Personal Data Request

Some regional, national, and state laws confer certain rights relating to personal data. If you would like to make a request pertaining to your personal data, please complete the form below.

* Required

What information do you need? Check all that apply

Access data

Correct or update data

Remove data (right to erasure)

Object to processing

Restrict data processing for specific purposes

Get a digital copy of data (portability)

Withdraw consent from marketing communications

Data request information

What is your specific request? Do not include any sensitive personal information.

Customer Number If applicable

Contact Information

First Name *

Last Name *

Phone *

Email *

Address

City

ZIP

Employer Name

Other Information

Enter any additional comments or relevant information Do not include any sensitive personal information.

By providing my phone number or email address, I agree to allow American Fidelity Assurance Company to contact me regardless of my status on any Do-Not-Contact list. Contact Terms and Conditions