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Copyright 2001


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1 Copyright 2001 1 Ver. 062001 Independe
Copyright 2001 1 Ver. 062001 Independent Insurance Agents of America, Inc. All rights reserved. (as of 11/02/11) Title V of the Gramm-Leach-Bliley Act (GIllinois, generally prohibit us from sharing nonpublic personal information about you practices describing the type of information of persons or entities to whom that information may be disclosed. In compliance with the GLBA and the laws of this state, we are providing you with this document, which notifies tices of TAVE Risk Management. at we inform you that we may not share your personal information with a non-affiliated third party for any purpose that is not specifically authorized by law unless we obtain your affirmative permission.OUR PRIVACY POLICIESInformation we collect: A. Categories of Information Collected and Sources From Which We Collect It ation about you from the following Information we receive from you on applications or other forms. Information about your tranaffiliates or others. Information we receive from a consumer reporting Information we receive from medical records or medical professionals.Unless it is specifically stated

2 otherwise in an amended Privacy Policy
otherwise in an amended Privacy Policy Notice, no additional information will be collected about you. Copyright 2001 2 Ver. 062001 Independent Insurance Agents of America, Inc. All rights reserved. B. Persons From Whom Information is Collected We may collect nonpublic personal information from C. Information From Credit Reportse Consumer Reports may obtain information about you from investigative consumer reparties at our request. If you authorize us to request such information and we do request such information, you should be aware that: connection with the preparThe information obtained from the report prepared by the third party may be retained by the third party and 2. Information we may disclose to third parties: ess practices, we may disclose the information that we collect (as dewithout your permission to the following types of institutions for the To a third party if the disclosure will enable that party to perform a business, professional or insurance To an insurance institution, agent, or credit reporting or prevent criminal activity, fraud or misrepresentation in connection with an To

3 an insurance institution, agent, or cre
an insurance institution, agent, or credit reporting agency for either this agency or the entity to whom we disclose the information to perform a function in Copyright 2001 3 Ver. 062001 Independent Insurance Agents of America, Inc. All rights reserved. To a medical care institution or medical professional in benefits, inform you of a medical problem of which you may not be aware, or treatment. To an insurance regulatory authority, law enforcement, or other governmental authority in order to protect our claims experience or conducting an audit of our In addition to those circumstances lis to by completing the attached Opt Out Form, we may disclose certain information about you to third parties whose only use of the information will be for the purpose of marketing a product or service. Under no circumstances will we disclose for marketing purposes: (1) any medical information; (2) information relating to a claim for a benefit or a civil or criminal proceeding involving you; or (3) personal information relating to your character, personal habits, mode3. Your right to access and amend your perso

4 nal information: the personal informatio
nal information: the personal information that we information and the identity of the persons, institutions or types of institutions to whom we have disclosed such information within two (2) information and copy it in person, or reyou by mail (for which we may chargeamendments or deletions of any information in our possession. The procedures that you must follow to request access to or an amendment of To obtain access to your information : You should submit a request nagement, 450 Skokie Blvd. Building Copyright 2001 4 Ver. 062001 Independent Insurance Agents of America, Inc. All rights reserved. name, address, social security number, telephone number, and the recorded information to which you would like access. The request should state whether you would like access in person or a copy of the information sent to you by mail. Upon receipt of your request, we will contact you within 30 business days to arrange providing To correct, amend, or delete any of your information: submit a request in writing to TAVE Risk Management, 450 ss, social security number, telephone number, the specific informati

5 on in dispute, and the identity of the d
on in dispute, and the identity of the document or record that contains the disputed information. Upon receipt of your request, we will contact you within 30 business days to notify you either that we have made the correction, amendment or deletion, orthe reasons for the refusal, which you will have an opportunity to 4. Our practices regarding information confidentiality and security: al information about you to those employees who need to know that information in order to provide products or services to you. We maintain physical, electronic, and protect information about you. Copyright 2001 5 Ver. 062001 Independent Insurance Agents of America, Inc. All rights reserved. (as of 06/06/08) opt out of the information sharing described. out, you must return this form to us at TAVE Risk Management, 450 Skokie Blvd. Please contact TAVE Risk Management at (847) 267-0415______ I wish to exercise my right under the Gramm- out of TAVE Risk Management's sharing nonpublic personal information about me to non-affiliated third parties for purposes other than those that are permitted by Customer Signature Da