Privacy Web Form

Please tell us who you are and the privacy right(s) you wish to exercise.

State

Note:

If you are a California resident, please use the form located here.

I am a (pick all that apply)

Required

Insured

Claimant

Vendor / Supplier

Agents

Authorized Agent

Parent/Guardian of a Minor

Employee

Former Employee

Employment Candidate

Other

No Relationship to Westfield

First Name

Enter the first name of the data subject

Last Name

Enter the last name of the data subject

Address

Address Line 2

City

Zip

Date of Birth

Email for correspondence with the data request

Enter email for correspondence with the data request.

Phone Number

Westfield Policy Number(s)

Westfield Claim Number(s)

Up to 10 supporting documents/files may be uploaded.

Select a File

Files larger than 10 MB are not supported.

Includes named insured, covered family members, and commercial insured employees

Includes Consultants

Includes Agent, Principal, or other Insurance Agency Employee

The person authorized under privacy law to exercise the privacy rights of another. (NOT the insurance agent)

Only check this if you are the parent or guardian submitting a request in the name of the minor child identified below.

Enter the first name of the data subject

Enter the last name of the data subject

Enter email for correspondence with the data request.