SIM mobile Cancellation Form

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Be careful, don't mistake this cancellation form with the SIM card one.
【SIMcard・Mobile】CANCELLATION FORM

Please fill the necessary information and click on "Confirm".

Membership ID (leave it blank if you do not know it)
Desired month of cancellation *
Full name *
University/School *
Address *
郵便番号 -
都道府県
市区郡町村
番地
ビル名
※ビル名がある場合は、ご記入ください。
Phone number
Email address *
Are you using a rental device? *

Reason for cancellation
Name of your Japanese bank (Only in case of refund)
Account holder
Branch name
Bank account type
Bank account number
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About personal information *

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