Instructions for Requesting Disclosure, etc.*
*Disclosure, etc. means procedures for being notified of the purpose of use of retained personal data, procedures for the disclosure, correction, addition, deletion, or suspension of use of retained personal data, procedures for the disclosure of records of retained personal data acquisition, disposal, or provision to a third party, procedures for the disclosure of measures taken against a third party in a foreign country regarding retained personal data, and etc.
Please follow the instructions below to request disclosure, etc.
I. Fill out a Request For Notification of Purpose of Use or Disclosure, etc. of Retained Personal Data
Print out or download a designated request form (Request For Notification of Purpose of Use or Disclosure, etc. of Retained Personal Data) from the link below and fill in the necessary information using one of the following methods.
- Paper Form: Fill out the form using an indelible writing implement such as a ballpoint pen. Applicants are responsible for postage costs.
- Electronic file: Download and fill out a Word file and submit it to us by e-mail.
(Download Form)
*Instructions if unable to print the form
Please contact the following Personal Information Hotline by telephone, e-mail, or post indicating (1) that you wish to be sent a copy of a Request For Notification of Purpose of Use or Disclosure, etc. of Retained Personal Data form, and (2) the address to which the form should be sent and instructions on how it should be sent (e-mail or post). We will then send you a request form by e-mail or Letter Pack Plus (550 yen).
19-48, Yoshino, Matsumoto, Nagano 399-8710
Personal Information Hotline, Legal Department, KISSEI PHARMACEUTICAL CO., LTD.
Telephone number:+81-(0)263-25-7922
(Office hours: 9:00–17:00)
E-mail:kojin@pharm.kissei.co.jp
(closed Saturdays, Sundays, national holidays, August 12–16, December 28–January 5)
II. Provide Identity Verification Documents
1．The following documents should be prepared if the request is being submitted by the individual whose personal information is involved in the request.Photographs of documents taken using a smartphone can be submitted as an electronic file by e-mail. In such case, be sure to take a photograph of the entire document so that the details are clearly visible.
Documents to be submitted for identity verification:
(1) Original copy of the certificate of residence
(2) Driver’s license *a
(3) Passport *a
(4) Health insurance card *a
(5) Pension book *a
*a Copy (front and back) of any one of (2), (3), (4) or (5)
2．The following documents should be prepared if the request is being submitted by a representative of the individual whose personal information is involved in the request. Photographs of documents taken using a smartphone can be submitted as an electronic file by e-mail. In such case, be sure to take a photograph of the entire document so that the details are clearly visible.
(1) Original copy of the certificate of residence for the individual concerned
(2) Letter of authorization
(3) Original copy of the registered seal certificate of the individual concerned used to prepare the letter of authorization
(4) Representative’s driver’s license *b
(5) Representative’s passport *b
(6) Representative’s health insurance card *b
(7) Representative’s pension book *b
*b Copy (front and back) of any one of (4), (5), (6) or (7)
III. Fees
Please deposit the following fees into our bank account if requesting disclosure of retained personal data, disclosure of records of provision to third parties, or notification of purpose of use. Note that the person making the request should pay any bank charges. Fees are NOT charged for other requests.
(1) If printing or downloading the request form: 1,000 yen
(2) If asking to be sent a request form:2,000 yen
Bank Details
Mizuho Bank, Matsumoto Branch
Account No.: Current account 5982
Account Holder: KISSEI PHARMACEUTICAL CO., LTD.
IV. Submit Request Form and Identity Verification Documents
Please submit the request form and identity verification documents prepared in II. and III. (hard copies or electronic files) above by post or e-mail.
1. Submission by post
Send documents to the following address by Letter Pack Plus (550 yen) or registered mail:
19-48, Yoshino, Matsumoto, Nagano 399-8710
Personal Information Hotline, Legal Department, KISSEI PHARMACEUTICAL CO., LTD.
2. Submission by e-mail
Send all electronic files as attachments to the following e-mail address:
kojin@pharm.kissei.co.jp
V. Response
1. Requests for disclosure of retained personal data, disclosure of records of provision to third parties, or notification of purpose of use: After conducting identity verifications and confirming payment of fees, we will respond in one of the following ways, according to the wishes of the individual concerned. Please indicate the way in which you wish to be contacted in the disclosure method section of the request form.
(1) Written response
A written response will be sent by Letter Pack Plus (550 yen) to the address of the individual concerned or the representative indicated on the request form.
(2) Electronic record
An electronic file will be sent by e-mail to the e-mail address of the individual concerned or the representative indicated on the request form.
2. Requests other than requests for disclosure of retained personal data, disclosure of records of provision to third parties, or notification of purpose of use: After conducting identity verifications, we will send a written response by Letter Pack Plus (550 yen) to the address of the individual concerned or the representative indicated on the request form.
Please contact the following Personal Information Hotline at the address below if you have any questions regarding our response. We will contact you at a later date.
19-48, Yoshino, Matsumoto, Nagano 399-8710
Personal Information Hotline, Legal Department, KISSEI PHARMACEUTICAL CO., LTD.
Telephone number:+81-(0)263-25-7922
(Office hours: 9:00–17:00)
E-mail:kojin@pharm.kissei.co.jp
(closed Saturdays, Sundays, national holidays, August 12–16, December 28–January 5)
