CALIFORNIA CONSUMER PRIVACY REQUEST

PRIVACY REQUEST

This privacy request form is being provided to California residents under the CCPA.
As a consumer you have the right to review and request changes or Opt-out of the sale of your personal information. In order to process your request, please complete the following form.

The information collected through this form will be used only for the purpose of Verifying your Request.

* Required fields

First Name*
Last Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone Number*
Email Address
Date of Birth
Last 4 digits of Social Security Number
Policy number (if applicable)
Request (Pick One)*
- Do not sell or share my personal information
- A report detailing the information collected about me
- Delete my personal information
Other - Please enter message
Phone
This field is for validation purposes and should be left unchanged.

You can also contact us at:
Lincoln Heritage Life Insurance Co
Consumer Privacy
PO Box 29045
Phoenix, AZ 85038

Email: privacy@lhlic.com
Toll free number 1-800-438-7180