Receipt Number:
Date:

To: Personal Information Inquiry Contact
Tokyu Fudosan Holdings Corporation

Request for Disclosure, etc. of the Personal Information
I request the disclosure of the following items regarding my personal information which is in the possession of Tokyu
Fudosan Holdings Corporation.
1. Applicant (Please tick the applicable item below)
Address:☐ Principal☐ Minor’s Statutory Agent☐ Adult Ward’s Statutory AgentName:☐ Representative Commissioned by

Phone Number:the Principal* Please provide an available daytime phone number.

2. In the case where the applicant is a representative, please provide the address and name of the principal.
Address:
Name:
Phone Number:
3. Purposes of the request for the disclosure, etc. of the personal information☐ Notification of the purposes of use☐ Disclosure of the personal information☐ Correction, addition or deletion of the personal information
Purposes of the request(Please tick the applicable item(s) )☐ Suspension of the use, cancellation or suspension of providing the personal
information to a third party☐ Disclosure of the records provided by a third party
4. Please provide the specific affiliation and name of the requested “personal data in possession”.
Business categories in which the personal information is connected with (Please tick the applicable item (s) below):☐ Subdivided Housing (Condominiums / Detached Houses)☐ Leased Offices☐ Business-Airport☐ Commercial Facilities☐ Senior Housing☐ Sports Facilities☐ Hotels☐ Resorts (Members-only Hotels / Cottages / Golf Courses / Ski Resorts))☐ Other (Please provide the name or type, etc. of the personal data in possession, if you know. (i.e. Member of Cosmos,
Member of **club, etc.)[]Time when our company obtained the above data:[Approximately,(month), (year)]5. In the case where the affiliation and name, etc. of the requested “personal data in possession” is not known,please answer the following questions. Please tick the applicable item(s) below and fill in the spaces.
Time [Approximately,
Name of the Property, etc.
month / year]☐ You executed a sale and purchaseagreement, etc. with our company.
☐ You requested our company to sendmaterials.
☐ You visited our information desks on site /showrooms, etc.
☐ You utilized any of our facilities.
☐ You received direct mail or e-mail fromour company.
Please provide any other information, which may assist us in finding your requested “personal data in possession”.
[Description]

6. Please provide the following information in the case where you request revisions, etc. to the personal information.
Items requested to be
Description before the revision
Description after the revision
revised7. Our company may ask you questions or contact you in order to identify and confirm your personal data or inconnection with the procedures for requesting the disclosure, etc. In this connection, please provide desiredmethod(s) of communication and contact information for such case.
Desired Method(s) of Communication☐ Post☐ Phone: Phone Number [☐ E-mail: E-mail Address []]8. Please tick your desired method(s) of notification of the results, and provide the necessary contact information.
☐ Post:☐ E-mail:☐ Phone:☐ Facsimile:☐ Other:

9. Identity Verification Documents
Identity
Verification A copy of one (1) identity verification document containing a photo of your face issued by aDocumentsofthe government or a public office such as a:
Principal☐ Driver’s License ☐ Residence Card ☐ Special Permanent Resident Certificate☐ Individual Number Card (Only the information contained on the front side of the card.
Please do not provide to us the information contained on the back side of the card, which
includes your Individual Number.)--------------------------------------------------------------------------------------------------------Or a copy of two (2) identity verification documents which do not contain a photo of yourface issued by a government or a public office such as a:☐ Health Insurance Certificate☐ Pension Book (Please do not provide to us the portion including your Individual Number.)]☐ Other [IdentityVerificationDocumentsofthePrincipal
andRepresentative in theCase of a Request from
Representative

A copy of one (1) identity verification document containing a photo of your face issued by agovernment or a public office such as a:☐ Driver’s License ☐ Residence Card ☐ Special Permanent Resident Certificate☐ Individual Number Card (Only the information contained on the front side of the card.
Please do not provide to us the information contained on the back side of the card, which
includes your Individual Number.)--------------------------------------------------------------------------------------------------------Or a copy of two (2) identity verification documents which do not contain a photo of yourface issued by a government or a public office such as a:☐ Health Insurance Certificate☐ Pension Book (Please do not provide to us the portion including your Individual Number.)]☐ Other [Documents Verifying theAuthority to Represent☐ In the case of a minor’s statutory agent, a certified copy of the family register or anabridged version of such copy and a copy of the residence certificate in which both namesof the principal and representative are included and their relationship is indicated;☐ In the case of a guardian, etc. appointed as a guardian of an adult, etc., a certificate ofregistered matters; or☐ In the case where the authority to represent is given by the principal, a power of attorney
affixed with the seal of the principal, and a seal registration certificate of the principal.

10. Fees
Prescribed fees will be charged for the notification of the purposes of use, disclosure of the personal information, anddisclosure of the records provided by a third party. Please enclose a postal money order equivalent to 1,000 JPY whensending the form of the Request for Disclosure, etc.

Fees: 1,000 JPY per request (by postal money order)

・Notification of the purposes of use
・Request for the disclosure of the personal information
・Request for the disclosure of records provided by a third party

＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊(Please do not fill in this section. It is for our company use only.)
Identity
Verification □ Driver’s License □ Passport □ Individual Number Card □ Residence Card
Documentsofthe □ Special Permanent Resident Certificate □ Health Insurance Certificate □ Pension Book
Principal (*)]□ Other [Identity
Verification
Documents
ofthePrincipalandRepresentative (*) in theCase of a Request from
Representative
Documents Verifying theAuthority to Represent□ Driver’s License □ Passport □ Individual Number Card □ Residence Card
□ Special Permanent Resident Certificate □ Health Insurance Certificate □ Pension Book]□ Other [□ Power of Attorney and Seal Registration Certificate □ Certified Copy of the Abridged
Family Register □ Health Insurance Certificate Containing the Name of Dependents□ Certificate of Registered Matters □ Copy of Residence Certificate]□ Other [(Extension)

Person in Charge
Remarks(*) Two (2) items should be verified if no photo of the principal’s face is contained in the identity verification
documents of said principal.