開示請求書.pdf

Please fill in the required information for the disclosure, correction, or deletion of personal data request to Kokuseido Publishing Co., Ltd.

Year:
Month:
Day:

Request for Disclosure, Correction, or Deletion of Personal Data
Kokuseido Publishing Co., Ltd. General Affairs Department
Person in charge of personal information management

To the company, we request the disclosure, etc. of the held personal data.

Requester:
Please encircle with ○
Individual
Legal representative of a minor
Legal representative of an adult under guardianship
Proxy appointed by the individual

Individual:
Address:
Name:
Seal:
Furigana:
Former name:
Furigana:
Phone number:

Proxy:
Address:
Name:
Seal:
Furigana:
Former name:
Furigana:
Phone number:

Request items:
Please encircle with ○ the corresponding request item number
1. Notification of purpose of use
2. Disclosure
3. Correction
4. Addition
5. Deletion/erasure
6. Suspension of use
7. Suspension of provision to a third party

----------------------------------- The following is for our company's use ---------------------------------------
Verification of individual/proxy
Driver's license
Passport
Resident certificate
Other ()
Verification of proxy qualifications
Family register transcript/certified copy
Resident certificate with listed items
Letter of attorney
Other ()
Person in charge:
Date of receipt:
Receiver: _