PO BOX 220

Your Privacy is Important to Us!
The Financial Services Modernization Act, otherwise known as the Gramm-Leach-Bliley Act (GLBA), was signed into law on November 12, 1999 with an enforcement date of July 1, 2001. The GLBA establishes new privacy standards for governing how the financial services industry (including insurance companies, agencies, and third party administrators) protect nonpublic personal information about their customers. These federal requirements are generally consistent with privacy practices we have had in place for some time. However, GLBA requires us specifically to notify our customers about our privacy practices and restricts the improper disclosure of nonpublic personal information.

Employees of Prins Insurance are held to strict standards when it comes to customer confidentiality. We have guidelines in force to assure you, the customer, that your nonpublic personal information is shared only in accordance with the law. Prins Insurance trains their employees in handling situations that involve sharing customer information with non-affiliates and third parties.

We may obtain the following customer information about you:

  • Name, Address, Date of Birth, Social Security Number, Drivers License Number
  • Phone Numbers
  • Claims Information
  • Financial Information
  • Motor Vehicle Record Violations
  • Information regarding your household

This information is either obtained from you or third parties including, but not limited to, credit reporting bureaus, driving record agencies, companies, regulatory agencies, or our staff. This information is collected strictly for underwriting purposes or as otherwise permitted by law. Our information is stored in client files or in our computer system. No one may access these records without the proper authorization or by means of computer access codes.

The information that you provide us with or that we collect about you is important to us. It is our policy not to disclose any nonpublic personal information about our customers or former customers to anyone, except as permitted by law. It may be necessary for us to disclose information such as applications, coverages, driving records, loss information, and transactions to the following third parties:

  • Third parties who provide business services for us relating to the products and services we offer
  • Third parties that require us to submit information to them such as insurance companies
  • Third parties who establish rates for insurance coverages

Unless you tell us not to, we may share information with our affiliated companies information about you, including:

  • Information we obtain from insurance application, such as your income or marital status
  • Information we obtain from a consumer report, such as your credit score or credit history
  • Information we obtain to verify representations made by you, such as your open lines of credit
  • Information we obtain from a person regarding its employment, credit, or other relationship with you, such as your employment history.

Our affiliated companies who may receive this information are insurance agencies we own or operate, and insurance companies with whom we are obtaining quotations. If you prefer that we not share this information with our affiliated companies, you may direct us not to share this information by completing the opt out notice on the next page and returning to it to our Privacy Compliance Officer as designated below.

Even though these activities are permitted by law, we do this only to help us meet our mission statement which is to provide a consistent and stable market with competitive insurance products to meet the needs of our clients. We would not, for example, sell a customer’s name or other non-public information, to a credit card company. Our employees are required to protect the confidentiality of your information and access information only when there is appropriate need to do so. In addition, we maintain the necessary electronic and procedural safeguards to protect your information. We continue to review our privacy practices to make our use of your information more meaningful and to provide superior service.

Your confidence in our agency and the manner in which we conduct our business is greatly appreciated. Our promise to you is that we will treat your personal information with utmost confidentiality, use it only to serve you better and in the manner described by law. If you have any questions regarding our privacy policy, you may contact us at the following address: Privacy Compliance Officer Prins Insurance, Inc. PO Box 220 Sanborn IA 51248 Or email us at:


Prins Insurance, Inc.
PO Box 220
Sanborn, IA 51248-0220

Opt Out Form
(As of July 1, 2001)
Please read the text below and decide whether you wish to exercise your right to opt out of the information sharing described. If you choose to exercise your right to opt out, you must mail this form back to us at Prins Insurance, Inc., PO Box 220, Sanborn, IA 51248. Your response must be postmarked no later than 30 days from the date you receive this notice from us in person in order to be valid. If you do not mail back this form within the 30 days, you have not exercised your right to opt out, and we can share the information described. ?

______ I wish to exercise my right under the Gramm-Leach-Bliley Act to opt out of Prins Insurance’s sharing nonpublic personal information about me to non-affiliated third parties for purposes other than those permitted by law.

______ I wish to exercise my right under the Fair Credit Reporting Act to opt out of Prins Insurance’s sharing nontransactional information about me to affiliates.

Customer Signature