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Consumer Privacy Rights Request Form

Not all persons are eligible for all data requests. This form will be used to determine your eligibility. To protect your privacy, you will be required to verify that you either are a person about whom we collected information or are someone authorized to act on such a person’s behalf. Requests are fulfilled as soon as practical, usually within 45 days.

Type of Requestor: [ Select One ] Type of Requestor: [ Select One ] Consumer Insurance Partner Vendor Authorized Person Employee Applicant

Type of Personal Information (PI) Request: [ Select All That Apply ] Type of Personal Information (PI) Request: [ Select All That Apply ] PI Report PI Access PI Deletion Do Not Sell/Share My PI Limit the Use of My Sensitive PI Opt Out of Profiling/Automated Decision-Making Do Not Email Do Not Call/Text Correct My PI