Right to Access Form

The California Consumer Privacy Act (CCPA) permits California residents to request access to personal information (PI) companies collect on them, request to erase PI and opt-out of permitting the companies from selling their PI. If you wish to exercise your rights under the CCPA or on behalf of another, please fill out the below information to submit your request.

Note: NAU Country Insurance Company does not sell consumer PI and thus does not provide an option to “opt-out”’

For all other inquiries related to the CCPA or to submit a request via phone, please call our toll free number: 1-866-942-6724. For more information on your rights under the CCPA, please visit the official CCPA website: https://oag.ca.gov/privacy/ccpa

Submitter Information

Who are you submitting this request for?

If you selected "Self" proceed to Consumer Information below.

If other than "Self" what is your relationship to the consumer?

Submitter First Name:

Submitter Last Name:

Submitter Phone Number:

Submitter Email Address:

Consumer Information

First name

Last name

Phone Number

Email Address

Address

City, State, Zip

CCPA Request Type:

Please note that NAU Country Insurance has strict data retention policies in accordance with various government mandates and may not be able to fulfill your request for deletion / erasure.

Contact Preference

Phone

NAU Country ALERT!

Submitter Information

Consumer Information