The California Consumer Privacy Act (CCPA) Webform Submission


The CCPA permits California residents to request access to personal information (PI) companies collect on them, request to erase PI and opt out of permitting the companies from selling their PI.
If you wish to exercise your rights under the CCPA or on behalf of another, please fill out the below information to submit your request.

Note: QBE Insurance and affiliates do not sell consumer PI and thus do not provide an option to "opt-out"

For all other inquiries related to the CCPA or to submit a request via phone, please call our toll free number: 1-866-784-7775.
For more information on your rights under the CCPA, please visit the official CCPA website: https://oag.ca.gov/privacy/ccpa

Requester Information
Requested for? * Relationship, if Other
First Name *
Last Name *
Suffix
   
Primary Phone *
Email
Consumer Information
First Name *
Last Name *
Suffix    
Primary Phone *
Email
Date of Birth *
  		 
Is Westwood Consumer
Permanent / Primary Address
Country *
Address Line 1 *  
Address Line 2  
City *  
State *  
Zip Code *
 
Mailing Address            
Country *  
Address Line 1 *  
Address Line 2  
City *  
State *  
Zip Code *
 
Other Details
Policy Holder? *    Quote Holder? *   
If yes, policy number(s) / quote number(s):





Request Type *
Right to Access - Categories of Data
The right for you to know what categories of personal information are collected, used, or shared about you

Right to Access - Specific Data Elements
The right for you to know what specific pieces of personal information are collected, used, or shared about you, and the right to receive such specific pieces of personal information in an accessible electronic or hardcopy format.

Right to Access - Both
The right for you to know and receive both the categories and specific pieces of personal information that are collected, used, or shared

Right to Erasure
The right for you to have your personal information held by businesses deleted, unless retention of the information is required or permitted by applicable law.
 
Previously requested? *    If yes, Request number  
Comments:
Contact Preference
Please select how you would like to be contacted. Please select at least one method  *