Notification Request for Purposes of Use of Retained Personal Data
Date (mm/dd/yy):

To Mitsubishi Corporation:
Home address(required)

Postal code:

Name (required)
Phone number(required)

Home: (Daytime: (Desired address forreceiving reply
notification from us(required)(Not required if it is thesame as home address)

Postal code:))-1. Organization holding the provided personal information
1) Subject organization name (required)Enter the name of our organization to which you provided your personal information:（１） Head Office (Tokyo)
Group/Section name: Select the relevant Group/Section.
□ Corporate Staff Section□ Mobility Group□ Environmental Energy Group□ Food Industry Group□ Materials Solution Group□ Smart-Life Creation Group□ Mineral Resources Group□ Power Solution Group□ Urban Development & Infrastructure Group
Department name: Enter the relevant department name.
()(2) Branch in Japan: Enter the relevant branch name and department name.
Branch name: ()Department name: ()2) Name of the product/service provided by the relevant organization (required)3) Situation, form (questionnaire answer, seminar participation, etc.) and time of personal information provision (required)Situation:
Form:
Time of provision:
Note: To specify your personal information, please enclose related materials to whatever extent ispossible. e.g., seminar material, brochure or application form

2. Inquiry/Opinion

3. Desired method of disclosure (required)□ Mail to the desired address for receiving documents□ Email to the relevant individual’s email address (in attachment)□ Office email address □ Private email address□ Mail to the desired address to receive reply notification in electronic medium such as CD-ROM
Desired address
Postal code:

Note:

If the disclosure by the desired method would incur large costs or is otherwise difficult, thedisclosure will be made by mailing documents.

Entry example
Notification Request for Purposes of Use of Retained Personal Data
Date (mm/dd/yy):

To Mitsubishi Corporation:
Home(required)address

Postal code: 123-4567#123 XX Heights, 1-2-3 Marunouchi, Chiyoda-ku, Tokyo

Name (required)
Taro Mitsubishi
Phone(required)

numberDesired address forreceiving
reply
notification from us(required)(Not required if it is thesame as home address)

Home: (03) 1234-5678
Daytime: (090) 4321-5678
Postal code: 765-4321
XX Team, XX Dept., XX Corporation, 4-5-6 Minato, Minato-ku, Tokyo

1. Organization holding the provided personal information1) Subject organization name (required)Enter the name of our organization to which you provided your personal information:（１） Head Office (Tokyo)
Group/Section name: Select the relevant Group/Section.
□ Corporate Staff Section□ Mobility Group□ Environmental Energy Group□ Food Industry Group□ Materials Solution Group□ Smart-Life Creation Group□ Mineral Resources Group□ Power Solution Group□ Urban Development & Infrastructure Group
Department name: Enter the relevant department name.
(XX Dept.)(2) Branch in Japan: Enter the relevant branch name and department name.
Branch name: ()Department name: ()2) Name of the product/service provided by the relevant organization (required)
Auto parts
3) Situation, form (questionnaire answer, seminar participation, etc.) and time of personal information provision (required)Situation: Participation in an exhibition
Form: Questionnaire answer
Time of provision: April 1, 2022
Note: To specify your personal information, please enclose related materials to whatever extent ispossible. e.g., seminar material, brochure or application form

2. Inquiry/Opinion
Want to know the purposes of use of the personal information I entered in a questionnaire.

3. Desired method of disclosure (required)□ Mail to the desired address for receiving documents□ Email to the relevant individual’s email address (in attachment)□ Office email address □ Private email address□ Mail to the desired address to receive reply notification in electronic medium such as CD-ROM
Desired address
Postal code:

Note:

If the disclosure by the desired method would incur large costs or is otherwise difficult, thedisclosure will be made by mailing documents.