Please use this form for future change. Please keep until the date of use and present at a hotel front desk. Date 07/ 6/ 21/ Applicant HIS No. (must) 1001-12345 <Fax to the below for reservation Resort Trust Reservation Center Fax 03-5323-7483 Tel 03-5323-8221 Monday -- Friday 9 00 18 00 Second & Fourth Saturday 9 00 12 00 Close on Sunday & National Holiday Contact Tel. No. TEL 0123-456-7890 Please fill in the bald boxes. Fax No. for reply FAX 0123-456-7891 Hotel Reservation Regarding Personal Information Resort Trust attempt to protect your personal information in complying with the PIP law, etc. Please access http://www.resorttrust.co.jp for the privacy policy of Resort Trust. Representative Home Tel. No. or mobile 0123-456-7890 07/ 7/ 21/ 7/ 22/ 1 nights 1 st choice Hotel 軽 07/ 7/ 28/ 7/ 29/ 1 nights Hotel desired 2 nd choice Hotel 軽 Total No. of people 4 No. of people (incl. representative adult male 1 children 1 (age 6 12) adult female 1 baby 1 (age 5 below) Total No. of rooms Medium 1 rooms Large rooms Transportation No. of cars 1 public transportation A parking lot of Atami is a complete reservation system Arrival time 3 am/pm Dinner for 1 st day Japanese, Western, Chinese, other Dinner for 2 nd day Japanese, Western, Chinese, other Adult Yen persons Adult Yen persons Children Yen persons Children Yen persons Plan name Plan name Contents of meal dinner should be reserved. Breakfast/Japanese, Western, Biking Breakfast/Japanese, Western, Biking For use of Resort Trust Reservation Center Reservation No. Cancellation charge (incl. decrease of persons) for Resorpia, Sunmembers will occurs 2 weeks prior to date of use for peak time 12/30 1/5 4/29 5/5 7/25 8/20 and 1 week prior to usually. 12/30 1/5 4/29 5/5 7/25 8/20 are two meals of one days systems. Change/cancellation after reserved Change I would like to change the above reservation as follow; Contents to change Cancellation I would like to cancel the above entire reservation. Signature for change/cancellation The personal information you provide is gathered to help the Bosch Health Insurance Society undertake its operations fairly and in accordance with the Health Insurance Law and relevant notifications. Under no circumstances will this personal information be provided to a third party or used for any purpose other than those stated above. In certain cases, we may contact you to seek clarification of details you have provided, or, if necessary, ask you to provide additional supporting documentation. Please address all inquiries concerning the handling of personal information, requests for disclosure of personal information, and so forth to the Bosch Health Insurance Society General Affairs Section (telephone: 0493-22-0890).