Canada Consumer Rights Form

Canada Request Form for Exercising Your Privacy Rights

If you are a Canadian resident, you have certain rights under federal and provincial privacy laws in Canada. Canadian residents can exercise the right to request disclosure on the personal information collected, used or communicated; the right to request access to your personal information; and the right to request correction of your personal information.

* indicates a required field

First Name *

Please fill out this field.

Middle Name (optional)

Last Name *

Please fill out this field.

Select all that apply Request for disclosure on personal information collected (tell me about my data) Request for access (give me my data) Request for correction (correct my inaccurate data)

Please select an option.

Please describe your relationship to the SCIC affiliate that collected your personal data (please list all categories that apply): (e.g., pre-need or at-need contract purchaser; pre-need contract beneficiary; next of kin/family member; website visitor; other; authorized agent of any of the above):

RELATIONSHIP TO THE SCIC AFFILIATE (OPTIONAL)

Additional information needed to verify your identity for request processing

* indicates a required field

Today's Date

Please enter a valid date in this format mm/dd/yyyy

ADDRESS 1

ADDRESS 2

CITY

STATE / PROVINCE

POSTAL CODE

Please enter a valid postal code.

CONTRACT NUMBER (IF KNOWN)

DESCRIPTION/AMOUNT OF RECENT PURCHASE (IF KNOWN)

DATE OF RECENT PURCHASE (IF KNOWN)

CONTACT PHONE * +1

Please enter a valid 10 digit phone number.

CONTACT EMAIL *

Please enter a valid email.

Please indicate how you would like to receive the information requested above by checking one of the following boxes.

By Mail (at Address above) By Email (at Email above)

Please select one of these options.

Prior Information (optional)

You may also submit prior information

Prior Phone Number(s)

Prior Last Name(s)

Prior Address(es)

ACKNOWLEDGEMENT * I understand that I may make a verifiable request to exercise my rights regarding the protection of my personal information under applicable Canadian law, and‎ I further understand that SCIC or its affiliate will respond to my request as necessary using the information I provided above.

Please check this box if you want to proceed.

For more information, please see our privacy policy.