ANA Crowne Plaza Fukuoka “Request To Change Personal Information” Form
Date of Request : Day/MonthProcedure

Please check to correct, delete or add the personal information.

/Year

Please ﬁll out and submit the identiﬁcation document to the address below.
(It is the applicants' responsibility to pay postage.)
Please ﬁll out the information in bold print.

Correction List

Correction Descriptions (before)

Correction Description (after)

1
Correction

Address for the Request
ATT: Privacy Policy ANA Crowne Plaza Fukuoka
3-3-3 Hakataekimae, Hakata-Ku, Fukuoka-shi,Fukuoka 812-0011, JAPANWe only accept requests by mail. We do not accept requests at the front desk or restaurants.

Deletion List

Deletion Descriptions

Addition List

Addition Descriptions

2Deletion

Personal Information(Please ﬁll out all of the information requested.)
Date of Bir thName

Day/Month/Year

Address*If we need to contact you to verify any information, pleaselist a daytime phone number.

Phone Number
Identiﬁcation

1. Driverʼs license 2. Passport, 3. Health insurance card 4.Basic resident register card (with a photo) 5. Pension
handbook 6. Physical disability certiﬁcate 7. Alien registration certiﬁcate 8. Proof of personal seal registration.
*Please submit copies of two identiﬁcation documents along with requested documents in an envelop.

3Addition

Applicantʼs Information(Please ﬁll out the sections below ONLY if the applicant is applying on behalf of someone else.)
Name

To correct, delete and add room, meetings / parties and restaurants reservations, please contact the hotel. For any
request, we will need to verify your identify before we reveal any information. If someone is sent to check on thestatus of a reservation, we will need to identify that person. If veriﬁcation can't be obtained, we wonʼt be able to giveout any information.

Address*In case we need to contact you to verify any information,please list a daytime phone number.

Phone Number
Relationship
Proof ofidentiﬁcation
and relationshipApplicantidentiﬁcation

Handling

Fee

1. Relative 2. Legal Guardian
3. Representative 4. Other ; please write the relationship in the parenthesis ()ANA Crowne Plaza Fukuoka
In-House System for Changing Personal Data

We will notify you with the reason(s) if we cannot change
the personal information.

This form will only be used to update the personal・The information provided was inadequate.

discarded after that period of time.

・The information requested to be changed doesn't fall under the "personal

information. All documents will be kept for a month and“letter of attorney” which proofs that the applicant is the representative and1. Koseki certiﬁcate (Japanese family registry) or 2. Certiﬁcate of Legal Guardian・The hotel cannot conﬁrm the checklist.
data" category.

・The change of the personal information will trouble our business.
・The change of the personal information is a violation of the law.

・The change in personal information leaves a negative impact on the customer.

1. Driverʼs license 2. Passport, 3. Health insurance card 4.Basic resident register card (with a photo) 5. Pension
handbook 6. Physical disability certiﬁcate 7. Alien registration certiﬁcate 8. Proof of personal seal registration.
*Please submit copies of two identiﬁcation documents along with other documents in an envelop.

■Oﬃcial Use Only

Free of charge

Manager use onlyDate and time of the request

This includes a physical, ﬁnancial or basic welfare detriment.