Please fill out in Japanese or English 日本語もしくは英語でご記入をお願いいたします(1) 9:00 to 12:00 (2) 12:00 to 15:00 (3) 15:00 to 18:00*We may phone the applicant at a time other than the desired time.

Zip
code

Cellphone-YM

D

Age

Nationality--

Full nameReading in Japanese

Emergency contact

Full name(autograph)

M

Married
Unmarried

Spousal statusFemale

D2 0Y

M

Fixed-line
phone--

Cell
Phone--

Male
FemaleDate ofbirth-

Plannedmove-indateY

Zip

MD AgeRelation□ parent □ brother or sister □ relative□ other （）-codeCurrent
address

If the applicant is a foreign national, also fill out the following columns.
□ transfer□ job change □ admission to school□ second house □ environment □ other （□ marriage□ becoming independent）

Profession□ regular worker □ contract (quasi) worker □ part-timer or temp staff □ unemployed□ public assistance recipient □ pensioner □ self-employed□ other （■ Emergency contact inyour home country

・Enter name of applicant's parent or brother or sister (second-degree relative) from home country.
・We may phone the emergency contact to identify the applicant in our examination.

Reading in Japanese

Employerphone
numberReading in JapaneseName ofemployer

Years ofserviceyears

使用
用途

Full nameReading in Japanese□ 居住用□ 事業用 （SOHO・店舗・事務所・倉庫等）

Sex

Relation円

D

AgeRelation□ parent□ other (□ brother or sister)

通信欄

Date of birth

MaleFemale

YM

D

AgeMaleFemale

YM

DAge

■管理会社（元付）※支店名もご記入ください。

①家 賃（）

②共益費

道県円

③駐車場円

④その他
固定費円

合計
①＋②＋③＋④円

プラン選択■仲介会社（客付）※支店名もご記入ください。

円社
名社
名住所

担当住所

TEL

TEL

FAX

FAX担当円□家主ダイレクト
礼金M

Total

事業内容

都
府

敷金

Y

Cellphone

Address

号室-Female-*If all tenant information cannot be filled into thefollowing entry columns, use another form to enternames of other tenants.

物件
名物 〒件
住所

Date ofbirth

Fixed-line
phone

Malemonths□ applicant only □ applicant & co-dweller□ person other than applicant
Tenants-Addressofemployer

Section,000 yen

Full
nameZipcode

income□ student）

Nationality

Reason torelocate*Forstudents, Type ofname of businesspart-time
employer Monthly取扱会社
様ご記
入欄

YMaleHome
phone

Applicant entry sections

Date ofbirth

2 0*Phone call may be omitted, depending on the examination.

Applicant must obtain the prior consent of its emergency contact that their personal information is treated pursuant to schedule titled "PersonalInformation Treatment Regulations" and also have them personally agree to the treatment. Applicant makes an application by providing
signature on this document.
Reading in JapaneseApplication
dateNationality

Desired time
for confirming
theidentity ofapplicantAddress

Guarantee Application Form
For individuals
保証委託申込書（個人用）■家主ダイレクト■ベーシックプラン（口座振替）□ベーシックプラン

審査結果送付先□ 管理会社□ 仲介会社※チェックがない場合は、管理会社へ結果を送付させていただきます。

審査課

FAX 0800-888-1515［Precautions］- Entries must be made in thick, clear lettering by the applicant(s) themselves.
Unclear letters and omissions of entries will result in an extended examination time.

＜お申込に関する問合せ＞ TEL : 03-5339-1049- The Examination Section (03-5339-1049) may call the applicant to confirm entries.

- If you wish to cancel your application after submission, please contact the Casa office.
- Casa may check with your employer regarding your employment, or call your emergency
contact for information.

D