California Consumer Privacy Act
By submitting this Request Form to you, I certify that I am a California resident who wishes to exercise my rights to make a request under the California Consumer Privacy Act (CCPA). I understand that you are required to keep a record of my request for at least 24 months, including any reference number assigned to my request, the request date and nature of the request, the manner in which the request was made, the date and nature of your response, and the basis for the denial of the request if the request is denied in whole or in part.
I understand that your response(s) to my request will be in writing and I authorize you to provide your response(s), send verification of receipt of my request, or contact me in connection with my request, using the following contact information and method(s) of delivery:
My Full Name
My Mailing Address
My Email Address
I understand that you need to be reasonably sure that I am making this request regarding my own information, or that I am authorized to make a request about someone else’s information. Therefore, I am providing the information below, which is accurate to the best of my knowledge, so that you can attempt to verify my request. I understand that you will use the verification data provided to cross-check information available in your records to the extent possible, and that you may require additional documentation if I am not making the request for my own information, and/or may deny my request if the information provided is insufficient for purposes of verification. (Check appropriate box and provide associated verification information as applicable):
- I request information or action regarding my own personal information.
My Date of Birth
Last four digits of My Social Security Number
- I request information or action regarding my minor child or a minor child for whom I serve as a legal guardian. By Checking this Box, I confirm that I am authorized to provide, and do hereby provide, consent for you to take action regarding and/or release to me information regarding the minor child.
Full Name of Minor
Address of Minor
Minor's Date of Birth
Last four digits of Minor's Social Security Number
My Relationship to Minor (Parent or Legal Guardian)
IMPORTANT – ADDITIONAL DOCUMENTATION REQUIRED: We require that you submit proof of your status as a parent or guardian. Acceptable forms of proof include a birth certificate or court document establishing your status.
This documentation can be emailed to CCPA@1fam.com or mailed to us at:
First Financial Asset Management, Inc.
3091 Governors Lake Dr., Ste 100
Peachtree Corners, GA 30071
Please include your CCPA request reference number (which we will provide to you after you submit this request), when submitting your documents.
- I make this request in my capacity as a designated and authorized individual seeking information or action regarding another person. By Checking this Box, I confirm that I am authorized to do so.
Full Name Whose Information is at Issue
Address of Person Whose Information is at Issue
Date of Birth of Person Whose Information is at Issue
Last four digits of the Social Security Number of the Person Whose Information is at Issue
IMPORTANT – ADDITIONAL DOCUMENTATION REQUIRED: We require that you submit proof of your authorized status. Acceptable forms of proof include a Power of Attorney or other legal document establishing your authority, or proof of registration with the California Secretary of State as a representative authorized to act for another consumer.
Alternatively, the consumer whose information is at issue may contact us directly, using the CCPA request reference number you will receive in response to this request, to verify his/her identity and then provide us written permission authorizing you to act for him/her.
The nature of my request is as follows, and I understand that I am only permitted to make a verifiable consumer Request to Know or Request to Access regarding my data under the CCPA twice in any 12-month period. (Check appropriate box and provide associated information as applicable).
- Request to Know (Categories of Information). I would like to know for the past 12 months:
- Request to Know (Access to Specific Information). I would like to receive a copy of the Personal Information collected about me for the past 12 months. Unless otherwise noted here, I would like to receive copies of all such information. I am aware that you will not disclose a social security number, as that information is deemed too sensitive to provide. I am also aware that you are not required to disclose specific pieces of personal information to me, as opposed to categories, unless I provide to you a written declaration under penalty of perjury that I am the consumer whose personal information is the subject of this request.
Optional Restriction: I would only like to receive copies of the following Personal Information/Categories of Personal Information from your records:
IMPORTANT – ADDITIONAL DOCUMENTATION REQUIRED: We require that you submit proof of your identity before we can disclose specific pieces of Personal Information. Please submit a Declaration, signed under Penalty of Perjury, confirming you are the consumer whose personal information is at issue in your request.
The Declaration can be emailed to CCPA@1fam.com, or mailed to us at:
Please include your CCPA request reference number (which we will provide to you after you submit this request), when submitting your Declaration.
- Request to Delete. I would like the Personal Information collected about me to be deleted.
Optional Restriction: I would only like you to delete the following Personal Information/Categories of Personal Information from your records:
We do not “Sell” your “Personal Information” to “Third Parties,” as those terms are used in the CCPA, which is why there is no option to submit a request to opt out of such sales.
If you have any questions about this form or your CCPA rights, you may contact us by telephone at 866-853-4435 or email us at CCPA@1fam.com.