Please note that this form is ONLY used to exercise your privacy rights and NOT for resolving customer service inquires related to a product or service. Please refer to:  https://www.assurant.com/assurant-phone-numbers for a list of customer service contacts.

To submit your consumer privacy right request, please complete this form. To protect your personal information, Assurant uses a service provider to verify your identity. Please provide the information below to begin the request process.


 

I Want to Exercise My Rights

Please note that if you have purchased multiple products with Assurant, you will need to submit a request for each product to ensure your request is processed across all applicable business systems.
Enter the Category
Category is required
Product is required

Personal Details

We are collecting this information to verify your identity. Please verify all information provided is accurate.
Enter the First Name
First Name is required
Enter the Last Name
Last Name is required
Enter the Date of Birth
Enter the Confirm Date of Birth
Enter the Last 4 digits of SSN
Last 4 digits of SSN is required
Enter the Confirm Last 4 digits of SSN
Last 4 digits of SSN is required
Enter the Email Address
Email Address is required
Enter the Confirm Email Address
Email Address is required
Enter the Street Address
Street Address is required
Enter the Confirm Street Address
Street Address is required
Enter the City
City is required
Enter the State
State is required
Enter the Zip Code
Zip Code is required
Enter the Confirm Zip Code
Zip Code is required
Please verify that you have confirmed that the information provided is accurate.
captcha

 

Once your identity is verified, you will automatically be presented with an additional form to complete your request.