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Please fill out the following information and submit using the button below

What is your full

What is your address

Telephone


YES
NO

Self
Minor child for whom I am the parent or legal guardian
Grantor of a Power of Attorney or Authorized Agent

3. If you are making a request on behalf of someone else, please provide the name and contact information of the consumer for whom you are making the request:
                Name
 
                Address
                Telephone
               

Policyholder/Insured
Claimant
Employee, owner, director, officer, or contractor of a company which does business with us
Other. If Other, please specify below



Alea North America Insurance Company
Catalina U.S. Insurance Services LLC
Danielson National Insurance Company
National American Insurance Company of California
National Home Insurance Company (A Risk Retention Group)
ProBuilders Specialty Insurance Company (RRG)
SPARTA Insurance Company
Other. If Other, please specify below



    I am requesting the following information the Company has collected in the past twelve (12) months:
        The categories of my personal information collected
        The categories of sources from which my personal information was collected
        The business or commercial purpose for collecting or selling my personal information
        The categories of third parties with whom the Company shared my personal information
        The specific pieces of my personal information the Company has collected
I am requesting that the Company delete my personal information
I wish to opt-out of the sale of my personal information by the Company

CONSENT: By submitting this form, I certify under penalty of perjury that I am submitting a request in connection with data that relates to me. I understand that falsifying information could lead to an improper release of another individual’s personal information. I authorize Catalina U.S. Insurance Services LLC to contact me if additional information is needed to verify my request.