SIM mobile Cancellation Form

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Be careful, don't mistake this cancellation form with the SIM card one.

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

Membership ID (leave it blank if you do not know it)
Desired month of cancellation《Available from the next month following the regulation》 *
Full name *
University/School *
Address *
郵便番号 -
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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