Personal Information Requests

1. Request Procedure

To request [1] notification of purpose of use, [2] disclosure, [3] correction, [4] addition, [5] deletion, [6] suspension of use, [7] elimination, [8] suspension of provision to third parties (collectively, “disclosure, etc.” or “disclose, etc.”) in regard to your personal information collected by the Mochida Pharmaceutical Group, please follow the procedure outlined below.

1) Postal address for request for disclosure, etc.

To request disclosure, etc., please mail the standard request form together with the required documentation (see 2) or 3) below) and the fee (only in the case of a request for [1] notification of purpose of use or [2] disclosure; No fee is required for other requests (see 4) below)) to the address shown below. Please write “Request Form for Personal Information Disclosure, etc. Enclosed” in red on the envelope.

Public Relations
Mochida Pharmaceutical, Co., Ltd.
1-1 Ichigayahonmuracho, Shinjuku-ku, Tokyo 162-0845

  • * If you have moved or for any other reason your current address is no longer the address you registered with us, please submit a certificate of residence evidencing a change of address.

2) Documents (forms), etc. to be submitted(If you are making the request for disclosure, etc. by yourself)

If you are making the request by yourself, please download and print off the following form A., fill out all the necessary information, affix you signature and seal to the form, if any, and send it to the address specified in “1) Postal address for request for disclosure, etc.” above, together with document B. to confirm your identity.

  • A. Our standard application form

    Download application form [PDF 56KB]

  • B. Document for confirmation of your identity

    Please enclose a copy of one of the following. In each case, please copy the part which states your name and address.

    • (1)Certificate of residence
    • (2)Passport
    • (3)Driver’s license
    • (4)Health insurance card
    • (5)Pension record book
    • (6)Tax payment certificate (or tax exemption certificate)
    • * If you have moved or for any other reason your current address is no longer the address you registered with us, please submit a certificate of residence evidencing a change of address.

3) Documents (forms), etc. to be submitted (If an agent is making the request for disclosure, etc.)

If the individual making the request for disclosure, etc. is your legal agent or your authorized agent, the documents shown below (C. or D.) should be enclosed in addition to application form A. in 2) above.

  • A. Our standard application form

    Download application form [PDF 56KB]

  • C. In the case of a legal agent
    • A copy of our standard declaration form

      Download declaration form [PDF 50KB]

    • One copy of document confirming power of legal representation (Abstract of your family register or certificate of registered matters defined in Article 10 of Act on Guardianship Registration, etc.)
    • One copy of document confirming that person making request is legal agent of a minor, adult ward, person under curatorship or person under assistance (Same as B. of 2) above)
  • D. In the case of an authorized agent
    • A copy of our standard letter of authorization

      Download letter of authorization [PDF 49KB]

    • One copy of your certificate of registration of seal affixed to letter of authorization if any
    • One copy of document confirming that the person making the request is the authorized agent (same as B. of 2) above)

4) Fee and method of its collection

A fee will be charged for each application for [1] Notification of purpose of use or [2] Disclosure. If you reside in Japan, please enclose a Japanese postal stamp for 839 yen with the application form. If you reside outside Japan, please enclose a Japanese postal stamp or an international reply stamp for the EMS fee required for replying (we do not accept money orders or cash). The EMS fee would be checked on the Japan Post website Open new window.
There is no fee for other types of request.

  • * The fee is the actual cost of replying in writing by certified mail (general registered mail).
  • * We will contact you if the fee does not cover the cost or if you neglected to enclose the fee, and we will deem that no request for disclosure, etc. was made if the fee is not paid within the prescribed period.

2. Response to request for disclosure, etc.

1) Personal information that will be subject to disclosure, etc.

The personal information that will be subject to disclosure, etc. will be information over which the Mochida Pharmaceutical Group has the authority to disclose, etc. and excludes information that is deemed an exception by laws and regulations.

2) Method of replying to request for disclosure, etc.

We will reply to you by certified mail to your address stated in the request form.
If we are unable to grant your request pursuant to the provisions of laws and regulations, we will reply to you giving the reason (you will still be charged the standard fee in this case).

3) Purpose of use of personal information collected in connection with your request for disclosure, etc.

The personal information collected in connection with your request for disclosure, etc. will be handled only to the extent necessary for your request for disclosure, etc. The documents submitted will be kept for two years after completion of our response to your request for disclosure, etc. and will then be destroyed.

Enacted April 1, 2005
Revised July 31, 2011

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