider from which the applicant receives entrustment (hereinafter referred to as the "principal electronic payment instruments service provider" in this Chapter);
電子決済手段仲介行為を行う場合 委託を受ける電子決済手段等取引業者（以下この章において「所属電子決済手段等取引業者」という。）の商号
if the applicant carries out cryptoasset intermediary acts: the trade name of the cryptoasset exchange service provider from which the applicant receives entrustment (hereinafter referred to as the "principal cryptoasset exchange service provider" in this Chapter);
details and means of the electronic payment instruments and cryptoasset intermediary services;
電子決済手段・暗号資産サービス仲介業の内容及び方法
if part of the electronic payment instruments and cryptoasset intermediary services is entrusted to a third party, the details of the business pertaining to the entrustment and the name or trade name or other name and address of the third party to whom the electronic payment instruments and cryptoasset intermediary services are entrusted;
電子決済手段・暗号資産サービス仲介業の一部を第三者に委託する場合にあっては、当該委託に係る業務の内容並びにその委託先の氏名又は商号若しくは名称及び住所
type of businesses, if the service provider conducts other businesses; and
他に事業を行っているときは、その事業の種類
other particulars specified by Cabinet Office Order.
その他内閣府令で定める事項
A document in which the applicant pledges that the applicant does not fall under any of the items of Article 63-22-5, paragraph (1), documents containing particulars concerning the establishment of a system for ensuring the provision of the electronic payment instruments and cryptoasset intermediary services in a proper and steady manner, and other documents specified by Cabinet Office Order must be attached to the written application for registration referred to in the preceding paragraph.
前項の登録申請書には、第六十三条の二十二の五第一項各号に該当しないことを誓約する書面、電子決済手段・暗号資産サービス仲介業を適正かつ確実に遂行する体制の整備に関する事項を記載した書類その他の内閣府令で定める書類を添付しなければならない。