┌───────────┬──┬────────────┬──┐
│Name of Applicant     │    │Nationality and Place of│    │
│                      │    │Corporate Headquarters  │    │
├───────────┼──┴────────────┼──┤
│Date of Establishment │                              │    │
│and License No.       │                              │    │
├───────────┴───────────────┴──┤
│Date of Application:                                        │
├───────────┬──────────────────┤
│Note                  │                                    │
├─────┬─────┴──────────────────┤
│Attachment│1.A statement, undertaking that none of the     │
│          │  circumstances in Article 7 of the Regulations │
│          │  Governing the Issuance of Call (Put) Warrants │
│          │  by Issuers applies to the issuer, and         │
│          │  supporting documents.                         │
│          │2.The two most recent CPA audited and certified │
│          │  annual financial reports of the issuer. If the│
│          │  date of application falls in the second half  │
│          │  of the year, a CPA audited and certified or   │
│          │  reviewed financial report of the first six    │
│          │  months is required (a foreign applicant may   │
│          │  prepare its financial report according to the │
│          │  laws and regulations of the jurisdiction in   │
│          │  which it is located, and a CPA of the Republic│
│          │  of China shall comment on the differences     │
│          │  between the accounting principles adopted in  │
│          │  the Republic of China and the jurisdiction    │
│          │  where the foreign applicant is located, and   │
│          │  the impact of the differences on the financial│
│          │  report).                                      │
│          │3.A statement, undertaking that the issuer has  │
│          │  satisfied the requirements under Paragraph 2, │
│          │  Article 5 of the Regulations Governing the    │
│          │  Issuance of Call (Put) Warrants by Issuers,   │
│          │  and supporting documents, or documents        │
│          │  certifying a foreign issuer's credit rating.  │
│          │4.Position, current value, and the method(s)    │
│          │  used to evaluate the price of the issuer's    │
│          │  derivatives as of the most financial          │
│          │  statements submitted by the issuer.           │
│          │5.The risk management system and strategy for   │
│          │  offsetting foreseeable risks.                 │
│          │6.A legal opinion issued by lawyer.             │
│          │7.If the issuer is a foreign institution, a     │
│          │  letter of consent issued by its board of      │
│          │  directors, or an affidavit guaranteeing       │
│          │  performance and documents certifying the      │
│          │  appointment of a designated agent in the      │
│          │  Republic of China for litigation,             │
│          │  administrative disputes, and non-litigation   │
│          │  matters.                                      │
│          │8.Where a foreign institution establishes a     │
│          │  branch in the territory of the Republic of    │
│          │  China directly or indirectly through a        │
│          │  wholly-owned subsidiary, the terms and        │
│          │  conditions of the agency agreement signed with│
│          │  the branch in the Republic of China.          │
│          │9.Where an issuer appoints a foreign institution│
│          │  to act as a risk management agency or an      │
│          │  issuer is a foreign institution, the letter of│
│          │  approval from the competent authority         │
│          │  regulating the foreign institution.           │
│          │10.Photocopy of the change form of corporate    │
│          │   registration or a photocopy of the permit /  │
│          │   license issued by the competent authority to │
│          │   the company.                                 │
│          │11.Other documents as required by the competent │
│          │   authority and the TWSE or TPEx.              │
├─────┴────────────────────────┤
│Applicant:                                                  │
│                                                            │
│Address:                                                    │
│TEL:                                                        │
│                                                            │
│Legal                                                       │
│Representative:          Signature (Contact and TEL:       )│
└──────────────────────────────┘

1. The application shall filed along with duplicates (including one original and two copies).
   
2. The application and the attached documents shall be printed and bound together on A4 paper (29.7 cm in length and 21 cm in width). The word "application" and the issuer's name, address and telephone number shall be marked on the front cover of the application. A table of contents is required for all attached documents. Page numbers shall be indicated on the top of each page. After all pages are bound together pursuant to provisions above, a general table of contents shall be created and its page numbers shall be indicated at the bottom of each page.
   
3. If changes to the information are required while the application is under review, a chart of comparisons explaining and indicating the changes and reasons for such changes shall be submitted.
   
4. If a document attached to the application is in a foreign language, a Chinese translation is required.