Personal Information

First Name:

{{firstName}}

Middle Name:

{{middleName}}

Last Name:

{{lastName}}

State of Residence:

{{stateofResidence}}

Email:

{{emailaddress}}
Phone Number: {{phonenumber}}
Other details (Self)

Relationship to Zurich:

Policy Numbers:

{{insuredNum}}

Claim Numbers:

{{claimantNum}}

Employee Number:

{{employeeNum}}

Producer Appointment ID:

{{producerAppointmentId}}

Other Details:

{{otherDetails}}
Relation to Individual

Relation:

{{relationToInd}}{{relationToIndOther}}
Personal Information (individual)

First Name:

{{indFirstName}}

Middle Name:

{{indMiddleName}}

Last Name:

{{indLastName}}

State of Residence:

{{indStateofResidence}}

Email:

{{indemailaddress}}

Phone Number:

{{indphonenumber}}
Other details (individual)
Relationship to Zurich:

Policy Numbers:

{{indInsuredNum}}

Claim Numbers:

{{indClaimantNum}}

Employee Number:

{{indEmployeeNum}}

Producer Appointment ID:

{{intProducerAppointmentId}}

Other Details:

{{indOtherDetails}}
Nature of Request

{{myInfoEnquiryNOR}}:

{{myInfoEnquiryNOR_val}}

{{enquiryNOR}}:

{{enquiryNOR_val}}

{{acopyNOR}}:

 Send information to:
{{sendInfo}}
{{emailNOR}}{{mailingAddressNOR}}

{{deletionNOR}}:

{{deletionNOR_val}}

{{InfoToBeCorrected}}:

{{InfoToBeCorrected_val}}
{{natureofRequest}}: {{natureofRequest_val}}
How did you/he become aware of the privacy rights?

{{awarenessWebsite}}:

{{awarenessWebsite_val}}

{{awarenessMailing}}:

{{awarenessMailing_val}}

{{awarenessAuthorizationForm}}:

{{awarenessAuthorizationForm_val}}

{{awarenessOther}}:

{{awarenessThroughOther}}

This email was generated on {{currentDate}} {{currentTime}}.