California Consumer Privacy Act Request Form

We are obligated to verify the identity of anyone to whom we release Personal Data to ensure that Personal Data is released to only authorized parties. If you submit your request using this form, you may be required to provide a separate Proof of Identity (POI) and Proof of Address (POA) for us to process your request. Any POI or POA you provide in connection will be used solely for the purpose of identity verification related to the request made. We may retain POI/POA as part of our record keeping for this transaction only, and any Personal Data we store is covered by our normal Security and Privacy data protection policies.

Are you making this request for yourself, or on behalf of someone else?

I am requesting for myself

I am an authorized representative, submitting on behalf of someone else

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    Awards and accreditations for Church Mutual.

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Church Mutual Insurance Company, S.I. (a stock insurer)
P.O. Box 357 | 3000 Schuster Lane | Merrill, WI 54452-0357
Telephone (800) 554-2642 or (715) 536-5577

© 2021 Church Mutual Insurance Company, S.I. All rights reserved. Protecting the Greater Good is a registered trademark of Church Mutual Insurance Company, S.I.

Church Mutual is a stock insurer whose policyholders are members of the parent mutual holding company formed on 1/1/20. S.I. = a stock insurer.