Form requesting disclosure <For Residents in China>
Request Date：//<How to apply>
・Print and fill out this form.
・Please send the application form and identification document to the below address by postal mail.
ANA Cargo Inc.
Personal Information Handling Desk
1-5-2, Higashi-Shimbashi, Minato-ku, Tokyo, Japan, 105-7140
Please be careful not to forget to fill in the required items in the bold frame.

Information for Identifying Person to Whom Disclosure Pertains（We may not be able to accept disclosure if all columns have not been completed.）

Last NameBirth DateDay/

First NameAddressMonthYear/

Zip Code－Telephone－*As we may call for identification, please fill in daytime phone
number.

*Please note that copies of two documents from the below should be attached with this form. Photo ID
is required as one of the documents.
Examples 1. Passport 2. Health insurance card (masking insurance card numbers and identification
symbols / numbers of insured individuals) 3. Basic resident registration card with photo 4. Pension
book 5. Physical disability certificate 6. Resident card or Special permanent resident certificate
7. Certificate of seal registration 8. Individual Number Card (front page only) 9. identification card
issued by the Chinese government

Documents toconfirm identificationof the principal

Information on Person Requesting for Disclosure(Please fill this out only if the request is being made through a representative.)

Last Name
Birth DateDay/

First Name
Address

MonthYear/

Zip Code－Telephone－*As we may call for identification, please fill in daytime phone
number.

Documents required
Relationship to the individualDocument to verify relationship to the individualDocuments to confirm Identification of representative

1.A person with parental authority

Person’s family register

2.Guardian of an adult

Guardian certificate*Please note that copies of two documents from thebelow should be attached with this form. Photo ID isrequired as one of the documents.
Examples 1. Passport
2. Health insurance card
(masking insurance card numbers and identification
symbols / numbers of insured individuals) 3. Basic
resident registration card with photo 4. Pension book
5. Physical disability certificate 6. Resident card orSpecial permanent resident certificate 7. Certificate ofseal registration 8. Individual Number Card (frontpage only) 9. identification card issued by the Chinese
government

Letter of trust
3.Representative(Legal representatives shall provide certifying（）
document)

Details of disclosure request
Please fill in the information to verify requesting item.

□Reservation information①Subject（Please fill in the disclosure information you are requesting for.）②Cargo Information[Date][AWB No（During transportation only）][Departure・Arrival][Reservation TEL No of cargo]□Others

Handling of this request formDenials for disclosure will be notified.

The personal data obtained in this form is only taken for this･Required item is missing.

request. We will dispose of this form and other related･Confirmation if not available.

documents one month after our reply by an appropriate･Requested item was not eligible for disclosure of personal data.

method.

･Disclosure has serious impact to ANA’s business operation.
･Disclosure offends other laws.
･Life, health, property and other rights of the individual or third parties are affected.

■For official use by ANA Cargo Inc.
Management representative validation

Acceptance date and time
Received on : YearMonthDateTime：
3_disclosure_CN_EN