Form requesting disclosure
Request Date：//

Please fill out the Form below and return to the Personal Data Information Desk with all documents required for
confirmation of identification. (Postage stamps required.) Please fill out all items below.
Personal Data Information Desk for disclosure
ANA Cargo Inc.
Personal Information Handling Desk
1-5-2, Higashi-Shimbashi, Minato-ku, Tokyo, Japan, 105-7140
Please note that this form is accepted only by mail.
Information for Identifying Person to Whom Disclosure Pertains（We may not be able to accept disclosure if all columns have not been completed.）

Last Name

Birth DateFirst NameAddressDayMonth/Year/

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

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

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 DateFirst Name
Address

DayMonth/Year/

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

Documents required
Relationship to the individualDocument to verify relationship to the individual

1.A person with parental authority

Person’s family register

2.Guardian of an adult

Guardian certificate
Letter of trust

3.Representative(Legal representatives shall provide certifying（）
document)

Documents to confirm Identification of representative*Please note that copies of two documents from thebelow should be enclosed with this form. Photo ID isrequired as one of the documents.
Examples 1. Driver’s license 2. Passport 3. Healthinsurance card (masking insurance card numbers andidentification symbols / numbers of insured individuals)
4. Basic resident registration card with photo 5. Pension
book 6. Physical disability certificate 7. Resident
card or Special permanent resident certificate 8.
Certificate of seal registration 9. Individual Number
Card (front page only)

US$5.00 will be charged for the request of each transaction.
Fee

Please enclose a fixed amount of money order for the total number of the request ofeach transaction.

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（Please provide details for records provided to a third party and for disclosure requests other than thoselisted above.）

Disclosure format
If you wish to request disclosure in electronic file format, please check the box below and provide an email address
to which the file should be sent
□ I would prefer disclosure in electronic file format（Send to email address_______________________________________________________________________）

Handling of this request form

Denials 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.
Acceptance date and time
Received on : YearMonthDate

Management representative validationTime：
1_disclosure_JP_EN