The Chadler Group, Inc.
Privacy Policy Notice
(as of 6/14/2001)
PURPOSE OF THIS NOTICE
Title V of the Gramm-Leach-Bliley Act (GLBA) and the laws of the State of New Jersey generally prohibit us from sharing nonpublic personal information about you with a third party unless we provide you with this notice of our privacy policies and practices, such as the type of information that we collect about you and the categories 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 you of the privacy policies and practices of [insert name of institution].
[If you share with third parties for a nonexempted purpose, insert the following:]
[The laws of this state further require that we inform you that we may not share your personal information with a nonaffiliated third party for any purpose that is not specifically authorized by law unless we obtain your affirmative permission.]
OUR PRIVACY POLICIES AND PRACTICES
1. Information we collect:
A. Categories of information collected and sources from which we collect it
[If you collect information about your consumer, insert the following:]
We collect nonpublic personal information about you from the following sources [insert all that apply]:
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information we receive from you on applications or other forms; |
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information about your transactions with us, our affiliates or others; |
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information we receive from a consumer reporting agency; |
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information we receive from medical records or medical professionals; |
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information we receive from personal interviews with neighbors, friends, associates or other acquaintances;5 and |
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[Insert any other categories of information that you collect.] |
Unless it is specifically stated otherwise in an amended Privacy Policy Notice, no additional information will be collected about you.
B. Persons from whom information is collected
[If you collect personal information from persons other than the individual(s) proposed for coverage, you should insert the following:]
We may collect nonpublic personal information from individuals other than those proposed for coverage.
[If you do not collect personal information from persons other than the individual(s) proposed for coverage, you should insert the following:]
We do not collect nonpublic personal information from anyone other than the individual(s) proposed for coverage.
C. Information from investigative consumer reports
[If you prepare or request the preparation of investigative consumer reports by an insurance support organization, you must include the following. You also must include a separate authorization form for the customer to sign, if he or she decided to do so (for a sample disclosure authorization form, see Section IX, Sample forms).]
If you authorize us to do so, we may obtain information about you from investigative consumer reports prepared by third parties at our request. If you authorize us to request such information and we do request such information, you should be aware that:
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you have the right to request to be interviewed in connection with the preparation of such a report; |
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upon request, you are entitled to receive a copy of the report; and |
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the information obtained from the report prepared by the third party may be retained by the third party and disclosed to other persons. |
2. Information we may disclose to third parties:
[If you disclose personal information outside of an exception to the opt-in requirement, insert either sample below depending on which describes your practices.]
[If you disclose nonpublic personal information outside a stated exception, and you disclose all of the categories of information that you collect:]
A. We may disclose all of the information that we collect about you, as described above.
[If you disclose nonpublic personal information outside a stated exception, but you only disclose some categories but not others:]
B. We may disclose the following kinds of nonpublic personal information about you:
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information we receive from you on applications or other forms, such as [provide examples, such as "your name, address, Social Security number, assets, income and beneficiaries"]; |
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information about your transactions with us, our affiliates or others, such as [provide examples, such as "your policy coverage, premiums, and payment history"]; and |
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information we receive from a consumer reporting agency, such as [provide examples, such as "your creditworthiness and credit history"]. |
[If you disclose any information under an exception to the opt-in requirement, however, you must, insert the following clause:]
C. In the course of our general business practices, we may disclose the information that we collect (as described above) about you or others without your permission to the following types of institutions for the reasons described [insert all that apply]:
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to a third party if the disclosure will enable that party to perform a business, professional or insurance function for us; |
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to an insurance institution, agent, or credit reporting agency in order to detect or prevent criminal activity, fraud or misrepresentation in connection with an insurance transaction; |
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to 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 connection with an insurance transaction involving you; |
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to a medical care institution or medical professional in order to verify coverage or benefits, inform you of a medical problem of which you may not be aware, or conduct an audit that would enable us to verify treatment; |
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to an insurance regulatory authority, law enforcement, or other governmental authority in order to protect our interests in preventing or prosecuting fraud, or if we believe that you have conducted illegal activities; |
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to a group policyholder for the purpose of reporting claims experience or conducting an audit of our operations or services; and |
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To an actuarial or research organization for the purpose of conducting actuarial or research studies. |
In addition to those circumstances listed above, and unless you tell us not to, we may disclose certain information about you to third parties whose only use of the information will be for purposes of marketing a product or service. Under no circumstances will we disclose for marketing purposes any medical information; information relating to a claim for benefit or, a civil or criminal proceeding involving you; or personal information relating to your character, personal habits, mode of living or general reputation.
3. Notification that certain disclosures require your authorization:
[If you disclose information other than as permitted by an express exception, you must include the following]:
As we have indicated in this Privacy Policy Notice, we collect certain personal information about you, and we may disclose that information to certain nonaffiliated third parties. We are permitted by law to disclose your personal information in the circumstances described in paragraph 2(c) without your permission. FOR ALL OTHER DISCLOSURES, WE ARE REQUIRED TO OBTAIN YOUR AUTHORIZATION. The disclosures that first require your authorization are described in more detail on a separate authorization form that we will provide to you.
[If you do not disclose information other than as permitted by an express exception, then you are not required to provide this notification or the separate authorization form.]
4. Affiliates with whom we share certain information protected by the Fair Credit Reporting Act, unless you tell us not to:
[If you have affiliates with whom you share nontransactional, FCRA-protected information, insert the following.] [If you do not have affiliates with whom you share such information, then you can delete this paragraph entirely from your privacy notice.]
A. Information we can share with our affiliates, unless you tell us not to:
Unless you tell us not to, we may share with our affiliated companies information about you, including:
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information we obtain from your insurance application, such as your income or your marital status; |
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information we obtain from a consumer report, such your credit score or credit history; |
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information we obtain to verify representations made by you, such as your open lines of credit; and |
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information we obtain from a person regarding its employment, credit, or other relationship with you, such as your employment history. |
B. Our affiliated companies who may receive this information are:
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financial service providers, such as:
[insert your financial service affiliates–you can describe them by name or by category, such as "mortgage lenders and brokers"]; |
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nonfinancial companies, such as:
[insert your nonfinancial affiliates–you can describe them by name or by category, such as retailers, direct marketers, airlines, and publishers]; and |
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our other affiliates, such as:
[name any other affiliates or describe them by category, such as "nonprofit organizations"]. |
C. How to tell us not to share this information with our affiliated companies:
If you prefer that we not share this information with our affiliated companies, you may direct us not to share this information by doing the following:
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call us toll-free at (1-800-706-2478); or |
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visit our Web site at www.chadler.com and choose Privacy Notices |
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e-mail us at info@chadler.com; or |
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check the appropriate box on the attached Opt-Out form |
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