Privacy Request Form

In some jurisdictions, applicable law may entitle you to make certain requests in connect with your personal information. Before Venbrook Group, LLC (“Venbrook”) can honor your request, we are required by law to verify your identity. Please complete this form to begin the verification process.

For more information on how Venbrook handles personal information and how our verification process works, please review our Privacy Policy on our website at www.venbrook.com.

Please describe your relationship with us. If you have an insurance policy and/or a claim number, please provide the insurance policy number and/or claim number:

Are you a California resident?

Yes - I am a California resident.

No - I am not a California resident.

Please tell us more about yourself so we can properly identify you.

First Name

Last Name

Telephone Number

Are you making a request regarding your own personal information or on behalf of someone else for their personal information (for example, an authorized agent or parent/guardian)?

Yes - I am submitting a request regarding my own personal information.

No - I am submitting a request on behalf of someone else.

What is your request? (Check all that apply)

Opt-out of the "sale" of my personal information.

Delete my personal information.

Access my personal information.

Name

Date

CONSENT: By submitting this form, I certify under penalty of perjury that I am filing a request in connection with data that relates to me. I understand that falsifying information could lead to an improper release of another individual’s personal information. I authorize Cardigan General Insurance Services, LLC to contact me if additional information is needed to verify my request.

Become An Agent

Become a Cardigan General Insurance Services appointed agent and expand your profitable business practices.

Benefits of a CGIS appointment:
• Selective appointment process
• Access to proprietary insurance programs
• Direct communications with program administrators and underwriters
• Coverages sponsored by A.M. Best A-Rated Carriers
• Claims administration and loss control services

Process for becoming an agent:

We will get you started and assist you with program details, our capabilities, and expectations and get you started on your way to establishing a profitable partnership.

If you prefer to speak with one of our program administrators,
please call 800-992-6648 and we’ll be happy to assist you.

For submissions: underwriting@cardigangeneral.com

Privacy Request Form

Become An Agent

Process for becoming an agent:

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