The story is adapted from "Death Knocks Three Times" in Batman #180 (May 1966) by Robert Kanigher and Sheldon Moldoff.
No splash page for this story when it was reprinted in Bat-Manga! The Secret History of Batman in Japan (Random House, 2008 series). First page is 7 panels of Batman and Robin talking to Lord Death Man who is up on a cliff above them. However when it was reprinted in Batman: The Jiro Kuwata Batmanga (DC, 2014 series) #1 there was a cover-like splash page with Batman and Robin. Whether this is from the original comic or was created for the reprint needs to be confirmed.