Form 4-1
Request for Disclosure of Records on Provision to Third Parties
To: Personal Information Manager, NTT Advanced Technology Corporation
I hereby request the disclosure of records on provision of my personal information to third parties, that canbe identified by the followings, in the databases held by your company.
Identification Item:

Identification Data:

1． Requester (the requesting person)
Request Date: Year/Month/Date
Address:
Name:
Phone Number:(Seal)--

E-mail address (if you wish to be contacted by e-mail):* A copy of an official ID card (either of driver's license, passport, health insurance card, certificate ofresidence (issued within last 3 months) or family register (issued within last 3 months)) is required.
* Please enclose a handling fee of 1,000 yen and mail it by registered mail for cash. (No refund will be given
regardless of the result of the disclosure request.)
2． Please fill in the followings in the case of a request by an attorney-in-fact.
Address:
Name:
Phone Number:(Seal)--* Please fill in the followings about the attorney-in-fact. (Check the applicable one.)□ The attorney-in-fact has parental authority in the case that the requesting person is under 15 years old.
→ A copy of the family register is required.
□ Adult guardian of the requesting person → Certificate of registered matters is required.
□ The attorney-in-fact other than those listed above → prescribed power of attorney, certificate of seal
impression registration of the requesting person (issued within last 3 months) and copy of the official
identification of the requesting person and the attorney-in-fact (either of driver's license, passport,
health insurance card, certificate of residence (issued within last 3 months) or family register (issuedwithin last 3 months)) are required.
However, in the requests of 1 or 2, when submitting a copy of official certificates that an individual can be
identified, please make a mask processing for permanent domicile, insurer’s number, symbol and number of
insured person (subscriber and member), etc. and basic pension number.

Form 4-2
Request for Disclosure of Records on Provision to Third Parties / Power of Attorney
To: Personal Information Manager, NTT Advanced Technology Corporation,I hereby grant my attorney-in-fact the power to request disclosure of records on provision of my personal
information to third parties, that can be identified by the followings, in the databases held by your company.
Identification Item:

Identification Data:<Requesting person>
Date: Year/Month/Date
Address:
Name:
Phone Number:(Officially registered seal)--* A seal is a registered seal. Certificate of seal impression registration (issued within last 3 months) anda copy of an official ID card (either of driver's license, passport, health insurance card, certificate ofresidence (issued within last 3 months) or family register (issued within last 3 months)) are required.
* However, when submitting a copy of official certificates that an individual can be identified, please
make a mask processing for permanent domicile, insurer’s number, symbol and number of insured
person (subscriber and member), etc. and basic pension number.

<Attorney-in-fact>
Address:
Name:
Phone Number:--