Consent Form For Statutory Agent

Year/Month/Date
同意書（補助帳票）
To SOFTBANK Corp.
Consent Form For Statutory Agent (Filtering Service Application Confirmation)
and Consent Form For Account or Card Holder
Applicant's Name
Date of Birth Year/Month/Date
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
① To be filled by Statutory Agent when Applicant is a minor
□ I, as a statutory agent for the applicant named below (in case the applicant is a minor and two or more people have parental authority/custody,
as a representative of them), consent in advance that the Applicant will apply the checked application items in <Table 1>.　I acknowledge that I
am fully informed about, and agree with the application for a filtering service as checked in <Table 2>(Applicable only when S!Basic Pack ( including
S!Basic Pack(i), the same shall apply hereinafter.) is applied).
<Table 1>◆Agreed application item (To be checked by Statutory Agent)
○
・Conclusion of New Contract under various services agreement stipulated by SOFTBANK CORP. (The
"Service Agreement" hereinafter) , and Conclusion of Purchase Contract for a mobile phone handset or
other products, Installment Purchase Contract or Third Party Credit Contract for Each Commodity
(collectively, "Installment Contract"※1) for a mobile phone handset or other products.
・Changing or cancelling service information regarding Terms and Conditions for 3G Communication
New Contract
Service※2 (payment plans, discount services, options, payment method etc.), termination of a contract,
(including Assignment of temporary suspension, and changing or cancelling Installment Contracts, after the conclusion of above
Contract)
contract(s),.
※1　If the payer in an installment payment contract is not the same person as the subscriber, the
subscriber’s information will be employed instead of the payer’s for inquiries/registration with credit
information bureaus.
※2　Except the application for S!Basic Pack and changing/cancelling for a filtering service.
○
Changing Handset
Models
○ Change of Service
Please fill out <Table 2>
when S!Basic Pack is
applied.
Please fill out ② below
when necessary.
Conclusion of Purchase Contract for a mobile phone handset or other products, or Installment Contracts
for a mobile phone handset or other products.
Application for S!Basic Pack or changing/cancelling a filtering service for existing customers.
Please fill out <Table 2>
<Table 2>◆Filtering service application confirmation (To be checked by Statutory Agent) ※
※There is no responsibility to confirm the filtering service when sign a contract of SoftBank Air.
There is a possibility that a user may be involved in crimes by accessing illegal and harmful websites or inappropriate use of the internet.
Please apply a filtering service to restrict the access to illegal or harmful websites. The internet use by minors must be monitored and supervised
by their parents/guardians at their responsibility. Please check our Website or catalogue for more detail.
<Web Safety Services>
□A：Yahoo! Kids　□B：Restricted Web Filtering
□C：Relaxed Web Filtering □E：Relaxed Web Filtering Plus
<Smartphone Safety Service>
Check only
□ F: Smartphone Safety Service (free version)
one
□ G: Smartphone Safety Service (charged version)
filtering
service ・In the case of SoftBank 3G, you will need a PIN code to purchase contents
when using Web Safety Services A to E.
・Smartphone Safety Service is only available on Android™ 4.0 or newer.
Subscribe to Web Safety Service if using an older OS than Android™ 4.0.
If you do not wish to apply any of these services, please
check the reason below.
※ If none of the filtering services or reasons are selected,
B: Restricted Web Filtering (SoftBank 3G/Smart Phone)
or F: Smartphone Safety Service (free version) is
deemed to be selected.
□1 These services interfere Applicant's work
□2 These services interfere the usage of internet for
Applicant's disabilities or health conditions.
□3 Parents/Legal Guardian will oversee and supervise the
Applicant's safe use of the internet.
●For SoftBank 3G, if any of Web Safety Services listed above as A
through E is.
Date of Birth
Statutory Agent's Name
Relationship to
the Applicant
Signature/Seal
Year/Month/Date
Please sign to the Japanese version.
Address
Contact Phone Number
〒　-
（サインは日本語版へお願い致します。）
①
（　）　-
②　Mobile Phone, Daytime Contact Phone Number
（　）　-
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
② To be filled by Billing Account Holder when the Applicant is NOT Billing Account Holder
□ I agree as follows:
●I agree that the billing statements will be sent to my current address and contact number.
●I agree to make the following payments for the Applicant from my bank account or by my credit card when I am designated as Payer by the applicant.
●In the event the Applicant fails to pay any of its debts by the due date, I agree to make best efforts to settle such non-payment.
① The payment for the service charges based on various services agreement stipulated by SOFTBANK CORP, and the payment for the
purchase price or the installment payment for a mobile phone handset and other products.
※ Cases where the subscriber is a minor and the payer exercising parental authority fails to make payments will be treated as delinquency on part
of the minor who is the subscriber. Also, the contract terms and payment status of subscribers with installment payment contracts will be
registered with a designated personal credit information bureau. If the credit information bureau has information on payment delinquency, etc., you
may not be allowed to make other credit contracts. Records of payment delinquency remain at credit information bureaus for five years after the
payment is completed, and may be used for investigations by member institutions.
② The payment for the fees and other charges for the services, etc provided by SoftBank Corp. or other designated contractors under the
regulations regarding "SoftBank Consolidated Billing" service, for content information under the terms and conditions for web use, and for the
purchase price for "S! Pay for All (S! Matomete Shiharai)".
③ The service charge and other liabilities ,which based on the terms of fixed-line telecommunications services that Yahoo!BB brand provides.
④ Payment and other obligations related to "SoftBank Electricity "and other services.
●I agree that SoftBank Corp. may use my personal information for the following purposes：
① To evaluate my solvency at the time of the Contract and for the duration of the Contract.
② To send a bill or request the payments under the Contracts with the Applicant.
③ To send notices for confirmation, amendment, etc regarding the above from SoftBank Corps; or to use for any other business related to the
above.
Date of Birth
Payer's Name
Signature/Seal
Please sign to the Japanese version.
(Billing Account Holder)
Address and
Contact Number
Relationship to
the Applicant
Year/Month/Date
〒　-
（サインは日本語版へお願い致します。）
Contact Phone Number
(
)
-
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
・SoftBank Corp. may call or mail you to reconfirm the above. If any of the parts written in this form turn out to be untrue, the subscription may be cancelled.
Please check our website and catalogue for product and service details when filling out this form. Please visit nearest SoftBank store or call SoftBank customer
support if you have any questions.
This translated version is only provided as a supporting tool to assist our English speaking customers.
Because there may be some slight variation in meaning due to translation,please refer to the Japanese version as the official document.
（この翻訳版は英語を話すお客さまのためのサポーツールです。翻訳の上で、意味が多少異なる場合がございますので、正式には日本語版をご覧ください。）
2016年4月版