Request to Correct Verification Form

First Name *

Last Name *

Phone Number*

Address*

Email Address*

Please provide your preferred method of verification if applicable.

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:

Pursuant to applicable state law(s), you have the right to request that Coface North America Insurance Company (“Coface”) correct information we have collected about you if it is inaccurate. Please indicate which information you are correcting, note the correct information and indicate any other the details of this request below:

Request Details:*

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.

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.