California Privacy Act

Relationship with Delaware Life:

Consumer
Insurance Producer

First Name:

Last Name:

Email:

Confirm Email:

Street Address:

City:

Zip code:

State:

Type of Request:

Access My Information
Confirm My Information
Correct My Information
Delete My Information
Receive Information About Onward Disclosures

Are you making this request on behalf of another individual?:

What is the name of the other individual?

Are you that individual’s authorized agent?

Certification Check Box:

By submitting this request, I am confirming:
(1) Accuracy: the information I have provided is true and accurate;
(2) Privacy: I understand the information will be handled by in accordance with Delaware Life’s Privacy Policy; and
(3) Contact: that Delaware Life has the right to contact me to verify my identity and to process this request.

California Consumer Privacy Act

Data Request Form