Data Subject Access Request Form - For Yourself

The fields indicated with an asterisk (*) are required.

Your Information

Information of the requestor, which may or may not be different from the subject of the request. I.E. Complete this section with your information (the person filling out this form, not necessarily the subject of the request)

Your Category *

Country of Origin *
Your Full Legal Name *
Your own name, even if you are making the request on behalf of someone else who you are authorized to represent. If you are representing someone else, you must have the legal authority to act on their behalf.
First name *:
Last name *:
Your Email Address *

Request Type

Identify the type of request you are submitting. If you have multiple request types, please submit separate forms for each request type.

Request Type *

Sworn Statements

Please read the following statements, and check the boxes to confirm that you agree.

Sworn Statements *

I consent to the processing of the personal information that I am submitting, as outlined below.

Hitachi America, Ltd. will use the personal information that you supply on this form (including your email address and any ID information) and any personal information you may submit in further correspondence for the purposes of processing your request and meeting our legal obligations. We may share details of your request with data protection authorities, but only when they require these details to investigate or review a decision that we have made.

I represent that the information in this request is accurate and that I am authorized to submit this request.

I understand that Hitachi America, Ltd.will not be able to process my request if the form is not properly filled out or if the request is incomplete.


Date *
MM/DD/YYYY (e.g. "12/19/2010")
Signature *
By typing your full name, you are providing us with your digital signature, which is as legally binding as your physical signature. Please note that your signature must exactly match the first and last names that you entered at the top of this web form in order for your submission to be successful.

e.g. John Doe