Request Form for correction, addition, Deletion, Cessation of use, Removal or
Cessation of Provision of Personal Data to Third Parties
Please fill out the necessary information below, attach a document confirming that you are the principal or aagent, and send it to our c our Inquiry Counter below.
LIXIL Corporation Personal Information Inquiry Center
24F Osaki garden tower, 1-1-1, Nishi-shinagawa , Shinagawa-ku, Tokyo, 141-0033, Japan* Personal information obtained through this request procedure will be used to the extent necessary for correction

procedures. We will promptly dispose of the documents that you have submitted to us to confirm your identity or yourrepresentative after the correction procedures are completed.
* We will not correct any information if there are any defects in this document or confirmation documents, if there is noinformation to be requested, if there is no error in personal data, if there is no use or provision to a third party inviolation of the Act on the Protection of Personal Information, or if there is no reason for correction.

1. Information of the requester ( you or your representative)
Please fill in the Personal Information. (Please fill in all fields.)
Furiganaseal

NameDate of birth(YYYY/MM/DD)-〒Address-

Phone number-* Please provide the number that we can reach during the day

EmailWhen requester is a representative, please also fill out the following form
(Please fill in all fields.)
Furiganaseal

NameDate of birth(YYYY/MM/DD)-〒

Address

Phone number--*Please provide the number that we can reach during the day.

EmailRelationship

1. Parental 2. Guardian of Adult 3. Agent 4. Other ()202211

2. Documents confirming that the person is the person or the agent

Please prepare the following documents (without personal number (My Number)).
Please mask the "symbol", "number", "insurer number" and "QR code" on the copy of the health insurancecard. (Example of masking: Use a non-transparent material such as sticky notes or tape to hide the area
before copying. After making a copy, fill the area so that it cannot be seen.)
Case of theprincipal
In the case ofan agent

A copy of your driver's license, passport, health insurance card, or certificate of residence, etc.
①②③④

A copy of the person's driver's license, passport, health insurance card, or certificate of residence
A copy of the agent's driver's license, passport, health insurance card, or certificate of residence,etc.
Power of attorney indicating representation (If the representative is an attorney, the registration
number and a power of attorney indicating the representative.)
Certificate of personal seal impression

3. History of Provision of Personal Data

Please circle the appropriate number. Please be as specific as possible as to when and where your personal
data was provided, the name of the specific service or campaign, and the name of the product youpurchased.
When and where it was provided, andName of service/product, etc.

History of provision of the service
1

Owner registration

2

Application for long-term warranty
service3

Request for repair

4

Purchase of parts and consumables

5

Request for materials and catalogs

6

Visit to the showroom

7

Apply for our company Campaign

8Inquiries by e-mail or telephone

9Other⚫

Date of provision (Approximately):(YYYY/MM/DD)⚫

Place (XX showroom, XX campaign website, etc.)：⚫

Method of provision (filling out customer card,registering on website, etc.)：⚫

Other Details:

202211

4. Invoice Details

Please circle your request and fill in the required information below.
*We will notify you or your representative the results of your request by mail.
*If any of the personal data held by our company is incorrect, please request correction, addition or deletion of the incorrect
information.
*If you believe that personal data has been used beyond the scope necessary to achieve the purpose of use, that it has been u sed
improperly, that personal data has been obtained by an illegal method, that it is no longer necessary to use it, or that a serious leak hasoccurred, please request the cessation of use or deletion.
*If you believe that personal data has been provided to a third party in violation of the provisions of the Act on the Protection ofPersonal Information, that it is no longer necessary to use it, or that a serious leakage has occurred, please request the cessation of theprovision to a third party .

1correction

2Addition

3

Delectation

4▶

If you request 1. Correction/2. Addition/3. deletion
Contents prior to amendment

Cessationof use5Erase6

Cessation of thirdparty provision

Contents after amendment

If you request 4. Cessation of use/5. deletion: Please select the reason from A) to G) below and fill in thedetails.
Reasons for Invoicing
ReasonA) Use beyond what is necessary to achieve theintended use
B) Improper use▶

C) Obtaining by illegal meansD) No longer need to use the productE) Due to serious leakage, etc.
F) There is a risk that the rights or legitimate
interests of the person may be harmed.
G) Other
6. If you request to stop providing to a third party: Please select the reason from A) to E) below and fill inthe details.
Reasons for request
ReasonA) Provided Personal data without your consent
to third parties
B) No longer need to use the product▶

C) Due to serious leakage, etc.
D) There is a risk that the rights or legitimate
interests of the person may be harmed.
E) Other202211