Add / Change of Beneficiary Account Details (individual)

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1 For office use Add / Change of Beneficiary Account Details (individual) Please make sure to submit this form in case the registered information changes. Please fill in all relevant information with your registered signature or seal and return this document to us. Details you filled in will be verified and examined by the Bank. Your application may be declined based on the Bank's specific criteria. If you need more spaces, please copy and use the second page. We ask that a processing time of approximately one week be allowed for when registering new beneficiary accounts, or changes in existing beneficiary account information. When all registration requirements have been satisfied, we will send you a Registration Letter / Account Amendment Confirmation Letter. Please complete all details and seal / signature inside of the bold highlighted boxes. Please tick either add or change. Add Change If you wish to change the details of an existing beneficiary account, please write the B-Link number below. B-Link number: Expected date of first remittance Customer Details Family name First name Middle name Tel: Home address Fax: Mobile: I declare that all information I have provided here is correct. I will submit this 'Add/Change of Beneficiary Account Details form again if there are changes or additions to the registered information already submitted. Registered signature or seal Date Address : Shinsei Bank GoRemit 4-3, Nihombashi-muromachi 2-chome, Chuo-ku, Tokyo Japan

2 For office use Please complete all details of the boxes. Name Family name First name Middle name Beneficiary account name Account holder name Bank/branch code e.g. ABA No., Sort code, BSB No. No.No. Beneficiary s current country of residence Account number Beneficiary s address Beneficiary bank : branch name and address Beneficiary s relationship to yourself SWIFT code Currency IBAN Source of funds Special instruction Purpose of remittance Please choose your purpose of remittance from the following. Import, Purchase of Goods 1 Intermediary Trade 1 Investment Family Support Tuition, Educational Fee Travel & Living Expenses Gift Loan Payment Savings OthersPlease provide details. If purpose of remittance is payment for purchasing or importing goods or intermediary trade, please fill in the following four boxes. Kind of goods Country of origin Place of shipment Destination If purpose of remittance is investment, please fill in the following box. Kind of investment products stocksfixed income securitiesfunds Are you dealing with a counterparty directly or via an intermediary? Dealing directlydealing via an intermediary Intermediary name If via an intermediary, did you confirm that such an intermediary is registered with the Japanese FSA? (If no, we cannot handle your remittance.) If purpose of remittance is Tuition or Travel fee, please fill in the following box. Date of departure Length of stay Please submit the Add / Change of Beneficiary Account Details (individual) in case you change information. (If we cannot confirm submission of this document, the GoRemit Shinsei Overseas Remittance Service may not be available.) If you wish to add more beneficiaries, please copy and use this page. For office use

3 Please fill in all details inside of the bold highlighted boxes. Sample of completed Application form 1 Add If you wish to add a new beneficiary, please check the Add box. Change If you wish to change the details of an existing beneficiary account, please check the Change box and write the B-Link number of the beneficiary you would like to change. Expected date of first remittance If there is a specific date that you would like to send funds by, please write it here. (Please allow processing time of approximately 1 week. ) Customer Details Please fill in your name, address and contact details. Registered signature or seal Please ensure you fill in the date when you stamp or sign the application form. How to make a correctionif you make a mistake when filling in the form, please follow the instructions below. Correction tape is not acceptable. ) When using a signature as identification When using a personal seal (hanko) as identification Signature Cross out the mistake using two parallel lines. Provide your signature in the nearest available space to the correction. Cross out the mistake using two parallel lines. Stamp over the parallel lines.

4 Please fill in the boxes. Name Please fill in your name. Beneficiary account name This is the account holder s name (recipient's account name). Beneficiary s current country of residence This is the country in which the beneficiary currently lives and is not necessarily the same as their nationality. If you are sending to your own overseas account that is in your own name simply choose Japan, because you currently reside in Japan. Beneficiary s address This is the beneficiary s (recipient's) address as registered with their bank. Beneficiary s relationship to yourself If you are sending funds to your own account, please type myself in this box. If the beneficiary account is not in your name, please provide the nature of your relationship to the intended beneficiary. e.g. my brother or the store where I bought a book Currency Please input the currency of the beneficiary s (recipient's) bank account. The currency should be the same local currency of the country in which bank branch is situated (if we offer that currency). USD and EURO can be remitted to any country. Bank / branch code This code is different from the bank account number. For details, please refer to the How to fill in the IBAN / Bank code / SWIFT code columns on the next page. Account number This is the beneficiary s (recipient s) account number. Beneficiary bank : branch name and address Please input the full name and the address of the bank where the beneficiary s account is held. SWIFT code For details, please refer to the How to fill in the IBAN / Bank code / SWIFT code columns on the next page. Sample of completed Application form 2 IBAN For details, please refer to the How to fill in the IBAN / Bank code / SWIFT code columns on the next page. Source of funds Please advise where your funds will be coming from, for example savings, salary, inheritance, etc. Special instruction Please use this space to provide any additional information that you feel is important. For example, when sending money to a securities firm or insurance company, please input your account number, user ID or security number (if necessary). If the beneficiary bank has instructed you to send funds via an intermediary bank, please input the bank name, branch name, and its account number here. Purpose of remittance Please input the purpose of remittance. If the purpose of remittance is payment for purchasing or importing goods or intermediary trade, please complete section 1. If the purpose is investment, please complete section 2. If the purpose is tuition or travel fee, please complete section 3. If the purpose is Family support, please write whose support it is in the space next to Family Support. If the purpose is loan payment, please describe the kind of loan it is in the space next to Loan Payment. Place of shipment Please provide the country or the name of place where the goods will be shipped from. If the place of shipment is in China, Korea or Russia, please provide the name of the city where the port of shipment is located. Destination Please provide the destination of the goods. e.g. if the goods are being imported to Japan, please write Japan. Kind of investment products Please provide details regarding the type of investment product such as stocks, fixed income securities, funds or FX trading. If you use intermediary services, please input the name of the intermediary. The intermediary will need to be registered with the Japanese FSA to perform financial transactions or to act in behalf of persons that reside in Japan. It is illegal to perform financial transactions without being registered.

5 How to fill in the IBAN / Bank code / SWIFT code columns Certain bank codes are required when sending funds to the following countries. If you are unsure of the correct bank branch code please contact the relevant bank directly or have the beneficiary confirm for you. The format of this code is different from the bank account number. Providing the Bank code helps ensure quick and safe credit of funds to the beneficiary bank. Failure to provide correct information to GoRemit may result in a delay in delivery, or non-delivery of funds into the intended beneficiary s account. Country in which bank branch is situated Currency IBAN Bank / Branch code SWIFT code Number of digit United States USD ABA number (Fed wire / Routing number) 9 Great Britain GBP Sort code Canada CAD Transit number + Institution number or / Routing number Transit number + Institution number : 5+3 Routing number : 9 Australia AUD BSB number New Zealand NZD BSB number India INR IFSC IFSC : 11 SWIFT : 8 or / 11 Europe EUR IBAN : Max34 SWIFT : 8 or / 11 Sweden SEK IBAN : Max34 SWIFT : 8 or / 11 Switzerland CHF IBAN : Max34 SWIFT : 8 or / 11 UAE IBAN : Max34 Regarding remittances to China China In order for individuals in China to work in the trading business, they must be registered in accordance with their local regulations. If their bank account type and the purpose of the remittance do not match, remittances may be delayed or rejected altogether. Please confirm in advance with the beneficiary that they are able to receive remittances for the purpose of trade.