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MD

AgeFemale
ZipcodeSpousal status

Married
Unmarried

Cellphone-Nationality---□ 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 （MEmployer
phone
numberReading in JapaneseReading in JapaneseMale,000 yen

incomeYears ofserviceyears

使用
用途

取扱
物会 件社 名様
〒ご 物
記 件
住入 所
欄

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

敷金FAX

Sex
MaleFemale
MaleFemale

Cell

Date ofbirthY
ZipcodeM----

Relatio □ parent □ brother or sister □ relativen□ other （）D Age-

Fullname--Dateofbirth*If all tenant information cannot be filled into thefollowing entry columns, use another form to enternames of other tenants.
Relation
Date of birth

事業内容
（都府円

D

■ Emergency contact in ・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.
your home country□ student）

MaleYMD

AgeFixedlinephone

Cellphone
Relatio □ parentn□ other (□ brother or sister)

Address

TotalYM

DAgeY

M

DAge

通信欄

①家賃円

②共益費円）■管理会社（元付）※支店名もご記入ください。

号室-Mmonths□ applicant only □ applicant & co-dweller□ person other than applicant
Full nameY

If the applicant is a foreign national, also fill out the following columns.

AddressofemployerSection

Fixedline
phone

Female Phone

FemaleZipcode*For
students, Type ofname of businesspart-time
employer Monthly

Tenants-2 0□ Guarantor (under the rent agreement)

Reading in JapaneseName ofemployer

D

Check one of the above persons (who must have a fixed-line phone or cell phone) and obtain the person's consent before
entry.

Current
address

Reasontorelocate

YNationality

Y

Male

Home
phone

Applicant entry sections

Date ofbirth

2 0Plannedmove-indate

Nationality

Reading in JapaneseApplicationdate□ Emergency contact
Emergency contact, etc.

Full name(autograph)

Applicant must obtain the prior consent of its emergency contact that their personal information is treated pursuant to schedule titled"Personal Information Treatment Regulations" and also have them personally agree to the treatment. Applicant makes an applicationby providing signature on this document.

Full name

For individuals
個人用Address

Guarantee Application Form
保証委託申込書

Desired time
for confirming (1) 9:00 to 12:00 (2) 12:00 to 15:00 (3) 15:00 to 18:00
the*We may phone the applicant at a time other than the desired
identity oftime.
applicant

道県礼金③駐車場

円

④その他
固定費円

合計円

円 ①＋②＋③＋④

審査課［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.

FAX 0800-888-1515- The Examination Section (03-5339-1049) may call the applicant to confirm entries.

＜お申込に関する問合せ＞
TEL ０３－５３３９－１０４９- If you wish to cancel your application after submission, please contact the Casa
office.

社
名■仲介会社（客付）※支店名もご記入ください。
社
名住所

担当住所

TEL

TELFAXFAX

審査結果送付先

□

管理会社

担当□

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。

CS201807