Personal Data Request

INSTRUCTIONS

Please fill in all fields with a red asterisk to submit a Personal Data Request. We will send you an acknowledgement with a Request Number for your reference, and your Personal Data Request response will be sent to you within 45 days. We’ll use this information to support the processing of any updates or requests you submit. We may also use it to help improve our compliance processes. The information won't be used for marketing, shared with third parties, or used for any other purposes.

If you need an accessible format, such as Braille, Audio CD, Screen Reader Accessible or Large Font, please call us at 866-858-5158.
Section 1
Please complete the following with the information of the individual for whom the data is requested (Note: This section is required in order to complete your request)
First Name
Last Name
Street Address
Policy Number
Phone Number
Email Address
Request Type
Incorrect Data
Correct Data
Do you need a portable format of the See Data response? (i.e., Excel file)

No
Yes

Who is this request for?

Yourself - Complete Section 1 only

Someone Else - Individual (i.e., a family with a Power of Attorney or a parent of a child) - Complete Sections 1 & 2

Someone Else - Organization (i.e. a lawyer within a law firm who has a Power of Attorney) - Complete Sections 1 & 3

Section 2
Information of the individual who is making the request on behalf of someone else (Note: If this is a self-request, fill out the information in Section 1 only. If this is someone from an organization who is making a request on behalf of someone, please fill out Sections 1 & 3 only)
Requestor's First Name
Requestor's Last Name
Requestor's Street Address
Requestor's Phone Number
Requestor's Email Address
Action Required: Email a PDF copy of the selected documents below tihcompliance@tihinsurance.com to complete this request
Proof of Requestor's Authorization

Power Of Attorney
Guardianship Papers
Birth Certificate (if for a minor)
Section 3
Information of an organizational requestor who is making the request. (i.e., law office)
Organization Name
Organization Street Address
Organization TIN
Action Required: Email a PDF copy of the selected documents below tihcompliance@tihinsurance.com to complete this request
Proof of Company

Articles of Incorporation
Requestor's First Name
Requestor's Last Name
Requestor's Phone Number
Requestor's Work Email Address
Action Required: Email a PDF copy of the selected documents below tihcompliance@truist.com to complete this request
Proof of Requestor's Authorization

Power of Attorney
Guardianship Papers
Birth Certificate (if for a minor)
Captcha

Section 1