Data Subject Requests - Zurich in North America
Data Subject Requests
Residents of Arizona; California; Connecticut; Georgia; Illinois; Maine; Massachusetts; Minnesota; Montana; New Jersey; Nevada; North Carolina; Ohio; Oregon; and Virginia are provided privacy rights based on current legislation. For further information surrounding these rights, please review our online Privacy Policy found at or contact us at

Instructions: Please complete the required fields below. In the event of multiple policies, claims, or appointments, please provide all numbers to which your request pertains. Information collected on this form will be used and retained only to process your request.
1) Tell us your name:
First Name *
Middle Name  
Last Name *
State of Residence *
2) How may we contact you:
Email address
Phone number
3) Are you submitting this request for yourself or on behalf of another individual?
Other individual
Please specify the nature of the request:
Tell me what categories of personal information you have gathered about me and what that information is used for
Tell me with whom you have shared my personal information
Obtain a copy of my personal information
Delete my personal information
Correct my personal information
How did you or the individual for whom you are submitting this form become aware of the privacy rights (select all that apply)?
Zurich’s website Privacy Policy
Privacy Notice mailing
Authorization form including Notice of Insurance Information Practices