Contents
ENCLOSED INFORMATION
Membership Categories and Dues
Application Procedure

ENCLOSED FORMS
Membership Application
Diners Club Card Registration Form
Recommendation by Proposer
Recommendation by Seconder
Billing Information and Signature for Company Transferable Membership Only

membership@tac-club.org · tokyoamericanclub.org
p. 1

Membership Requirements
MEMBERS OF TOKYO AMERICAN CLUB SHALL BE OF GOOD
CHARACTER, FINANCIAL STANDING AND REPUTATION.
I. Qualified applicants must submit a completed application form and two completed
recommendation forms from existing Members (Proposer and Seconder). A Proposer and Seconder
must be Resident, Company Transferable, Term Regular or Senior/Emeritus Members in goodstanding for more than one year.
II. Qualified applicants are required to attend an interview reception with the Board of Governors andMembership Committee members and an orientation.
III. Acceptance to the Club is subject to the Membership Committee’s review. Final approval of any
application shall be by resolution of the Board of Governors.

membership@tac-club.org · tokyoamericanclub.org
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Membership Options
Details & Benefits

RESIDENT MEMBERSHIP• Duration of membership is unlimited.
• Conversion to other categories is possible.
• Not transferable.
• There are three designations for membership: Single, Couple and Family. If Family is selected, all children under 21 years old are included.
• The membership belongs to the individual, who has reciprocal club and voting privileges (so long as the Member registers to vote).
• Membership includes access to Tokyo American Club Nihonbashi (adults only).
		 See fee structure for details.

COMPANY MEMBERSHIP• Duration of membership is unlimited.
• Conversion to other categories is possible.
• Allows for three-month overlap when transferring to succeeding applicant.
• There are three designations for membership: Single, Couple and Family. If Family is selected, all children under 21 years old are included.
• The membership belongs to the company. The incumbent has reciprocal club and voting privileges (so long as the Member registers to vote).
• The company has the option to sponsor other Members for short periods, whenever a membership is vacant.
• Membership includes access to Tokyo American Club Nihonbashi (adults only).
		 See fee structure for details.

TERM REGULAR MEMBERSHIP (NON-JAPANESE APPLICANTS ONLY)• Duration of Membership is three years.
• Membership can be extended after three years by paying six-month extension fees.
• Conversion to other categories is possible.
• Full credit on entry/extension fees if converting to Resident Regular Membership.
• Not transferable.
• IIf the individual wants to include his or her family, monthly term regular family dues will cover the individual, spouse and all		 children under 21 years of age.
• The Membership belongs to the individual, who has reciprocal club and voting privileges.
• Copy of resident card required.
• Membership includes access to Tokyo American Club Nihonbashi (adults only).
		 See fee structure for details.

JUNIOR MEMBERSHIP• For sons and daughters of Members, between the ages of 21 and 29.
• The duration of membership is until the person reaches the age of 30.
• Conversion to other membership types is possible.
• The Junior Membership non-refundable entrance fee will be deducted from the regular entrance fee at the time of conversion to another		 membership type.
• There are three membership designations: Single, Couple and Family. The Family designation includes all children under 21 years old.
• The membership is not transferable.
• Membership includes access to Tokyo American Club Nihonbashi (adults only).
		 See fee structure for details.

membership@tac-club.org · tokyoamericanclub.org
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Membership Options
Details & Benefits

SENIOR/EMERITUS TRANSFER MEMBERSHIP• A Senior/Emeritus Member may transfer Regular membership to a son, daughter or grandchild.
• When the child or grandchild’s application is approved, the Senior/Emeritus Member must resign.
• The Senior/Emeritus Member can become an Adult Family Member of the son, daughter or grandchild, without having to reside with		 that person.
• Duration of membership is unlimited.
• Conversion to other categories is possible.
• There are three membership designations: Single, Couple and Family. The Family designation includes all children under 21 years old.
• The membership belongs to the individual, who has reciprocal club privileges and voting privileges (so long as the Member registers to vote).
• The membership is not transferable.
• Membership includes access to Tokyo American Club Nihonbashi (adults only).
		 See fee structure for details.

membership@tac-club.org · tokyoamericanclub.org
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Fees & Payment
The following fees are applicable as of September 28, 2023.

RESIDENT MEMBERSHIP
Entrance fee
Application fee
Building maintenance fund contribution
Refundable deposit
Monthly dues

Monthly building maintenance assessment

COMPANY MEMBERSHIP
Entrance fee
Application fee
Building maintenance fund contribution
Refundable deposit
Monthly dues

Monthly building maintenance assessment

COMPANY TRANSFER MEMBERSHIP
Transfer fee
Application fee
Building maintenance fund contribution
Refundable deposit
Monthly dues

Monthly building maintenance assessment

TERM REGULAR MEMBERSHIP

Foreign Nationals

Japanese Nationals¥1.9 million¥33,000¥300,000¥200,000¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000¥4.5 million¥33,000¥300,000¥200,000¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000Foreign Nationals

Japanese Nationals¥1.9 million¥33,000¥300,000¥200,000¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000¥4.5 million¥33,000¥300,000¥200,000¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000Foreign Nationals

Japanese Nationals¥950,000¥33,000¥150,000–¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000¥2.25 million¥33,000¥150,000–¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000SingleFamilyCouple¥950,000¥950,000
Entrance fee¥950,000¥33,000¥33,000
Application fee¥33,000¥150,000¥150,000
Building maintenance fund contribution¥150,000¥200,000¥200,000
Refundable deposit¥200,000¥50,000¥63,000
Monthly dues
¥56,500
Duration (valid for three years)¥250,000¥250,000
Six-month extension¥250,000
Conversion						Full credit on entry/extension fees if converting to 									 Resident membership¥3,000Monthly building maintenance assessment¥3,000¥3,000membership@tac-club.org · tokyoamericanclub.org
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Fees & Payment
The following fees are applicable as of September 28, 2023.

JUNIOR MEMBERSHIP
Entrance fee
Application fee
Building maintenance fund contribution
Refundable deposit
Monthly dues

Monthly building maintenance assessment

SENIOR/EMERITUS TRANSFER MEMBERSHIP
Transfer fee
Application fee
Building maintenance fund contribution
Refundable deposit
Monthly dues

Monthly building maintenance assessment

Foreign Nationals

Japanese Nationals¥950,000¥33,000¥300,000¥200,000¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000¥2.25 million¥33,000¥300,000¥200,000¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000Foreign Nationals

Japanese Nationals¥750,000¥33,000¥300,000–¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000¥750,000¥33,000¥300,000–¥27,500 (Single)¥36,000 (Couple)¥44,000 (Family)¥3,000membership@tac-club.org · tokyoamericanclub.org
p. 6

Fees & Payment
PAYMENTAll applicable membership fees can be paid by either bank transfer (details below) or Diners Club credit card. Monthly
bills must be settled by Diners Club card.

BANK DETAILSINTERNATIONAL TRANSFER
Bank: Mitsui Sumitomo Bank (0009)
Branch: Shinjuku-Nishiguchi (259)
Address: 2-1-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-0402
Account no: 2670848
Account type: savings
Account name: Ippan Shadan Hojin Tokyo American ClubSWIFT code: SMBCJPJTDOMESTIC TRANSFER
Bank: Mitsui Sumitomo Bank (0009)
Branch: Nadeshiko (971)
Account no: 1092990
Account type: savings
Account name: Ippan Shadan Hojin Tokyo American Club

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Application Procedures
1. APPLICATION MATERIALS
Please submit all application materials as detailed below to the Club’s Membership Office:•Membership application form with the applicant’s signature and a passport-size photograph.

•

Recommendation by Proposer form.

•
			
			

Recommendation by Seconder form.
The Proposer and Seconder must hold a Resident, Company Transferable, Term Regular or Senior/Emeritus Membership, be in good standing,have been Members for at least one year.

•

All applicants applying as a Foreign National must provide a valid passport as proof of citizenship•

Copy of valid passports for applicants and all family members applying for couple or Family Membership.

•

Marriage certificates (if applicable). Residence Card copy or Juminhyo (required for domestic partnerships in lieu of
marriage certificates).

•

Diners Club card registration form, together with a copy of the applicant’s driver’s license or national health insurance card(for Japanese applicants) or a copy of the applicant’s residence card (for non- Japanese applicants).

2. APPLICATION REVIEW BY THE MEMBERSHIP COMMITTEE
Once completed application materials have been submitted to the membership office, the membership committee will conduct athorough review of the documentation. Applicants may be asked to provide further information during the review process.
3. INTERVIEW RECEPTION
After a successful application review by the Membership Committee, applicants will be invited to an interview reception at Tokyo
American Club. The interview reception will be conducted in English.
4. ORIENTATION
Applicants are required to attend an orientation at which they will learn about Club facilities, services, procedures and rules andhave the chance to ask questions.
5. TO BE ISSUED WITH A TEMPORARY MEMBERSHIP CARD, APPLICANTS MUST FIRST MEET THE FOLLOWING CRITERIA:•

Submitted all the necessary application materials, including a Diners Club application form.

•

Attended an interview reception and orientation.

•

Completed payment of the entrance fee and deposit before the interview reception.

6. After official approval by the Board of Governors, applicants will be notified in writing. If an application is not accepted or iswithdrawn by an applicant prior to approval, it will be returned to the applicant, along with any deposits made, less any money
owed to Tokyo American Club.

membership@tac-club.org · tokyoamericanclub.org
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Membership Application
Tokyo American Club is a private members’ club, owned and run by the Members for the benefit of
the Members. Members shall be persons of good character, financial standing and reputation and, if
elected to the Membership, will join the Club as an individual or family Member in their own right.

MEMBERSHIP CATEGORY

Attach photo here

Please circle one from each column:
MEMBERSHIP TYPE

CATEGORY☐ Resident☐ Single☐ Company (New)☐ Couple☐ Company (Transfer)☐ Family☐ Term Regular☐ Senior/Emeritus Transfer☐ Junior
I was previously a Club Member. Membership no:
Monthly dues paid by:☐ Company☐ SelfEntrance fee paid by:☐ Company☐ SelfResignation Date:

Senior/Emeritus Membership Transfer/Junior. Parent’s name:Membership no:

Full Name:
Nationality:

Date of birth:

M

D

CURRENT EMPLOYMENT INFORMATION (please print)
Name of company:
Type of business:
Position and title:
Business address in Japan:

Zip code:Tel:E-mail:PERSONAL INFORMATIONHome address in Japan:
Zip code:
Tel:

Cell:

E-mail:membership@tac-club.org · tokyoamericanclub.org
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YMembership Application
ENGLISH LANGUAGE ABILITY(please circle)

NativeFluentBusiness/Advanced

ConversationalYears spent in other English-speaking countries:

Years spent in the United States:

Please supply the information below only if you are applying for Couple/Family membership.
Gender		Spouse Name:☐ Male ☐ Female

Spouse e-mail:Spouse cell:

Children:Date of birth

Nationality

M

D

Y

☐ Male ☐ Female

M

D

Y

Children:☐ Male ☐ Female

M

D

Y

Children:☐ Male ☐ Female

M

D

Y

EMPLOYMENT HISTORY
Name of company					Location

Dates

Position

Location

Dates

DegreeEDUCATION
Name of school						CLUB AND ASSOCIATION MEMBERSHIPDISCLOSURE OF BODY MARKINGS AND TATTOOS
Do you or anyone covered under this application have body markings or tattoos? If yes, please state name of person.

The presence of a body marking or tattoo does not imply any negative or positive impact on a prospective Member’s application.

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MinimalMembership Application
PERSONAL STATEMENT
Please complete each of the sections below:• Background
Explain how your professional and educational background aligns with those of the membership.

• English language ability
If English is not your native tongue, please detail your English-speaking ability.

• Financial status
Confirm your ability to meet your financial obligations as a Member.

• Character
Explain how your personal qualities align with the values and culture of the Club.

• Interests
Highlight any interests you have and explain how you intend to immerse yourself in the Club community.

• Motivation
Share why you want to join Tokyo American Club.

membership@tac-club.org · tokyoamericanclub.org
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Membership Application
HOW DID YOU FIND OUT ABOUT TOKYO AMERICAN CLUB?
☐ Company☐ Magazine☐ Club website☐ Reciprocal club

☐ Relocation company☐ Tokyo American Club Member☐ Chamber of commerce☐ Advertisement☐ Direct contact from Tokyo American ClubWHY DO YOU WANT TO JOIN THE CLUB? PLEASE CHECK ALL THAT APPLY.
☐ Business activities☐ Dining outlets☐ Event, meeting and catering service☐ Family activities☐ Recreation and fitness facilities ☐ Socializing and networking☐ Other (please specify):
I certify that all the statements made in this application are true to the best of my knowledge and, if I am elected to the Membership,
I pledge to abide by the Club Articles of Association, General Rules, House Rules and any other applicable regulations and policies.
I hereby declare that neither I nor anyone within my application have been convicted of any crimes or pled guilty or nolo contendere(no contest) to any crimes in Japan or elsewhere.
I also certify that neither I nor anyone within my application has never had any dealings with any organized crime group or withpersons related to any organized crime group.
I certify that I will keep the Club informed of any change of status regarding the information provided in this application.
I hereby give my consent to a full background check by the Club.

Signature of applicant:
The information I have provided is accurate and in adherence with the General Rules and Articles of Association of the Club.

BILLING AND MAILING INFORMATION
Mailing address for Club magazine (check one):Monthly statement by e-mail (PDF):☐ Home ☐ Business ☐ Not required

E-mail:COMPANY TRANSFERABLE MEMBERSHIP (Only) - Company Guarantee
Company:
Club applicant’s name:☐ New Company Transferable Membership (disregard the “Replacing” and “Membership no.” details).
☐ Replacing Company Transferable Member (please fill out below)													 Company no.:Replacing (name):

Membership no.:The company agrees to be fully responsible for the behavior and all debts incurred by the Member and his or her family.
Name of company representative (other than applicant):
Signature:
Title:

Tel:

Should you have any questions regarding the application process, please contact the Membership Office at 03-4588-0687
or e-mail membership@tac-club.org.
FOR OFFICE USE ONLY
☐ Check☐ Cash☐ Bank Remittance

Date Received:

Fee Amount:

Deposit Amount:

Date Completed Application Received:

membership@tac-club.org · tokyoamericanclub.org
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Recommendation by Proposer
Membership candidate proposers must have been a Resident, Company Transferable, Term Regular, Senior or Emeritus Member (orSenior or Emeritus Member now under the family membership of a child or grandchild), or a spouse Member, in good standing for atleast one year and should not be planning to resign within the next 60 days.
The proposer and seconder must not be on the same Club membership and cannot be related to the applicant.
DETAILS
Name of applicant:
How long have you known the applicant?
In what context? o BusinessoSocialEnglish language ability of the applicant:oNativeoFluentoBusiness/AdvancedoConversationaloMinimalRECOMMENDATION
When writing your recommendation statement below, please include references to the following criteria:•

Professional and educational background
The proposer should highlight their familiarity with the candidate’s experience and qualifications.

•

English language ability
The proposer should confirm the English-speaking ability of the candidate.

•Financial status
The proposer should detail their understanding of the candidate’s ability to meet the Club’s financial obligations as a Club Member.

•

Characteristics and Club values
The proposer should describe how the candidate’s personal qualities, including their integrity, demeanor, communication andsocial skills and cultural awareness, align with the values and culture of the Club.

•Interests
The proposer should highlight how they expect the candidate to contribute to the Club community and its activities.

•

Referrals and recommendations
The proposer may provide referrals or recommendations from individuals and/or associations that can further support thecandidate’s character and qualifications.

DECLARATION
To the best of my knowledge, the candidate for membership, whom I have met, is of good character and reputation. I believe that, if
selected, they would be a good and active Club Member.
I recommend the candidate for membership of Tokyo American Club.
Name:

Membership no:

Signature:

Date:

Should you have any questions regarding the application process, please contact the Membership Office at 03-4588-0687 or e-mailmembership@tac-club.org.

membership@tac-club.org · tokyoamericanclub.org
p. 13

Recommendation by Proposer
RECOMMENDATION STATEMENT:

Professional and educational background

English language ability

Financial status

Characteristics and Club values

Interests

Referrals and recommendations

membership@tac-club.org · tokyoamericanclub.org
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Recommendation by Seconder
Membership candidate seconders must have been a Resident, Company Transferable, Term Regular, Senior or Emeritus Member (orSenior or Emeritus Member now under the family membership of a child or grandchild), or a spouse Member, in good standing for atleast one year and should not be planning to resign within the next 60 days.
The proposer and seconder must not be on the same Club membership and cannot be related to the applicant.
DETAILS
Name of applicant:
How long have you known the applicant?
In what context? o BusinessoSocialEnglish language ability of the applicant:oNativeoFluentoBusiness/AdvancedoConversationaloMinimalRECOMMENDATION
When writing your recommendation statement below, please include references to the following criteria:•

Professional and educational backgroundThe seconder should highlight their familiarity with the candidate’s experience and qualifications.

•

English language ability
The seconder should confirm the English-speaking ability of the candidate.

•Financial status
The seconder should detail their understanding of the candidate’s ability to meet the Club’s financial obligations as a Club Member.

•

Characteristics and Club values
The seconder should describe how the candidate’s personal qualities, including their integrity, demeanor, communication andsocial skills and cultural awareness, align with the values and culture of the Club.

•Interests
The seconder should highlight how they expect the candidate to contribute to the Club community and its activities.

•

Referrals and recommendations
The seconder may provide referrals or recommendations from individuals and/or associations that can further support thecandidate’s character and qualifications.

DECLARATION
To the best of my knowledge, the candidate for membership, whom I have met, is of good character and reputation. I believe that, if
selected, they would be a good and active Club Member.
I recommend the candidate for membership of Tokyo American Club.
Name:

Membership no:

Signature:

Date:

Should you have any questions regarding the application process, please contact the Membership Office at 03-4588-0687 or e-mailmembership@tac-club.org.

membership@tac-club.org · tokyoamericanclub.org
p. 15

Recommendation by Seconder
RECOMMENDATION STATEMENT:

Professional and educational background

English language ability

Financial status

Characteristics and Club values

Interests

Referrals and recommendations

membership@tac-club.org · tokyoamericanclub.org
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Diners Club Card Registration Form
Page 1

To. Sumitomo Mitsui Trust Club Co., Ltd
I/We hereby apply for the membership of Diners Club Card upon consent of all contents in "Consent to the Card Application" in this registration form, and other related special
provisions, with prior consent that "Terms and Conditions for ETC Card", "Terms and Conditions for Sumitomo Mitsui Trust Club Rewards Program", "Terms and Conditions for
Diners Global Mileage", "Companion card tokuyaku", and"Business account card tokuyaku" (The special provisions for the Companion card, Business account card services)incidental to the" Terms and Conditons for Diners Club Card / TRUST CLUB Card Membership "become part of the contract. I further consent with Sumitomo Mitsui Trust Club
Co., Ltd that upon my actual enrollment into Diners Club Card membership, the result of the screening of my application for Diners Club Card will be provided to Tokyo
American Club (TAC) , with necessary protective measures in place, so that TAC can use such information for the purpose of enhancing various services it offers to its
members.
Date of
Application

Year

Month

/

Please tick the purpose of transaction. (check the
Purpose of transaction(Shopping)

Day

/
)

Payment of living expense 1

Payment of business expense 2

Both 3• Please tick the box below if you are a Politically Exposed Foreign Person listed on Page 5.

Yes

I am a Politically Exposed Foreign Person.

*Please note that some services will not be available to you if your answer is "Yes".

Select plan

①Three years package plan Fee:【Fee:¥231,000（including tax）】
Fee ￥231,000（including tax） is required in the first year.
※ No refund for midterm cancellation with Three years package plan.
※ Require ¥143,000(including tax) annual fee from 4th year.
※ No downgrade when selecting Three years package plan during the period.
②Single year plan
First year's annual fee is waived,and your membership is automatically renewed every year, and accordingly ,annual fee ¥143,000（including tax）is charged from thesecond year forward.

Select optional card
Card type

Annual fee (excluding tax)

Diners Club Premium Card 480

Principal Member

Family Members

1

Three years package plan

Apply for ETC Card

2

Single year plan

Apply for Revolving Card

Apply for ETC Card
Apply for Revolving Card

• Applicants cannot apply for only a Family or ETC card.
• Applicants for Family Cards will be issued the same card type as Principal Member’s card.
• Applicants who check the box to apply for a Family Card(s) should fill in “ 4 About Family Card Members” on Page 3.

Shopping Revolving Payment Course
The shopping revolving payment course is initially set as "Select Revolving(Type B)". You can change the course after card issuance.
“Select revolving (Type B)” … A revolving payment will apply if you designate the revolving payment method at stores in Japan. Only a single payment is available for shopping at overseas.

• Use of Revolving payment will be restricted to the Revolving shopping credit line determined by Sumitomo Mitsui Trust Club screening.
• Revolving payment cannot be used for annual fees, fees, insurance fees, execution of agreement fees, etc.

If you already have a credit card issued by Sumitomo Mitsui Trust Club Co., Ltd please note the following.
• The information included on this application form (home address, telephone numbers, place of business, address of place of business, etc.) will be registered as
your current information. Please note that it alters the information of other cards issued by Sumitomo Mitsui Trust Club Co., Ltd• The card and billing statements will be sent to the address indicated on this application form.
• No more than one address can be registered (You can have one registered address for home and work each).

2 B 7 1 9 0 9 4 9 0 0 A31
0 0 0 1 1 0 0 1 0 1 3

1 B 7 1 9 0 9 4 9 0 1 A31
0 0 0 1 1 0 0 1 0 1 3

Agent

0 0 T A C

(Client ID)

当社使用欄
取引形態
確認方法
確認者・作成者

クレジットカード交付/貸金
提示・写し
提示・写し

確認書類
確認書類

免・パ・健・個・在（
免・パ・健・個・在（

確認日時

（

/

/

） 確認書類との不一致︓無・有 補完書類︓無・有） 確認書類との不一致︓無・有 補完書類︓無・有
)

(

:

PID

)

Y

N

M

C

23MK-1656-202404
membership@tac-club.org•

www.tokyoamericanclub.org

Be sure to fill in Page 2

Diners Club Card Registration Form
Page 2

1 Principal Member Information*1 Include people in the household (excluding cases in which people in the same household acknowledge that they are financially independent of one another) and those who shareliving expenses, including those who live apart from the main household but receive financial support.
*2 Email addresses must be 40 characters or less. Information about products and services that are beneficial to customers will be sent via email. Please spell your e-mail address clearly.
The registration may fail if it is unclear.
*3 Those who do not have PC email addresses should list their mobile phone email address.
*4 Those who are unemployed, employed part-time or temporarily, and housewives should fill in “household income.” All others should fill in “last year's income” only.

*One space is allowed in your name.
*Please enter your name exactly as it appears on your identification document.
Last

First

Middle

Last

First

MiddleName(blockletters)Name(katakana)Theembossed
name*Clearly print FIRST NAME and LAST NAME in no more than 19 letters (including the space in between).

Year

Date
of Birth

Month

/

Day

/

GenderMale 1-M

Female 2-F

Be sure to include your postal code. Please use the same address as that on your personal identification. Your card and monthly billing statements(for those who prefer that paper statements be mailed to them) will be mailed to this address.

Home
AddressHome
Tel. No.

()
Home ownerHome owner

RentingRenting a house 6-3(in applicant’s name) 1-1

Type ofResidence(apartment, condominium) 5-3(in family member’s name) 2-2

Company housing/dormitory 3-5

Emailaddress *2

MobilePhone No.

-The number of family membersin the same household *1(including yourself))

1 person 1

2 person 2

Married withno children 1-1

Marital andFamily Status

Other 0-6(-

Married withchildren

3 person 3

4 person or more 4

Single, livingwith parents 2-3

Single, living apartfrom parents 2-3

PC or Mobile Phone *3

Last year’s income(annual income,including taxes) *4

Payingmortgage or rent?
(including spouse)

Household income(excluding applicant’s income)(annual income, including taxes) *4

¥
Yes 1
No 0

Do you have acredit card fromother companies?

Yes Y
No N

¥

Savings(optional)¥

PIN*Do not use the following numbers: repeated digits/date of birth/phone number.
*We may change the PIN if you use any of the numbers above.

membership@tac-club.org•

www.tokyoamericanclub.org

Be sure to fill in Page 3

Diners Club Card Registration Form
Page 32 Occupational Information

Temporary employees should fill in the name of their temporary staff agency.

*1 Self-employed and freelance professional persons without a company name should fill in their type of business. Name of employer must be 20 characters or less.
*2 If the number of years of employment is less than 1 year, fill in 0 years. Those who are self-employed or freelance professionals should fill in the number of years they have been in business.
*3 Section or department must be 10 characters or less.
*4 Those who are contract or temporary employees, unemployed persons, and those who are employed part-time or temporarily are not eliglible to apply for a Diners Club card.
*5 Housewives are not eliglible to apply for a Diners Club card.

katakana

Section or
department*3

Company
name *1

Work
Telephone no.

()

Years ofservice*2

-

Years

Be sure to include your postal code.

Work
Address

Type ofOccupation

Applicant(Mainoccupation)

Occupation(If you havemore than one)

Occupation,
position
at work
CapitalAgriculture, forestry,
fisheries industry, mining 10-01

Construction, real estate 20-02

Manufacturing 30-03

Electric, gas industry 70-04

Transportation,communication 60-05

Wholesale, retail, other
distribution industry 40-06

Financial, insurance services 50-07

Other service industries 89-08

Government and municipal offices 87-09

Other 99-10

Employed by a private company 02-021

Public servant 01-041
Lawyer, certified public accountant,
Licensed tax accountant, judge, prosecutor 14-002
Employee (other) 20-071

Doctor, dentist, veterinarian 13-001
Self-employed (business, agriculture,
forestry, fishing, real estate, etc.) 03-011
Pensioner 12-094

Housewife*5 10-092

Employed by a private organization 17-031
Other certifications(pharmacist, real estate appraiser, etc.) 15-003
Entertainer, artist, etc. 16-012
Unemployed, employed part-timeor temporarily*4 09-091

Teacher 18-051
Assemblyman, diplomat 06-081
Contracted or
temporary employee*4 19-061

Only if you have an occupation beside your main
occupation, please write the above number.
e.g.) Teachers: Please write 051.

Owner 1-1

Representative director 2-2

Director, executive, trustee 3-3

Manager 4-4

Other, not managerial 5-5

Principal/Dean, professor, assistant professor 6-6

Teacher 7-7

Laborer 8-8

Technician/Engineer 9-9

Less than ¥10 million 1-1¥10 million-less than ¥50 million 2-2

Less than 10 1-1

10-29 2-2

30-49 3-3

50-99 4-4

100-499 5-5500 or more 6-6¥300 million or more 4-4

Other 7-7

Number of
employees¥50 million-less than ¥300 million 3-3

3 Address for Billing Statement
Home Address 1

Want to receive billingstatement in English.

Work Address 2

Unless the check box
above is checked, billingstatement in Japanese
will be sent.

Unless the check box above is selected,billing statements will be sent to your home address by mail.

4 Family Member Information Those qualified for family membership are limited to spouse, children (age 18 and over), and parents.
• If this section of Family Members is filled out, the family member will receive the same card type as principal members.
• No identification document of the family member is required for this application.
I/We hereby apply for the family membership of Diners Club Card the following people as family members upon family's consent of all contents in "Consent to theCard Application" on page 5-8 in this registration form, and other related special provisions, with prior consent the terms and conditions, special agreements, etc.,
described in the first letter of this application form that become part of the contract.
The family member applying for the membership him/herself must both fill out the information below.

Family
Name

Last

First

Middle

Last

First

Middle(blockletters)

FamilyName(katakana)

Dateof Birth

Year

/

Month

/

Day

GenderMale 1-M*If you are foreign national,please clearly print your FIRST NAME and LAST NAME in 19 charactersTheor less with a space in between. *One space is allowed in your embossed name.
embossednamemembership@tac-club.org•

Female 2-F

Relationship

PIN

Spouse 1-1
Parent 2-3*Do not use the following numbers:
repeated digits/date of birth/phone number.
*We may change the PIN if you use any of
the numbers above.

www.tokyoamericanclub.org

Child 3-2

Diners Club Card Registration Form
Page 45 Application for Direct Debit and Automatic Payment If you make a mistake, cross out the mistake with double lines and sign or place your seal next to it.
Be sure to indicate the applicant’s own personal bank account (Company bank accounts and bank accounts under a family member's name may not be used).
Please make sure to write down the exact same name ,furigana and stamp your name seal or sign your signature as is written on forms registered with your bank.
* If your bank ,including but not limited to online banks,requires neither a registeredseal nor a signature for transactions,please check the box below.
 (We)hereby confirm that my bank account for direct debits requires neither aregistered seal nor a signature.
信用金庫 Credit Association
銀行 Bank
労働金庫 Workers Credit Union
信用組合 Credit Union
農協 Agricultural Cooperative

金融機関

ゆうちょ銀行
以外の金融機関

Financial
institutions
other than
JP Bank

Financial
institution

預金種類

口座番号

Account no.

Type of acct

普通・総合

1 Savings/
deposit

本店 Main branch
支店 Branch
出張所 Sub-branch

当座

2 Current/

checking account*Registered stamp（金融期間お届け印）*Signature

フリガナ
口座名義

Account
nameor

振替日：毎月10日（休日の場合は翌営業日）

Registeredstamp
or signature

Date of direct debit： 10th day of the month （If it falls on a holiday, the next business day）

以下は当社使用欄です。
銀行コードBank code

支店コード

Branch code

金融機関使用欄（不備返却事由）

1 印鑑相違2 印鑑不鮮明

3 預金種目相違

6 預金取引なし

7支店名相違8 その他（4 口座番号相違

5 名義人相違

検 印）＜不備返送先＞ 〒104-6035 東京都中央区晴海一丁目8番10号トリトンスクエアＸ棟 三井住友トラストクラブ株式会社 口座振替係

I choose to pay, through direct debit, any amount billed by Sumitomo Mitsui Trust Club Co., Ltd. from the above-identified account of mine,and hereby make a request by undertaking the Direct Debit Terms and Conditions.
Direct Debit Terms and Conditions (excluding JP Bank)
1. If you receive a bill payable by me, please withdraw the amount indicated therein from the account without giving notice to me. In such
event, I will not submit my passbook, make a request for withdrawal or issue a check regardless of the Savings Account Terms and Conditions
or Checking Account Terms and Conditions.
2. If the amount indicated in a bill exceeds the amount withdrawable from the account (including the amount within the overdraft limit) as ofthe designated date of direct debit (or the following business day if the designated date falls on a bank holiday), you may, without giving
notice to me, return the bill or withdraw any amount on any day after the designated date of direct debit and apply the amount to part or allof the payment fund.
3. In order to terminate this contract, I will give written notice to you. If you have a good reason, such as no arrival of bills for a long periodof time without such notice, the contract may be treated as if it was terminated, unless otherwise requested by me.
4. I will hold you harmless from any dispute that may arise from the account for direct debit, unless such dispute is attributable to you.
三井住友トラストクラブ株式会社から請求された金額を私名義の上記預金口座から預金口座振替によって支払うこととしたいので、預金口座振替規定を確約のうえ依頼します。
預金口座振替規定（ゆうちょ銀行除く）
1.貴行（金庫、組合）に請求書が送付されたときは、私に通知することなく、請求書記載金額を預金口座から引き落としのうえ支払ってください。この場合、預金規定または当座勘定規定にかかわらず、預金通帳、同払い戻し請求書の提出または小切手の振出しはしません。
2.振替指定日（当日が金融機関の休日の場合は翌営業日）において請求書記載金額が預金口座から払戻すことのできる金額（当座貸越を利用できる範囲内の金額を含む。）をこえるときは、私に通知することなく、請求書を返却してもまた貴行（金庫・組合）任意の金額を振替指定日以降任意の日に引き落としのうえ、
支払資金の一部または全部に充当されてもさしつかえありません。
3.この契約を解除するときには、私から貴行（金庫、組合）に書面により届け出ます。なお、この届出がないまま長期間にわたり請求書の送付がない等相当の事
由があるときは、とくに申出をしない限り、貴行（金庫、組合）はこの契約を終了したものとして取扱ってさしつかえありません。
4.この預金振替口座についてかりに紛議が生じても、貴行（金庫、組合）の責めによる場合を除き、貴行（金庫、組合）には迷惑をかけません。

membership@tac-club.org•

www.tokyoamericanclub.org

印鑑照合

受付印

Diners Club Card Registration Form
『Please keep this document Page5 to Page8 of consents, provisions and Notice regarding usage of cards, etc. at hand.
The English version of the Terms and Conditions for Diners Club Card / TRUST CLUB Card Membership can be find at www.sumitclub.jp/ja/tc/index.html. 』

Page 5Consent to the Card Application
I hereby agree that I acknowledged the provisions of Agreed Provisions and Important Matters regarding Handling of Personal Information provided by
Sumitomo Mitsui Trust Club Co., Ltd (hereinafter called "you") and that you collect, use and provide my personal information. I also hereby present andwarrant that I acknowledged the provisions of "Consent for Representation and Warranty Concerning Non-Anti Social Force" and that I am not anti-social
force and any of the items listed therein is not applicable with respect to me. In case that I apply for a card that is issued under your partnership withanother company / body (hereinafter called "co-branded card") and the co-branded card has the special agreement in regard to Agreed Provisions andImportant Matters regarding Handling of Personal Information, I apply for the card upon my acknowledgement of and consent to the provisions.
If you issue a card to me as a result of screening, I will agree swiftly to the Terms and Conditions of the Membership and Special Agreement in regard to
holding and using the card provided by you. I will not raise an objection to the result of your screening. I acknowledge and agree that the contract with you
takes effect as of the date when you issue the card, etc. as a result of the screening.

Consent for Representation and warranty Concerning Non-Anti Social Force
Article 13. (Rejection of Transactions with Anti-social Forces)
1. Members and membership applicants ("Members, etc.") hereby represent andwarrant that each of them is not and will not be any of the followings:(1) An organized crime syndicate (Boryokudan);(2) A member of an organized crime syndicate or a former member of such a
syndicate who ceased to be a member less than 5 years ago.
(3) A quasi member of an organized crime syndicate;(4) An enterprise connected with an organized crime syndicate;(5) A corporate extortionist (Sokaiya) etc., racketeering organization proclaiming to
be a social activist, etc., group committing special intellectual crimes, etc.;(6) A person who cooperates with any of the above (any of above referred to “
Organized Crime Syndicate Member, etc. ”);(7) A person who is designated as the subject of economic sanctions by the Japaneseor foreign governments, etc.; or(8) Any other persons or entities that Trust Club recognizes as being equivalent to anyof the above .
2.“A person who cooperates with Organized Crime Syndicate Member, etc.”
prescribed in the Article 13.1(6) refers to any person who falls under any of thefollowings:(1) A person who attempts to benefit from engaging in activities to gain funding forthe organized crime syndicate, etc. or by utilizing the power, information gathering
capability or financial strength, etc. of an Organized Crime Syndicate Members, etc.;(2) A person who is recognized as having a relationship with business that iscontrolled by or has substantial involvement by an Organized Crime Syndicate
Member, etc.;(3) A person who is recognized as having a relationship that makes improper use ofan Organized Crime Syndicate member, etc.;(4) A person who knowingly provide funding, etc.to or otherwise facilitates an
Organized Crime Syndicate Member, etc.; or(5) A person who has a socially condemnable relationship with an Organized
Crime Syndicate Member, etc.
3. Members, etc. hereby covenant that each of them shall not directly or througha third party conduct any of the following:(1) To make a demand with violence;(2) To make an unfair demand beyond legal liability;(3) To use threatening language or use violence in relation to Card transactions(including but not limited to the use of Cards, payment of charges, and use of
Supplementary Services, etc.);(4) To damage Trust Club’s reputation or interfere with Trust Club’s business bydisseminating rumors, or using fraudulent means or threatening forces; or(5) Any other act equivalent to any of the foregoing.
4. If Trust Club recognizes that any of the following applies or is likely to become
applicable to a Member etc., Trust Club may reject the membership application bysuch a person:(1) any of the items in Article 13.1;(2) the Member, etc. commits an act in any of the items listed in Article 13.3; or(3) the Member, etc. is revealed to have made a false statement in relation to anyof the representations and warranties pursuant to the provisions of Article 13.1 or
13.3.
5. If Trust Club recognizes that any of the above applies or is likely to become
applicable to Members, the provisions of Article 15 shall be applied mutatis
mutandis to him/her and Trust Club may take measures such as suspension ofuse or lending of Card, legal actions, cancellation of membership.

A politically exposed foreign person
1. You are a "politically exposed foreign person" if you are or have been entrusted witha foreign function equivalent to any of the following public functions.
・Head of State or Head of Government
・Prime Minister, other Minister of State or Vise Minister of State・Chairman of the House of Representative, Vice-chairman of the House ofRepresentative, President of the House of Councilors or Vice President of the Houseof Councilors
・Justice of the Supreme Court
・Ambassador Extraordinary and Plenipotentiary, Envoy Extraordinary and
Minister Plenipotentiary, Ambassador on Special Mission, Representative of theGovernment or Plenipotentiary.
・Chief of Staff, Joint Staff; Vice Chief of Staff, Joint Staff; Chief of Staff, G.S.D.F.; Vice
Chief of Staff, G.S.D.F.; Chief of Staff, M.S.D.F.; Vice Chief of Staff, M.S.D.F.; Chief ofStaff, A.S.D.F. or Vice Chief of Staff, A.S.D.F.

・Board member of Central Bank・Executive of the corporation that must receive approval of the cabinet for thebudget through voting.
2. The above No.1 has been applicable to you in the past.
3. You have a family who holds any of the positions prescribed above (e.g. spouseincluding a partner who is not legally married but has a common-low marriage toyou, parents, children, siblings and the spouse’s parents and children)* It is not applicable to grandparents or grandchildren of a politically exposed
foreign person.
* It can be applicable even if a spouse of politically exposed foreign person is aJapanese. Furthermore, Cash advance/Card loan credit line will not be available if
any of the above No.1-No. 3 is applicable to you.

Consent Clause and Important Matters Regarding Handling of Personal Information〈These consent clause (the “Consent Clause”) and important matters (the“Important Matters”) shall constitute a part of these Terms and Conditions for Diners
Club Card / TRUST CLUB Card membership (the “Terms and Conditions”).〉
This English version of the Consent Clause shall be for reference purpose only. If there
is any inconsistency between the English and Japanese versions, the Japanese version
shall prevail.
Article 1. (Collection, Holding, Use and Provision of Personal Information)
1. Members and membership applicants (“Members, etc.”) agree to the collection,
holding, use and provision by Trust Club of the information set forth in the following
items concerning themselves (the “Personal Information”), for the purposes ofmaking credit decisions, management after extending credit, provision of
Supplementary Services, and handling of administration including but not limited tothe processing of Account Transfers, etc., upon taking necessary protection
measures. Management after extending credit shall include the confirmation ofCard use, notification to Members of charges for Card use (including any
payment request in case of delinquency), confirmation of contact details, and use
for debt collection.
(1) Particulars of Members, etc. including but not limited to name, age, date ofbirth, address, telephone number, e-mail address, employer, office telephone
number, occupation, purpose of transaction, code/number of a driver’s license,
etc., assets, income, debts, status of residential circumstances, information on thestatus of residence that the Member etc. notifies to Trust Club at the time of
membership application; particulars that a Member, etc. notifies to Trust Club
such as documents that are submitted; particulars that a Member, etc. notifies toTrust Club pursuant to these Terms and Conditions; and matters that become

Diners Club Card Registration Form
Page 6
known to Trust Club through telephone inquiries or by any other means;(2) Matters concerning the agreement between Trust Club and a Member, etc.,
such as the date of membership application, date of contract, and credit line;(3) The date of application for use by Members, date of contract, name of
Merchant, name of goods, contract amount, number of payments, ID or any otheridentifying information, etc., Card activities and status of payments by Members
and information concerning credit line management (including information that
Trust Club lawfully obtains from Merchants, etc. accepting the credit cards);(4) Records of card use and payments, etc. by Members, etc. received by TrustClub from the personal credit information agencies prescribed in Article 2 ;(5) Identification documents that Members, etc. submit to Trust Club pursuant to
the Act on Prevention of Transfer of Criminal Proceeds and the identification
procedures prescribed by Trust Club, and the matters stated therein;(6) Matters stated in a document issued by a public organization that Trust Club
lawfully or properly obtains from a Member, etc. or the public organization;(7)Status of personal identification by Trust Club or a financial institution, etc. atwhich a Payment Account is opened; and(8) In addition to the above, information obtained through the use of Trust Club’s
website, information disclosed to the general public by means including but notlimited to the Internet, official gazettes (Kampo), or employee lists, and any otherinformation (including individual-related information) that Trust Club obtains in
an appropriate manner.
2. Members, etc. consent to the use by Trust Club, upon taking necessary
protection measures, of the Personal Information listed in items (1) to (3) in thepreceding paragraph for the following purposes (detailed contents of operations
are available on Trust Club's website, etc.):(1) Notification of new products in credit-related operations and related after-saleservices;(2) Market research and product development in credit-related operations;(3) Delivery of promotional materials and publications concerning credit-related
operations, and sales activities including but not limited to telemarketing; and(4) Delivery of promotional materials and publications concerning sales activities
of entities including but not limited to the Merchants, etc.
3. Members, etc. consent to the use by the following companies with which TrustClub is partnered (the "Joint User Companies"), upon taking necessary protection
measures, of the Personal Information listed in Article 1.1(1)-(3) and (5) for thefollowing purposes:
Sumitomo Mitsui Trust Holdings, Inc. and its consolidated subsidiaries andequity method affiliated companies stated in its annual securities report, etc. (wewill handle the information in compliance with the Financial Instruments andExchange Act and related statutes where such shared use is restricted by law).
Purposes:(1) Acceptance of applications / consultations for financial products, trust
products and services of the Joint User Companies;(2) Matters including but not limited to the identification of Members, etc.,
pursuant to the Act on Prevention of Transfer of Criminal Proceeds andconfirmation of eligibility for financial products, trust products and services;(3) Research and development of financial products, trust products and services
by measures including but not limited to market research, data analysis andquestionnaires;(4) Various proposals concerning financial products, trust products and services
including but not limited to the dispatch of direct mails, telephone or e-mails;(5) Assessment of risks as a necessary part of business management for the Joint
User Companies.
4. If a Member, etc., (except Family Members, the same shall apply hereunder inthis paragraph.) is admitted under the membership referral system operated by
Trust Club, the Member, etc. shall consent to the disclosure by Trust Club of thefact of admission of the Member, etc. to the referrer (being a Member) for the
purpose of delivering a gift or any other reward for the referral.
5. Members, etc., shall agree to the continued application of this Consent Clause
and these Important Matters for a period that Trust Club deems appropriate after
Member's withdrawal from the membership due to reasons including but notlimited to the cancellation thereof.
6. Members, etc. shall agree to the provision of Personal Information to publicorganizations, etc. if Trust Club is called upon to submit such information
pursuant to the provisions of laws and regulations and if required for a publicbenefit equivalent thereto.
Article 2. (Inquiries to, Registration with, and Use of Personal Credit
Information Agencies)
1. Members, etc. (except Family Members; the same hereafter in this paragraph)consent to Trust Club making inquiries to personal credit information agencies(entities engaged in the business of collecting information concerning individuals’

solvency and repayment capacity and providing such information to theirmembers; the "Agency") where Trust Club is a member, as well as personal credit
information agencies partnered with the Agency (the "Partner Agencies"), when
making transactional decisions relating to these Terms and Conditions, and to
Trust Club utilizing such information if Personal Information (i.e., "Registered
Information" column in the table below with history, and includes informationsuch as agreement details and status of repayment registered by the Agency’
members; information on dishonored bills/checks, information on bankruptcy
and other information published in official gazettes (Kampo), and information
published in telephone directories registered by Partner Agencies; andinformation registered at the request of the Japan Financial Services Association)of Members, etc. and spouse is registered, exclusively for the purpose of assessing
the solvency and repayment capacity of Members, etc.
2. Members, etc. (except Family Members) consent to having information (i.e.,
information contained in "Registered Information" column in the table below
with history) designated by the Agency shall be registered with the Agency for aperiod set forth in the “Registered Period” in the table below, and to having theinformation registered used by members of the Agency and the Partner Agencies
for the purpose of assessing solvency and repayment capacity.
3. Members, etc. (except Family Members) consent to having information under
Articles 2.1 and 2.2 exchanged among and used by the Agency, the Partner
Agencies and their respective members to the extent necessary for ensuring theprotection and proper use of the Personal Information, such as maintaining suchinformation accurate and up-to-date, processing complaints, and Agency’monitoring their members’ compliance with rules.
4. Contact information of the Agency (name, address, and telephone number forinquiries), and information registered and period registered at the Agency are as
set out below. If Trust Club were to become a member with another personalcredit information agency, Trust Club shall give a separate notice in writing to theMembers, etc. and obtain their consent. The details such as Agency membership
qualifications and names of their member companies are available on its website.
Credit Information Center Corp. (CIC) https://www.cic.co.jp/【Designated personal credit information bureau under the Installment Sales Act
and the Money Lending Business Act】
Shinjuku First West 15F, 1-23-7 Nishi-Shinjuku, Shinjuku-ku, Tokyo
160-8375
Telephone: 0120-810-414
Registered Information and Period Registered(Please see the Agency's website, etc. for details.)
Registered Information

Period Registered① Evidence for filing applications in relation to theTerms and Conditions

Six (6) months from the date of inquiry by Trust Club

② Objective evidence on transactions related to theTerms and Conditions

For the duration of agreement and up to five (5) years aftertermination of agreement③ Evidence of delinquency in payment of obligations

For the duration of agreement and up to five (5) years aftertermination of agreement

5. The personal credit information agencies partnered with the Agency are as
follows. Any queries to the following Partner Agencies should be made throughthe personal credit information agency in Article 2.4.
(1)
Zenkoku
Ginko
Personal
CreditInformation
Center(KSC)https://www.zenginkyo.or.jp/pcic/【a personal credit information agency whose members are mainly financial
institutions and their affiliates】
1-3-1 Marunouchi, Chiyoda-ku, Tokyo 100-8216 Telephone: 03-3214-5020(2) Japan Credit Information Reference Center Corp. (JICC)
https://www.jicc.co.jp/【a designated personal credit information agency under the Money Lending
Business Act】
Sumitomo Fudousan Ueno Building 5
1-10-14 Kita-Ueno, Taito-ku, Tokyo 110-0014
Tel: 0570-055-955※ CIC has established a network for mutual exchange of information(CRIN) with partners in order to prevent multiple debts. Trust Club utilizes KSC
and JICC’s information through CIC.
6. The information registered with the personal credit information agency ofwhich Trust Club is a member (as set out in Article 2.4) is as follows:
Name, date of birth, address, telephone number, employer, office telephone
number, driver’s license and other codes, numbers and information for
identification; the contract type, date of execution, contract amount , loan
amount, number of payments, and other information on contracts; activity
balance, balance of installment purchases, scheduled amount of annual charges,
Date of Payment, date of full repayment, delinquency in payment, and otherDiners Club Card Registration Form
Page 7
information concerning the status of payments.
Article 3. (Disclosure, Correction and Deletion of Personal Information)
1. A Member, etc. may request Trust Club, the Joint User Company, or the Agency
to disclose the Personal Information concerning himself/ herself pursuant to theprovisions of the Act on the Protection of Personal Information. Such requests fordisclosure shall be made as follows:(1) A request for disclosure to Trust Club and the Joint User Company should bemade to the Customer Service at the end. The procedures for such a request areavailable on Trust Club's website, etc.
(2) A request for disclosure to the Agency should be made to the personal credit
information agency in Article 2.4.
2. In the event any information registered is found to be untrue, Trust Club and the
Joint User Company shall promptly accept a request for correction or deletion.
Article 4. (No Consent to Handling of Personal Information and Request for
Suspension of Use/Provision of Personal Information)
1. If a Member, etc. does not wish to fill out matters required to apply formembership or does not consent to all or part of the handling of Personal
Information set forth in this Consent Clause and these Important Matters, TrustClub may refuse membership or initiate membership cancellation process.
However, Trust Club shall not refuse membership or cancel membership on the
grounds that a Member, etc. fails to give consent to Articles 1.2 and 1.3.
2. If Members request the suspension of use of the Personal Information related to
Article 1.2 and 1.3, Trust Club shall suspend such to the extent operations are notaffected and will exclude delivery, etc. of Cards, statements of charges, etc.
Members should request suspension to the Customer Service at the end.
Article 5. (Use/Provision of Personal Information when Agreement Is Not
Concluded or when Agreement Is Terminated)
Even if the agreement between Trust Club and a Member, etc. fails to conclude,
Trust Club may use and provide the fact that the Member, etc. applied to TrustClub for the membership pursuant to Article 1 and Article 2.2 regardless of thereason for the failure of the agreement to conclude. Trust Club shall not, however,use or provide the fact in any other manner whatsoever. Similarly, even if theagreement is terminated, Trust Club may use and provide person information in
the same manner regardless of the reason for the termination.
Article 6. (Amendment to Provisions)This Consent Clause and these Important Matters may be amended to the extent
required in accordance with the procedures set forth under the applicable laws andregulations, etc.
■ Please contact the following for any request for disclosure or suspension of use of
Personal Information:<Customer Service>
Triton Square Building X, 1-8-10 Harumi, Chuo-ku, Tokyo 104-6035
Telephone: 03-6852-0935
If the above line is busy, please call the following Call Center number:◆ Diners Club
Toll Free: 0120-074-024◆ TRUST CLUB Card
Toll Free: 0120-003-081＊Please have your Card number and PIN at hand when you call.
(24LC-3666-202403)

Notice regarding usage of cards, etc.
Special clauses concerning the usage of cards, etc.
Matters concerning theannual membership fee

In principle the annual membership fee that has been already paid
will not be refunded, irrespective of the reasons, such as withdrawal
or cancellation of the membership.

Matters concerning
storage or managementof the cards, etc.

Please use and manage your card with great care and caution.

Matters concerning the
responsibility of the
cardholder when his/hercard, etc. is used by athird party.

Matters concerning theChanges of conditionsof transactions(changes in Terms andConditions, fees, etc.)

In case it is determined by Trust Club that your card has been usedor could have been used by a third party. Trust Club would invalidate
the card and issue a new card.
In case your violation of the Terms and Conditions leads to the usageof your card or card information by a third party, you would be held
responsible for the damage and It’s repayment.
Regarding a counterfeit card, please note that if you are inadvertently
or intentionally involved, you are required to pay the charges on the
counterfeit card if you are inadvertently or intentionally involved.
Trust Club may change the interest rate due to the changes in thefinancial situation.
If you use your card after Trust Club revised Terms and Conditions,etc. and announced or disclosed the revisions, it would be regarded
that you have agreed on the revisions of Terms and Conditions, etc.

【Payment method】
In principle, the card charges are closed on the 15th day of each month and thepayment (principal + charges) is made on the 10th day of the following month (orthe following business day if the 10th day falls on a Saturday, Sunday or holiday) bymeans of direct debit from the account at a financial institution designated by themember.
* While there is no across-the-board total credit line to the amount of usage, if theamount exceeds a certain level, a merchant would contact Diners Club forreference.
One lump-sum payment
It is an ordinary payment method. If you don’t designate a specific payment
method when you use your card at a merchant’s outlet, your payment would be
one lump-sum payment.
One lump-sum payment at bonus time
It is to pay off the card charges at bonus time in one lump-sum payment.
Summer: Card charges are settled on the August’s payment date for the amountspent during the period from the day following the Closing Day of the lastDecember to the Closing Day in June of the said year.
Winter: Card charges are settled on the January’s payment date of the following
year for the amount spent during the period from the day following the Closing
Day in July to the Closing Day November of the said year.
* No Interest is charged.
* Some merchants may not accept this payment method. As the handling period
and amount vary from merchant to merchant, please confirm at merchant’s
outlets.
* One lump-sum payment at bonus time is not available outside Japan.
* For the one lump-sum payment at bonus time, ”Revolving shopping credit line”
needs to be set. The credit line is decided by Diners after a due screening, which isno larger than ¥3,000,000. The card can be used within the credit limit.
Revolving payment“Revolving payment” is a payment method in which the monthly payment amount(repayment) is almost equal every month, irrespective of the amount or frequencyof the card usage in the month. An interest fee is charged according to theoutstanding balance. The card can be used up to the amount decided by Diners
after a due screening, which is no larger than ¥3,000,000.
For details, please see below.
* ”Revolving Card” is also available.
【Revolving Payment】
1. Revolving shopping credit line / fee rate, etc.
Revolving Shopping
Credit LineFee Rate(Actual Annual
Rate)

Payment Method

Payment Period/ Number of Payments/
Payment Date

Amount determined by
Trust Club after
examination, not toexceed ¥3,000,000

15.00%

Minimum payment method: The
applicable amount will be the higher ofthe principal payment amount that a
Member agrees to in advance with TrustClub at the time of the credit card
application and the amount of theprincipal payment that varies dependingon your outstanding balance.
＊If Member wishes, a setting to makehigher payments may be made in bonus
months.
＊The principal payment is set at 20,000
yen at the time of enrollment.

■ Payment Period/Number of Payments
Depending on the outstanding balance andpayment method, the payment period andnumber of payments until the principal payment
and fee are fully paid will vary.
■ Payment Due Date
In principle, the closing date is the 15th day ofeach month and payment is due on the 10th
day of the following month. Payment is to bemade on the 10th day of each month (eachmonth’s principal payment + fee).
※ Trust Club may, upon examination, allow a
revolving shopping credit line that exceeds therevolving shopping credit line set forth above.

※ Trust Club may, upon examination, allow a revolving shopping credit line thatexceeds the revolving shopping credit line set forth above.

Diners Club Card Registration Form
Page 8〈Fees〉
The calculation method for the revolving payment fee shall be the Without
Method, with the revolving balance as of the Closing Date multiplied by one
twelfth (1/12) of the effective annual rate. In addition, the initial revolving fee also
is calculated based on the revolving balance as of the Closing Date regardless of thenumber of days from the Card activity date until the Payment Date.
2. Principal Payment (based on the outstanding balance as of the Closing
Date)
Outstanding
Balance
Principal Payment

Up to ¥500,000

Up to ¥1,000,000

Up to ¥1,500,000

Up to ¥2,000,000

Up to ¥2,500,000

Over¥2,500,000¥20,000¥40,000¥60,000¥80,000¥100,000¥120,000

3. Example of Revolving Payment (example of a specific calculation of themonthly amount due)If using revolving payment for the cash price (the Card use amount) of ¥100,000 on
10 April (where Closing Date is the 15th day of each month, Payment Date is the10th day of each month, effective annual rate is 15.00%, and principal payment in
the minimum payment method is ¥20,000):First payment (on 10 May)
(Amount Due)A. Principal payment: ¥20,000
B. Fee: ¥1,250 〔¥100,000 x 15.00% ÷ 12 months x 1 month = ¥1,250〕
Amount Due: A (¥20,000) + B (¥1,250) = ¥21,250

Second payment (on 10 June)(Amount Due)

Principal payment: ¥20,000
Fee: ¥1,000 〔¥80,000 (¥100,000 – ¥20,000) x 15.00% ÷ 12 months x 1 month = ¥1,000〕
Amount Due: A (¥20,000) + B (¥1,000) = ¥21,000※ Amounts Due in the third and subsequent payments will be calculated in thesame manner as in the second payment.
※ Any fraction below one yen will be rounded down.

Important Information about Personal identification documents.
From April 1, 2020 “Act on Prevention of Transfer of Criminal Proceeds” Due to amendment of the enforcement regulations,two personal identification documents are required.
Accordingly, if your application form will arrive at Sumitomo Mitsui Trust Club Co., Ltd. after March 1, 2020, be sure to
enclose two personal identification documents.
※Please refer to the following for the combination of personal identification documents.
※Please note that for applications submitted on or before March 1, 2020, you may be required to submit one more personal
identification document, depending on the screening process.
Upon submission of personal identification documents□Be sure to check the combination of personal identification documents on the back and prepare two documents to be submitted.
□It is necessary for the copy of the page showing the name, date of birth, and current address when you submit two personal identification documents.
□Limited to those valid at the time of application, or those with the issue date or receipt date printed within 6 months.
□If the copy is unclear, you may be required to resubmit it.
□If the address or name has been changed, a copy of the back side is also required.

※1 If the validity period of your residence card is less than one month, please enclose the updated residence card.
※2 It is necessary to submit two more personal identification documents, or supplementary documents with your address(Necessary documents are 3 in total) since Japanese passports issued after February 2020 does not have an address field and we cannot verify
the address.

Please check the details before submission.
If the personal identification document and the address stated on the application form are different,
please submit an additional copy of the address identification document .
One more copy from Ⓑ or Ⓒ is required in addition to the above two documents when the address of one document is different.
➡ Necessary documents are 3 in total.
Two more copy from Ⓑ or Ⓒ (different types) is required in addition to the above two documents when the address of two documents
are different.
➡ Necessary documents are 4 in total.

＜For Example＞※ Copies of 2 items areForforeign
National

Driver’s License
or Driving
RecordCertificate

required.

Yes

Residence Card or Special Permanent Resident Certificate,and Driver’s License or Driving Record Certificate (Issued in Japan only)

No

Residence Card or Special Permanent Resident Certificate,
and another 1 item from Ⓑ or Ⓒ.

19LC－1965-202004

Acknowledgement for the Payment of Club Fees by Diners Club Card
ダイナースクラブカードによる決済の同意書
Attn.: Sumitomo Mitsui Trust Club Co., Ltd.
三井住友トラストクラブ株式会社

宛

Attn.: Tokyo American Club
東京アメリカンクラブ

宛

I hereby acknowledge the following conditions pertaining to the fee payments (entrance fee, refundable
deposit and monthly fees) to Tokyo American Club with my Diners Club Card.
私は、私の東京アメリカンクラブの利用代金（入会金、保証金、月会費等）を私のダイナースク
ラブカードで決済するにあたり、以下の事項に同意します。

1. I agree that Sumitomo Mitsui Trust Club Co., Ltd. provide Tokyo American Club with the result of thescreening of my application for Diners Club Card, the name of the cardholder, the card number and theexpiry date for the purpose of registering my fee payments with Tokyo American Club.
私は、三井住友トラストクラブ株式会社が、私の東京アメリカンクラブの利用代金をダイナー
スクラブカードで決済するために、私のダイナースクラブカード入会申し込みに係る審査結果
情報、カード名義、カード番号及び有効期限を、東京アメリカンクラブに提供することを承諾します。

2. I will settle my Tokyo American Club account on a monthly basis with my Diners Club Card until suchtime I notify Tokyo American Club of a change in my payment method.
私は、支払方法の変更の申し入れを東京アメリカンクラブに行わない限り、ダイナースクラブ
カードで毎月の利用代金を決済します。

3. I will notify Tokyo American Club immediately of any change to my Diners Club Card number or the
expiry date as a result of the credit card being lost, stolen or terminated.
私は、紛失・盗難等により、当該カード番号及び有効期限などが変更になった場合や、会員資格を喪失した場合は、東京アメリカンクラブに対し速やかに通知します。
//

Name of Member
メンバー氏名：Phone Number
電話番号：
15C-2824-201512