Retained Personal Data Corrections Request Form

Date:   /   /   /

To the English Service Desk

Corrections Requester

Name :

Address :


I request the correction of retained personal data as below according to the provisions in Paragraph 1 of Article 26 and Paragraph 1 and 2 in Article 27 in the Act on the Protection of Personal Information

Details of the request

(Please circle the applicable number)

1. Correction, addition or deletion (Paragraph 1 of Article 26)

2. Suspension of use or elimination (Paragraph 1 of Article 27)

3. Suspension of provision to third parties (Paragraph 2 of Article 27)

Reason for the request

Details of the correction, addition or deletion

Corrections requester category

(Please circle the applicable number)

1. Individual in question

2. Representative entrusted by the individual in question to seek the correction

3. Statutory representative of a minor or adult ward

Information on the individual in question




License number

Member number


1. Please read "Procedures for Requesting Disclosure/Correction/Suspension of Retained Personal Data" before enclosing the following documents and sending it to our Customer Help Desk above to request the correction of retained personal information.

(1) Copy of a document confirming you are the individual in question requesting the correction (e.g. driver's license)

(2) Self-addressed stamped envelope (Write the address of the person requesting the correction on it and affix a postage stamp worth 612 yen)

2. In case making a request via a representative, please enclose the following document in addition to the documents in 1.

(1) Document verifying the status of the representative (e.g. power of attorney)

3. In case there are any omission on this form or documents are missing, we will contact the telephone number you have given us. If we cannot reach you or if you do not send the information we request one week after contacting you, we will treat it as though you have not made a request for correction.

4. The documents you submit to request a correction will be disposed one year after the reply.

5. In case you make a request for correction by visiting one of our business offices or by telephone, we will make the correction after confirming your identity only for matters that we can correct.

6. We will correct only the permissible matters after confirming your identity on our website for Japan. This is limited to Super Red Member.