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Personal Information Request Form

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Miller Nash LLP (“Miller Nash”) Personal Information Request Form

Personal Information Request

(Please select which of the following rights you wish to exercise)

The right to obtain information regarding how we collect, use, and share your personal information.
The right to obtain a copy of the specific pieces of personal information we have collected about you.
The right to obtain a copy of the categories of personal information we have collected about you.
The right to request deletion of personal information we have collected from you, subject to certain exceptions under applicable law.

Verification

Miller Nash (“we”) need to verify your identity before we comply with your request. You can provide any of the following pieces of verification information: full name, financial account number on file, mailing address, email address, or phone number.

If you are only requesting the disclosure of the categories of personal information we have about you, only two (2) pieces of information are required. For all other requests, three (3) pieces of information are required:

Additional Information

We may ask for additional information to fulfill your request.

Declaration

I declare that (1) the contents in this request are accurate, (2) I am the person whose personal information is the subject of this request (or their agent), and (3) the personal information is subject to the CCPA.

If you are making this request on behalf of someone else as their agent, provide the following information:

I declare under penalty of perjury that I am the authorized agent of the person whose personal information is the subject of this request. A notarized statement containing my signature and the signature of the person I represent is attached to confirm my authority to make this request.

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