FORM California Consumer Privacy Act Request Form

• CCPA Form Fields Panel

• If you are an existing New York Life client, or have applied to purchase a financial product from us, please call 1-800-225-5695 for privacy inquires.
• If you are a current employee, please reach out to HR_Central@newyorklife.com using the subject line: “CA Privacy Request”  or complete the form below.
• If you are a current NYL agent, please reach out to Agent_Privacy@newyorklife.com using the subject line: “CA Privacy Request” or complete the form below.

What is your relationship with New York Life? (Select all that apply.)*

New York Life Client or Applicant (e.g., product offered through a New York Life agent or directly by New York Life)

Group Product Client or Applicant (e.g., offered by your employer)

Current Employee

Former Employee

Employment Applicant

Current NYL Agent / Financial Advisor

Former NYL Agent / Financial Advisor

Agent Applicant

Third-party Financial Advisor

Other

If you selected “Group product” please include the name of your employer, if you are covered through your employer, or name of your association, if you are covered through an association, in the text box below. If you selected “Other”, please describe the nature of your relationship with NYL (For example, you received an email or postal mail from us about our products and services):*

We will use the information you provide below to help us understand and respond to your request. Before fulfilling your request, we will call you using the phone number you provide to verify your identity.

Are you a California Resident?*

Yes

No

First Name*

Middle Name

Providing your full name helps us locate relevant information in our systems.

Last Name*

Email*

Phone Number*

Date of Birth*

Full Address (number, street, apartment, building, etc.)*

City*

State*

Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code*

Please describe your California Consumer Privacy Act request.

Send

*Required