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Please let us help you to recover from disaster!

If you face any issues after disaster and need our support, please fill up the following information.
It would be greatly appreciated if you share as detailed information as possible.
We will urgently contact with you as soon as we receive it.

*Required Item

Name* (Company Name/Division)*

Building Name or others*

Block Number*

City*

Zip Code*

Prefecture*

Surname*

First Name*

Telephone Number*

Email Address*

Address*

Date of Incident Occurred*

Type of Disaster (Fire, Water, Others)*

Address of Affected Place (Building Name)*

Affected Floor*

Affected Machine/Equipment*
Yes No

Situation of Damaged Place (Please explain in detail as possible)*

Image File
Size of the file must be smaller than 2MB.
Available extension: gif, jpg or png

Video File
Size of the file must be smaller than 2MB.
Available extension: avi, mov, mp3 or wav