VENTURE
Transcripción
VENTURE
I4 VENTURE GENERAL AGENCY LLC ELECTRONIC SIGNATURE AGREEMENT AND DISCLOSURES Policy No. VGAL-105349-000 In order to obtain auto insurance with Old American County Mutual Fire Insurance Company through Venture General Agency, LLC, insurance applicants may be required to answer certain questions on the application by key pad, mouse or other device used to select an item, button, icon or similar act/action. All questions were answered by me personally or answered on my behalf with my expressed consent, agreement to, and approval of the response given. Further, my electronic signature was affixed to the application only after I had read, understood and agreed to the terms proposed therein. Applicants may also be required to use an electronic signature when such signature is necessary on the application. You acknowledge and agree to the use of this electronic service in accessing or making any transaction regarding any application or policy for auto insurance through Venture General Agency, LLC. The Insured's Signature below further reflects the insured's choice as required by section 1952.101 through 1952.110 of the Texas Insurance Code, regarding Uninsured/Underinsured Motorist Benefits and as required by Section 1952.152 through 1952.161 of the Texas Insurance Code, regarding Personal Injury Protection as indicated by the electronic signature on the application for Automobile Insurance. Con el fm de obtener un seguro de automovil con Old American County Mutual Fire Insurance Company por medio de Venture General Agency, LLC, los solicitantes podran ser obligados a responder a ciertas preguntas de la aplicacion por medio del teclado, mouse o otros dispositivos utilizados para seleccionar un articulo, boton, un icono o acto/accion similar. Los solicitantes tambien pueden ser requeridos a utilizar una firma electronica cuando dicha firma es necesaria en la aplicacion. Usted reconoce y acepta el use de este servicio electronico para acceder o hacer cualquier transaccion concerniendo la aplicacion o poliza de seguros de auto por medio de Venture General Agency, LLC. Para completar la solicitud de seguros de auto con Old American County Mutual Fire Insurance Company por medio de Venture General Agency, LLC, conteste las preguntas determinadas de la aplicacion y seleccione las respuestas correctas por medio del teclado, mouse o otros dispositivos utilizados. Ademas, he colocado mi firma electronica cuando fue necesaria en la aplicacion. Todas las preguntas fueron respondidas por mi, personalmente o respondidas con mi consentimiento expresado, estoy de acurdo, y doy mi aprobacion a las respuestas dadas. Ademas, aplique mi firma electronica solo depues de que yo habia leido, comprendido, y aceptado los terminos propuestos. The following statement only applies to policies that begin with VGAL My signature below also verifies that I have been informed both verbally and in writing of the following statement: WARNING: A NAMED DRIVER POLICY DOES NOT PROVIDE COVERAGE FOR INDIVIDUALS RESIDING IN THE HOUSEHOLD THAT ARE NOT NAMED ON THE POLICY. ADVERTISIO: UN CONDUCTOR MENCIONADO EN LA POLIZA NO PROVEE COVERTURA A LAS PERSONAS QUE EN EL HOGAR DEL ASEGURADO QUE NO SON MENCIONADES EN LA POLIZA DE SEGUROS. Named Insured Signature Date 08/24/2016 PLEASE ATTACH TO POLICY OR FAX IMEDIATELY TO VENTURE GENERAL AGENCY 855-480-3756 • i li GENERAL AGENCY LLC Privacy of Non-Public Financial Information Venture General Agency represents licensed insurers and through its producers requests and obtains from consumers and customers nonpublic personal financial information, as defined below ("Nonpublic Personal Financial Information"), for use in connection with providing certain insurance products. It is understood Nonpublic Personal Financial Information includes personally identifiable financial information and any list, description or other grouping of consumers, and publicly available information pertaining to them, that is derived using any personally identifiable financial information that is not publicly available. "Personally identifiable financial Information" means any information a consumer provides Venture General Agency to obtain a financial product or service, information otherwise obtained about a consumer in connection with providing a financial product or service to that consumer, and any information about a consumer resulting from any transaction involving a financial product or service between Personable and a consumer. Personally identifiable financial information includes a consumer's name, address, zip code, email address, phone number, credit history, social security number, driver's license number, date of birth and any other information that itself identifies, or when tied to the above information, may identify a consumer. Pursuant to the Gramm-Leach-Bliley Act of 1999 (the "GLB Act") and state insurance laws and regulations promulgated thereunder requiring that financial institutions develop policies to protect the confidentiality of Nonpublic Personal Financial Information, Venture General Agency has prepared a privacy notice regarding its privacy practices, which may be amended from time to time in accordance with the GLB Act and the state insurance laws and regulations of those states in which products are sold (the "Privacy Notice"). The Privacy Notice is provided to consumers and states that (1) Venture General Agency does not disclose any Nonpublic Personal Financial Information to any third party except as set forth in the Privacy Notice; and (2) the Privacy Notice does not provide the consumer an opportunity to opt out of disclosure of their Nonpublic Personal Financial Information for purposes of the GLB Act. The Privacy Notice is sent to all insureds at the inception of their insurance policy and annually thereafter as long as the insurance policy remains in force. Venture will not disclose or use Nonpublic Personal Financial Information obtained other than in connection with the duties and obligations set forth in the insurance contract and in connection with servicing and processing a product that a consumer requests or authorizes in the ordinary course of business and except as otherwise set forth in the Privacy Notice or as otherwise provided by applicable federal and state laws and regulations.