California Consumer Privacy Act (Email Form)

CALIFORNIA CONSUMER PRIVACY ACT
REQUEST FOR INFORMATION

Under the California Consumer Privacy Act (CCPA) of 2018, effective January 1, 2020, California residents have a right to know what personal information has been collected on them in the past 12 months since the date this request form is received. The CCPA also gives California residents the right to request that personal information be deleted from our records.

Columbian Financial Group, hereafter referred to as ‘the Company’, does not sell any personal information. Any information that we do collect on our customers is used solely by the Company or its business partners as part of the Company’s routine business practices regarding the administration of any insurance policy or contract that a policy owner has or may have had with the Company. 

In accordance with the Company’s existing personal information policies, and the ongoing business need to administer any and all active policies on record, requests to delete personal information may be declined by the Company. Any reasons for declining such requests will be provided in the Company’s response to this request.

I. REQUESTOR INFORMATION: Please tell us about yourself
II. CALIFORNIA RESIDENT INFORMATION: Please tell us about the person the company may have personal information on

III. Authorized Agent: Any information we have is held in the strictest confidence and may not be shared with anyone other than the policy owner. However, under the California Consumer Privacy Act, you have a right to authorize another person to act as your agent. To do this, the Company requires that you (1) provide us with a certified copy of the document giving your authorized agent written permission to act on your behalf in this matter, or (2) provide the Company with a certified copy of your Power of Attorney document, and you must be able to verify your own identity with us by properly completing Section II, which must then match our records on file.

Please complete this form to the best of your ability.  The more information the Company has, the better the search results will be.
 
The Company may need to contact the requestor for additional information as needed.
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