Request for Privacy Data

Full name of person making the request

Email of person making the request

Consumer Name

Consumer email

Consumer Address

Consumer Date of Birth

Consumer Phone Number

California Resident

YesNo

Relationship

Request for Access

I hereby request that Mercer Advisors provide me with the following information, in each case with respect to Mercer Advisors’ processing of my personal information during the past twelve (12) months:

The categories of personal information that Mercer Advisors has collected about meThe specific pieces of personal information that Mercer Advisors has collected about meThe categories of sources from which Mercer Advisors has collected my personal informationMercer Advisors’ business or commercial purpose for collecting my personal informationThe categories of third parties with which Mercer Advisors shares my personal informationThe categories of my personal information that Mercer Advisors has disclosed to third parties for a business purposeConfirmation that Mercer Advisors has not sold my personal informantion

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Request for Delete

I hereby request that Mercer Advisors delete all personal information it has about me

Form of Response

By mail to the address provided aboveElectronically to the mail address provided above

Authorized Agent

YesNoI am an authorized agent submitting this request on the consumer’s behalf.

Request for Privacy Information

Please fill out this form