Personal Data Request

Instructions

Please fill in all boxes with an asterisk to submit a Personal Data Request. We will send you an acknowledgement with a Request Number for your reference and your Personal Data Request response will be sent to you within 45 days. We’ll use this information to support the processing of any updates or requests you submit. We may also use it to help improve our compliance processes. The information won't be used for marketing, shared with third parties, or used for any other purposes.

SECTION 1: Information of the subject of the request whose data should be shown (Note: This section should ALWAYS be completed)

First Name *

Last Name *

Street Address Line 1 *

Street Address Line 2

City *

State *

Zip or Postal Code *

Account Number *

Phone Number *

Email Address

Request Type: *

Right to Correct Request - Incorrect Data

Right to Correct Request - Corrected Data

Communication Method *

Do you need a portable format to See Data Response? (i.e., Excel or CSV file)

Who is this request for?

SECTION 2: Information of the individual who is making the request on behalf of someone else (Note: If this is a self-request, fill out the information in Section 1 only. If this is someone from an organization who is making a request on behalf of someone, please fill out Sections 1 & 3 only)

Requestor’s First Name

Requestor’s Last Name

Requestor’s Street Address

Requestor’s City

Requestor’s State

Requestor’s Zip Code

Requestor's Phone Number

Requestor's Email Address

Proof of Requestor’s Authorization

Action Required: Email a PDF copy of the selected documents to AFCO-Compliance@afco.com to complete this request

SECTION 3: Information of an organizational requestor who is making the request. (i.e., law office)

Organization Name

Organization Street Address

Organization City

Organization State

Organization Zip Code

Organization TIN

*Proof of company - Articles of Incorporation

Action Required: Email a PDF copy of Articles of Incorporation to AFCO-Compliance@afco.com to complete this request

Requestor’s First Name

Requestor’s Last Name

Requestor's Phone Number

Requestor's Work Email Address

Proof of Requestor’s Authorization

Action Required: Email a PDF copy of the selected documents to AFCO-Compliance@afco.com to complete this request

If you need an accessible format, such as Braille, Audio CD, Screen Reader Accessible or Large Font, please call us at 800-288-2313 and select the option for a Privacy Specialist.

Personal Data Request

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