OUR PRIVACY POLICIES AND NOTICES

Categories of Information Collected and Sources from Which We Collect It

1) We collect personal and privileged information about you from the following sources:

a) Information that you provide on applications and other forms.

b) Information about your transactions with us from the insurance companies we contact to underwrite your insurance.

c) Information we receive from Arizona’s Motor Vehicle Division (MVD) or other consumer reporting agencies.

d) Information contained in medical records or from medical professionals that is related to insurance claims.

Unless it is specifically stated otherwise in an amended Privacy Policy Notice, no additional information will be collected about you.

2) We may collect personal and privileged information from individuals other than those proposed for coverage.

3) Information we may disclose to third parties – In the course of our general business practices, we may disclose the information that we collect (as described above) about you or others without your permission to the following types of institutions for the reasons described below:

a) To a third part if the disclosure will enable that party to perform a business, professional or insurance function for us.

b) To an insurance institution, agent, or credit reporting agency in order to detect or prevent criminal activity, fraud, or misrepresentation in connection within insurance transaction.

c) To an insurance institution, agent, or credit reporting agency for either this agency or the entity to which we disclose the information to perform a function in connection with an insurance transaction involving you.

d) To a medial care institution or medical professional in order to verify coverage or benefits, inform you of medical problem of which you may not be aware, or conduct an audit that would enable us to verify payment.

e) To Arizona Department of Insurance or other insurance regulatory authority, law enforcement, or other governmental authority in order to protect our interests in preventing or prosecuting fraud, or if we believe that you have conducted illegal activities.

f) To a group policyholder for the purpose of reporting claims experience or conduction an audit of our operations or services.

YOUR RIGHT TO ACCESS & AMEND YOUR PERSONAL &

PRIVILEGED INFORMATION:

You have the right to request access to the personal information that we record about you. Your right includes the right to know the source of the information and the identity of the persons, institutions or types of institutions to whom we have disclosed such information within 2 years prior to your request. Your right includes the right to view such information and copy it in person, or request that a copy of if be sent to you by mail (for which we may charge you reasonable fee to cover our costs). Your rights also include the right to request corrections, amendment or deletions of any information that is in our possession. The producers that you must follow to request access to or an amendment of your information are as follows:

1.) TO OBTAIN ACCESS TO YOUR INFORMATION: You should submit a request in writing to Insurors Network, Ltd. P.O. Box 1929 Sedona, AZ 86339. The request should include your name, address, social security number, telephone number, and the recorded information to which you would like access. The request should state whether you would like access in person or copies that you have requested.

2) TO CORRECT, AMEND, OR DELETE ANY OF YOUR INFORMATION: You should submit a request in writing to Insurors Network Ltd. P.O. Box 1929 Sedona, AZ 86339. The request should include your name, address, telephone number, the specific i9nformation in dispute, and the identity of the document or record that contains the disputed information. Upon receipt of your request, we will contact you within 30 business days to notify you that we have made the correction, amendment or deletion or that we refuse to do so and the reasons for the refusal, which you will have the opportunity to challenge.

3) OUR PRACTICES REGARDING INFORMATION CONFIDENTIALITY AND SECURITY:

We restrict access to personal and privileged information about you to those employees who need to know that information in order to provide products or services to you. We maintain physical, electronic and procedural safeguards that comply with federal regulations to guard your personal and privileged information.

4) OUR POLICY REGARDING DISPUTE RESOLUTION: Any Controversy or claim arising out of or relating to our privacy policy, or the breach thereof, shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.

5) CUSTOMER ACKNOWLEDGEMENT AND SIGNATURE: By signing my name below, I am indication that I have read the privacy policy of Insurors Network, Ltd. and that I understand its terms. No promise or representation has been made to me to induce me to sign this form.

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