Name*

Address*

Phone*

Email*

Last 4 Digits of Social Security Number*

Date of Birth*

Hunt Henriques Account Number (if known)

REQUEST – Pursuant to the California Consumer Policy Act, I hereby declare under penalty of perjury that the information above is true and correct and that I (the individual described above) am the individual that is providing the information above.

If you are not the individual described above, to act on behalf of an individual consumer, you must provide Hunt & Henriques with written and signed permission from the individual consumer (please email the permission to privacy@hunthenriques.com) and the consumer must call us at 1-866-625-9835 to verify their identity with us and confirm that they have provided the authorized agent with permission to submit the request on their behalf.

I hereby request the categories of information that you have collected about me.

I hereby request identification of the specific information that you have collected about me.

I hereby request the categories of third parties to which you have disclosed information about me.

I hereby request deletion of the following information that you have collected about me. (I acknowledge that the information that I am requesting be deleted may be subject to various exceptions and that you will inform me if my request cannot be honored because of such exceptions.)

Today’s Date*

Signature*