Request to Delete Verification Form

First Name *

Last Name *

Phone Number*

Address*

Email Address*

Please provide any other non-personal information/fact-based information [insert, e.g., provide the last date that you interacted with Coface] below.

Related Non-Personal Information:

Please check the box below if you agree to the following statement.

Pursuant to applicable state law(s), I am requesting that Coface North America Insurance Company (“Coface”) delete any and all personal and/or sensitive information collected about me.

Checking this box is your legal declaration of agreement with the statement above.

If your request is invalid for any reason, or if we require additional information to process this request, we will contact you directly using the contact information you provide to us on this form. This request is signed under the pains and penalties of perjury.

Coface does not use your sensitive personal information for purposes other than essential business purposes or as legally permitted or required by applicable law(s). However, Coface will comply with such request the extent applicable and/or permitted by applicable law(s).

By entering your full name below, you consent to the use of your electronic signature.*

Please enter the date signed below.*

Enter your relationship to the Consumer (if other than named individual e.g. parent or guardian)

RETURN TO DATA REQUEST FORMS SELECTION PAGE.

Upon receipt of your completed form, we will determine whether we hold personal information about you and respond to your request within 45 calendar days. If we are unable to process your request within that time period, we may extend the response time for an additional forty-five (45) calendar days. In that case, we will notify you and explain the reason for the extension within the initial forty-five (45) day period.

Coface does not sell your information or share your information for purposes of cross-context behavioral advertising. While California residents have the right to opt-out of the sale and/or sharing of their personal information under the California Consumer Privacy Act, we do not sell or share personal information, and therefore, we cannot accommodate these requests. If our practices change, we will update our Privacy Statement and take any other necessary action to comply with applicable law. To review our Privacy Statement, click here.

Coface Services North America, Inc., is part of the Coface Group (“Coface”), which is authorized in France by the Autorité de Contrôle Prudentiel et de Résolution and is subject to regulation by the Financial Conduct Authority and limited regulation by the Prudential Regulation Authority. For our full terms and conditions, click here.