Access and Deletion Rights Request Form

California Consumer Privacy Act of 2018 (CCPA) – Access and Deletion Rights Request Form

If you are a California resident, subject to certain limitations under applicable law, you may have the right to request (1) access to Personal Information we have collected about you and (2) that we delete Personal Information we have collected from you. To exercise these rights, please complete this form.

If you would like to submit a request as an authorized agent on behalf of another individual, please email legal@abacus.net. References to “us”, “our” and “we” refer to Abacus Insurance Brokers, LLC (“Abacus”). To learn more about our information practices and your rights, please read our Privacy Notice (CA): CALIFORNIA PRIVACY NOTICE.

Section 1. Your Information

Please provide the information below so we can verify your identity and California residency. (Fields marked with an asterisk * are mandatory.)

First Name *

Middle Name

Last Name *

Email Address *

Street Address *

City *

State *

Zip Code *

Telephone Number

Section 2. Your Rights Requests

Please identify which privacy right(s) you wish to exercise.

Right to Know Request: *

You have the right to request that we disclose to you certain information about our collection, use and disclosure of your Personal Information within the preceding 12 months.

Please click below relating to the information you would like us to provide you:

Deletion Request: *

You have the right to request that we delete the Personal Information that we collected from you, subject to certain exceptions as permitted by law.

Are you requesting information on behalf of another person? *

Please select how you would like to receive our response: *

NOTE: Proper authentication is critical to ensuring the protection of Personal Information. Depending on the response to your request, you may be required to provide proof of identity before it can be fulfilled. We will respond to your request consistent with applicable laws.

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California Consumer Privacy Act of 2018 (CCPA) – Access and Deletion Rights Request Form

California Consumer Privacy Act of 2018 (CCPA) – Access and Deletion Rights Request Form

Section 1. Your Information

Section 2. Your Rights Requests

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