Request for Retained Personal Data Third-Party Provision Record
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,the disclosure will be made by mailing documents.

Entry example
Request for Retained Personal Data Third-Party Provision Record
Date (mm/dd/yy):

To Mitsubishi Corporation:
Home address(required)

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

Name (required)
Taro Mitsubishi
Phone number(required)

Home: (03) 1234-5678
Daytime: (090) 4321-5678

Desired address forreceiving reply
notification from us(required)(Not required if it is thesame as home address)Postal code: 765-4321
XX Team, XX Dept., XX Corporation, 4-5-6 Minato, Minato-ku, Tokyo

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.
(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 have the record of provision of my personal data to third parties.

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,the disclosure will be made by mailing documents.