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[null,null,"JITCO保険　保険金請求書作成ツール　ver.2.00"]
[null,null,"※マクロを有効にして開いてください。",null,null,null,null,null,null,null,null,null,"損害保険ジャパン株式会社"]
[null,null,"※水色セルは入力、黄色セルはプルダウンから選択してください。「表面」シートに自動反映します。"]
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[null,null,null,"団体名または会社名",null,"必須！",null,null,"氏名アルファベット",null,"必須！"]
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[null,null,null,"メールアドレス",null,"必須！",null,null,"職種",null,"必須！"]
[null,null,"保険金受取人","氏名",null,null,null,"監理団体","名称",null,null,null,null,null,null,null,null,null,null,null,"フィリピン","信組"]
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[null,null,null,"店番（ブランク可）",null,null,null,"お怪我またはご病気の内容","お怪我をされた日／ご病気の場合は初診日",null,{"$f":"IF(J20=\"\",\"必須！\",\"\")","v":"必須！"},null,null,null,null,null,null,null,null,null,"ネパール"]
[null,null,null,"口座種類",null,null,null,null,"お怪我をされた場所",null,null,null,null,null,null,null,null,null,null,null,"モンゴル"]
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[null,null,null,"口座名義（カタカナ/アルファベット）",null,null,null,null,"お身体の部位",null,null,null,null,null,null,null,null,null,null,null,"バングラディッシュ"]
[null,null,null,"被保険者との関係",null,null,null,null,"以前からあったお怪我／ご病気",null,null,null,null,null,null,null,null,null,null,null,"シンガポ－ル"]
[null,null,"ゆうちょ銀行","支店名",null,null,null,"状況　※110文字以内",null,null,{"$f":"IF(I25=\"\",\"必須！\",\"\")","v":"必須！"},null,null,null,null,null,null,null,null,null,"台湾"]
[null,null,null,"預金種別",null,null,null,null,null,null,"→","現在の入力文字数",null,null,null,null,null,null,null,null,"韓国"]
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[null,null,null,"通帳記号（５桁）",null,null,null,"過去に同じ病気または怪我での請求はありますか？",null,null,{"$f":"IF(J28=\"\",\"必須！\",\"\")","v":"必須！"},null,null,null,null,null,null,null,null,null,"チュニジア"]
[null,null,null,"通帳番号（８桁）",null,null,null,"今回のご請求内容を補償する他の保険契約に加入されていますか？",null,null,{"$f":"IF(J29=\"\",\"必須！\",\"\")","v":"必須！"},null,null,null,null,null,null,null,null,null,"ルワンダ"]
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[null,null,"入力が完了しましたら、「表面」シートおよび「裏面」シートを印刷のうえ、被保険者の署名（必須）を取り付けてください。その際に控えを取っておかれることをお勧めします。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ポ－ランド"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"外国人技能実習修了者総合保険　特定技能外国人総合保険　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","ベトナム"," "]
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[null,"下記の内容が事実と相違ないことを確認し、保険金を請求しますので下記支払指図の通りお支払いください。\n口座への振込をもって保険金を受領したものと認めます。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","ラオス"," "]
[null,"過去に同じご病気またはお怪我での請求の有無をご記入ください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!J28=\"\",\"\",入力用シート!J28)","v":""},null,null,null,null,null,null,"今回のご請求内容を補償する他の保険契約の有無をご記入ください (注)",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!J29=\"\",\"\",入力用シート!J29)","v":""},null,null,null,null,null,null,null,null," "," ","カンボジア"," "]
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[null,"被 保 険 者",null,"氏  名",null,"漢 字",null,null,null,{"$f":"IF(入力用シート!J6=\"\",\"\",入力用シート!J6)","v":""},null,null,null,null,null,null,null,null,null,"国  籍",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","韓国"," "]
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[null,null,null,null,null,"カタカナ",null,null,null,{"$f":"IF(入力用シート!J7=\"\",\"\",入力用シート!J7)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","スロバキア"," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡が\nとれる電話番号",null,null,{"$f":"IF(入力用シート!E10=\"\",\"\",入力用シート!E10)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ","ポ－ランド"," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職  種",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","チェコ"," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!J12=\"\",\"\",入力用シート!J12)","v":""},null,null,null,null,null,null,"FAX",null,null,{"$f":"IF(入力用シート!E11=\"\",\"\",入力用シート!E11)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","ドイツ"," "]
[null,null,null,null,null,"アルファベット",null,null,null,{"$f":"IF(入力用シート!J8=\"\",\"\",入力用シート!J8)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"メールアドレス",null,null,{"$f":"IF(入力用シート!E12=\"\",\"\",入力用シート!E12)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","アメリカ"," "]
[null,null,null,"性別",null,null,{"$f":"IF(入力用シート!J10=\"\",\"\",入力用シート!J10)","v":""},null,null,null,null,"生年\n月日",null,{"$f":"IF(入力用シート!J9=\"\",\"\",YEAR(入力用シート!J9))","v":""},null,"年",{"$f":"IF(入力用シート!J9=\"\",\"\",MONTH(入力用シート!J9))","v":""},"月",{"$f":"IF(入力用シート!J9=\"\",\"\",DAY(入力用シート!J9))","v":""},"日(",null,{"$f":"DATEDIF(入力用シート!J9,入力用シート!E5,\"Y\")","v":125},"才)",null,"監理団体",null,null,null,null,{"$f":"IF(入力用シート!J13=\"\",\"\",入力用シート!J13)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","カナダ"," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","メキシコ"," "]
[null,"被保険者№  ",null,null,null,null,null,{"$f":"IF(入力用シート!J5=\"\",\"\",入力用シート!J5)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（TEL）",null,null,null,{"$f":"IF(入力用シート!J14=\"\",\"\",入力用シート!J14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null," "," ","ブラジル"," "]
[null,"委任状兼\n同意書",null,null,null,null," 私は裏面(次頁)の内容に同意します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","ペルー"," "]
[null,null,null,null,null,null," 我同意反面（下一頁）的内容。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","パラグアイ"," "]
[null,null,null,null,null,null," I hereby give my consent to the details\n on the reverse side and the following page.  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","アルゼンチン"," "]
[null,null,null,null,null,null," on the reverse side and the following page.  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," ","その他"," "]
[null,"お怪我又はご病気の内容",null,"お怪我をされた日／",null,null,null,null,null,null,null,{"$f":"IF(入力用シート!J20=\"\",\"\",YEAR(入力用シート!J20))","v":""},null,null,null,"年",{"$f":"IF(入力用シート!J20=\"\",\"\",MONTH(入力用シート!J20))","v":""},null,null,"月",{"$f":"IF(入力用シート!J20=\"\",\"\",DAY(入力用シート!J20))","v":""},null,"日",null,"お怪我をされた",null,null,null,{"$f":"IF(入力用シート!J21=\"\",\"\",入力用シート!J21)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," "]
[null,null,null,"ご病気の場合は初診日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"場所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," "]
[null,null,null,"診断名",null,null,null,{"$f":"IF(入力用シート!J22=\"\",\"\",入力用シート!J22)","v":""},null,null,null,null,null,null,null,null,null,"お身体の部位",null,{"$f":"IF(入力用シート!J23=\"\",\"\",入力用シート!J23)","v":""},null,null,null,null,"以前からあった\nお怪我/ご病気",null,null,null,{"$f":"IF(入力用シート!J24=\"\",\"\",入力用シート!J24)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "," "]
[null,null,null,"状　況",null,null,null,{"$f":"IF(入力用シート!I25=\"\",\"\",入力用シート!I25)","v":""}]
[null,null,null,"※具体的にご記入ください"]
[null,null,null,null,null,null,null,"※業務上の事由または通勤による事故について救援者費用を除き保険金をお支払いできません。\n※保険金のお支払は事故発生の日または治療を開始した日からその日を含めて１８０日以内に要した費用に限ります。"]
[]
[null,null,null,"治療を受けた病院名等",null,null,null,{"$f":"IF(入力用シート!J15=\"\",\"\",入力用シート!J15)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL",null,{"$f":"IF(入力用シート!J16=\"\",\"\",入力用シート!J16)","v":""}]
[]
[]
[null,"請求額",null,"内　訳",null,null,null,null,null,null,null,"金       額",null,null,null,null,null,null,null,null,null,null,null,null,"内　訳",null,null,null,null,null,null,"金       額"]
[]
[null,null,null,"治 療 費 用\n（薬代含む）",null,null,null,null,null,null,null,{"$f":"IF(入力用シート!J17=\"\",\"\",入力用シート!J17)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,"交 通 費",null,null,null,null,null,null,{"$f":"IF(入力用シート!J18=\"\",\"\",入力用シート!J18)","v":""}]
[]
[]
[null,"保険金の受取人が保険金請求者と異なり、受取人へお支払ハガキの案内の送付をご希望される場合、受取人の氏名と住所をご記入ください。"]
[null,"保険金受取人氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険金受取人住所"]
[null,{"$f":"IF(入力用シート!E13=\"\",\"\",入力用シート!E13)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〒",null,{"$f":"LEFT(IF(入力用シート!E14=\"\",\"\",入力用シート!E14),3)","v":""},null,null,"－",{"$f":"RIGHT(IF(入力用シート!E14=\"\",\"\",入力用シート!E14),4)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!E15=\"\",\"\",入力用シート!E15)","v":""}]
[null,"金機","融関",null,"フリ\nガナ",null,{"$f":"PHONETIC(入力用シート!E16)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!E17=\"\",\"\",入力用シート!E17)","v":""},null,null,"保険金の振込先に関する指図書",null,"ゆうちょ銀行\nJapan\nPostal\nBank",null,null,null,"支　店　名",null,null,null,null,null,null,null,null,null,"預　金　種　別"]
[null,null,null,null,"ガナ"]
[null,null,null,null,{"$f":"IF(入力用シート!E16=\"\",\"\",入力用シート!E16)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!E25=\"\",\"\",入力用シート!E25)","v":""},null,null,null,null,null,null,"支店",null,null,{"$f":"IF(入力用シート!E26=\"\",\"\",入力用シート!E26)","v":""}]
[null,null,null,null,"フリ\nガナ",null,{"$f":"PHONETIC(入力用シート!E18)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!E19=\"\",\"\",入力用シート!E19)","v":""}]
[null,null,null,null,{"$f":"IF(入力用シート!E18=\"\",\"\",入力用シート!E18)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"コード",null,null,9900,null,null,null,"店　番",null,null,{"$f":"IF(入力用シート!E27=\"\",\"\",入力用シート!E27)","v":""}]
[null,"口種","座類",null,{"$f":"IF(入力用シート!E21=\"\",\"\",入力用シート!E21)","v":""},null,null,null,null,null,null,"店    番",null,null,null,"口    座    番    号",null,null,null,null,null,null,null,null,"通 帳\n記 号",null,null,{"$f":"IF(入力用シート!E28=\"\",\"\",入力用シート!E28)","v":""},null,null,null,null,null,"通 帳\n番 号",null,{"$f":"IF(入力用シート!E29=\"\",\"\",入力用シート!E29)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(入力用シート!E20=\"\",\"\",入力用シート!E20)","v":""},null,null,null,{"$f":"IF(入力用シート!E22=\"\",\"\",入力用シート!E22)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口 座\n名 義\n（ｶﾀｶﾅ /アルファベット）",null,null,{"$f":"IF(入力用シート!E30=\"\",\"\",入力用シート!E30)","v":""}]
[null,"口 座\n名 義\n（ｶﾀｶﾅ /アルファベット）",null,null,{"$f":"IF(入力用シート!E23=\"\",\"\",入力用シート!E23)","v":""}]
[]
[null,"被保険者との関係",null,null,null,null,null,null,null,{"$f":"IF(入力用シート!E24=\"\",\"\",入力用シート!E24)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者との関係",null,null,null,null,null,{"$f":"IF(入力用シート!E31=\"\",\"\",入力用シート!E31)","v":""}]
[null,"（注)　有の場合は保険証券コピーを添付ください。健康保険等公的医療保険の場合は「無」としてください。"]

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[]
[]
[]
["損害保険ジャパン株式会社    御中"]
["三井住友海上火災保険株式会社    御中"]
["１．保険金請求及び個人情報の取り扱いに関する同意"]
[null,"（１）","私は表面（前頁）の事案に関して、表面（前頁）の保険金請求者を代理人と定め、本件事故に係る外国人実習生総合保険（外国人研修生総合保険等）の請求及び受領に関する一切の権限を委任します。"]
[null,"（２）","私は貴社が本保険請求に関する私の個人情報を、保険引受・支払いの判断、本契約の履行、付帯サービスの提供、損害保険等貴社の取り扱う商品・各種サービスの案内・提供、アンケートの実施、等を行うために利用するほか、下記①から⑤まで、その他業務上必要とする範囲で、取得・利用・提供または登録を行うことに同意します。"]
[null,null,"①","損保ジャパンが、上記業務のために、業務委託先（保険代理店を含みます。）、保険仲立人、医療機関、保険金の請求・支払いに関する関係先、等に提供を行い、またはこれらの者から提供を受けることがあること。なお、これらの者には外国にある事業者等を含みます。"]
[null,null,"②","損保ジャパンが、保険制度の健全な運営のために、一般社団法人日本損害保険協会、損害保険料率算出機構、他の損害保険会社、等に提供もしくは登録を行い、またはこれらの者から提供を受けることがあること。"]
[null,null,"③","損保ジャパンが、再保険契約の締結や再保険金等の受領のために、国内外の再保険会社等に提供を行うこと（再保険会社等から他の再保険会社等への提供を含みます。）があること。"]
[null,null,"④","損保ジャパンが、国内外のグループ企業や提携先企業に提供を行い、その企業が取り扱う商品等の案内または提供を行うことがあること。なお、保健医療等の特別な非公開情報（センシティブ情報）については、保険業法施行規則により限定された目的以外の目的に利用しないこと。"]
[null,null,"⑤","損保ジャパンが、契約の安定的な運用を図るために、保険金請求情報等を契約者に対して提供すること。"]
["２．医療機関の提供および事故調査に関する同意"]
[null,"私を診療または治療した全ての病院、医師および関係者、または本件事故に関する諸機関および関係者が、損保ジャパンまたはその指名する者に、私に関する全ての疾病、傷害または事故の記録を提供することを承認します。なお、本書の写真複写も同じ効力があると認めます。"]
["３．他の保険契約等の保険金請求に関する同意"]
[null,"私は同一の損害または費用に対して、支払責任を負う保険契約および他の保険契約等（保険契約、共済契約その他いかなる名称であるかを問いません。以下同様とします。）から、保険契約等で定められた保険金等の額を超えて支払いを受けた場合には、その超えた額を、損保ジャパンまたは他の保険契約等の損害保険会社･共済等へ直ちに返還します（損保ジャパンまたは他の保険契約等の損害保険会社･共済等から返還方法の指定があった場合には、その方法に従います。）。また、他の保険契約等がある場合、損保ジャパンがその保険契約等の損害保険会社･共済等に対して、損保ジャパンの負担すべき部分（他の保険契約等がないとする場合に各損害保険会社･共済等が支払うべき保険金等の額の合計額に対する損保ジャパンの支払うべき額の割合をてん補損害額に乗じて得た額）を超えて支払った額を求償することに同意します。"]
["致日本财产保险公司"]
["致三井住友海上火灾保险公司"]
["1.关于理赔和处理个人信息方面的同意事项"]
[null,"(1)","关于正面（前页）的案件，本人指定正面（前页）所记载的保险金理赔申请人为代理人，委任有关本件事故的外国实习生综合保险保险金（外国研修生综合保险等保险金）的申请及领取的相关所有权限。"]
[null,"(2)","对于和本保险理赔相关的本人个人信息，我同意贵公司可将其用于保险的承保及理赔的判断、本合同的履行、附带服务的提供、贵公司经营的如损害保险等商品及各种服务的说明和提供，以及问卷调查的实施等。并同意在以下①～④以及其他业务的必要范围，进行获取、利用、提供以及登录。"]
[null,null,"①","为了进行上述业务，日本财产保险公司可向其业务委托单位（包括保险代理店）、保险中介、医疗机构、与保险金的理赔及支付相关的单位提供，或者从这些单位获取本人相关个人信息。并且包括位于国外的公司等。"]
[null,null,"②","为了保险制度的健全运营，日本财产保险公司可向一般社团法人日本损害保险协会、损害保险费率计算机构以及其他损害保险公司等提供、登录，或者从这些单位获取本人相关个人信息。"]
[null,null,"③","为了签订再保险合同以及领取再保险金等，日本财产保险公司可向国内外的再保险公司等提供（包括再保险公司等提供给其他再保险公司等）本人相关个人信息。"]
[null,null,"④","日本财产保险公司可向其国内外集团内部企业及合作企业提供本人相关个人信息，并且说明或提供该企业经营的商品等。此外，关于保健医疗等特殊非公开信息（敏感信息），不得用于保险业法施行规则限定的目的以外的用途。"]
[null,null,"⑤","日本财产保险公司为了保证保险合同的稳定运转，将向投保人提供保险理赔等信息。"]
["2.关于提供医疗服务和调查事故方面的同意事项"]
[null,"本人同意并授权，所有给本人进行过诊断或治疗的医院、医生及其相关人员，还有与本事故相关的各机构及其相关人员，可向日本财产保险公司或其指定人员提供与本人有关的所有疾病、受伤或事故的记录。此外，本文件的复印件也具有同样的效力。"]
["3.关于其他保险等的理赔同意事项"]
[null,"我承诺，对于同一损失或费用，如果通过申请多个可以理赔的保险合同（不论是保险合同、互助合同或其他名称，下同），获得了超过保险合同所约定的保险金的数额，将把超出的金额立即返还给日本财产保险公司或者其他保险合同的承保损害保险公司以及保险互助合作社等。（如果日本财产保险公司或其他保险合同的承保损害保险公司以及保险互助合作社等指定返还方法，将遵照执行。）\n此外，在有其他保险合同的情况下，同意日本财产保险公司就超出应当承担的部分，向其他保险的承保损害保险公司或保险互助合作社等进行求偿。在没有其他保险合同的情况下，则同意日本财产保险公司按照比例，计算其在所有损害保险公司或保险互助合作社等应当支付总金额中应当承担的部分，并就超出部分向对方进行求偿。\n"]
["To: Sompo Japan Insurance Company, Ltd. "]
["To: Mitsui Sumitomo Insurance Company, Ltd."]
["1.AUTHORIZATION FOR INSURANCE CLAIMS AND MY PERSONL INFORMATION"]
[null,"(1)","the  undersigned, authorize the claimant indicated on the front of this form to administer all authorities concerning the claim for and receipt of the compre- hensive insurance for foreign technical trainee, foreign trainee and post-foreign technical trainee pertaining to the accident described on the front of this form.\nI hereby give my consent to your company to acquire, use and offer my personal information concerning this insurance claim, within the scope necessary to achieve the following purposes of use.\n"]
[null,"(2)","Sompo Japan Insurance Inc.(hereinafter referred to as the “Company”) uses personal information regarding this insurance claim in order to perform activities such as judgment on insurance underwriting or claim payouts, fulfillment of this insurance policy, provision of ancillary services, notification/pro- vision of the Company’s products/services such as nonlife insurance, and implementation of a questionnaire (hereafter referred to as “the Company’s Activities”). In addition, the Company acquires, uses, provides or registers such personal information to the extent the Company needs for its operations in the manners listed to below"]
[null,null,"①","The Company may provide such personal information to its business contractors (including agents), insurance brokers, and parties involved in the claim/payment of insurance benefits (such as medical institutions, nonlife/mutual insurance companies, parties involved in the insured events, etc.), or receive such personal information from these parties for the Company’s Activities. These parties include businesses outside of Japan."]
[null,null,"②","The Company may provide such personal information to or resister it with organizations such as The General Insurance Association of Japan, The Life Insurance Association of Japan, General Insurance Rating Organization of Japan, other nonlife insurance companies, etc., or receive such personal information from these organizations and companies to ensure sound operation of the insurance system."]
[null,null,"③","The Company may provide such information to reinsurance companies, etc., in Japan or overseas (including provision of such information from a reinsurance company, etc., to another reinsurance company, etc.), in order to conclude reinsurance contracts or receive reinsurance benefits, etc."]
[null,null,"④","The Company may provide such personal information to its group companies or partner companies in Japan or overseas, and they may use it for notification or provision of their products/services and judgment of such notification or provision."]
[null,null,"⑤","The Company may provide information of the insured’s insurance claim, etc., to the policyholder to ensure the stable management of the insurance contract."]
["2. AUTHORIZATION FOR MEDICAL RECORDS AND INFORMATION ON THE CASE"]
[null,"I hereby authorize any hospital, physician, or other person who has attended or examined me, or any government authority or other person who is related  to the accident, to furnish Sompo Japan or its authorized representative with any and all information or document with respect to any sickness/injury or accident. I accept that a photocopy of this authorization shall also be considered as effective and valid as the original."]
["3. AUTHORIZATION FOR INSURANCE CLAIMS FROM OTHER POLICIES"]
[null,"I agree that if I receive payments such as insurance payouts that exceed the amount of insurance money, etc., stated in the policy under which this claim is made or in any other policies, etc., (insurance contracts,mutual aid contracts or any other contracts under whatever name they are known and under which payouts,etc., are made to cover the same damage or cost; and the same applies in this contract) for the same damage or cost, I shall repay, without delay, the amount exceeding the insurance money, etc., to Sompo Japan or to the other non-life insurance companies, mutual aid associations, etc., with which the relevant insurance contracts, etc., are concluded. [lf Sompo Japan, other non-life insurance companies, mutual aid associations, etc., with which the relevant insurance contracts, etc., are concluded, specify procedures for such repayment,I shall follow the procedures.]\nIn the case of the existence of other insurance contracts, etc., I agree that Sompo Japan may claim any excess of the amount it is obliged to payout from the non-life insurance companies, mutual aid associations, etc., with which the relevant insurance contracts, etc., are concluded.\n"]

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