CCPA Request My Privacy Rights Form

Your contact information

*First Name*Last Name*Legal name of your Company (if you are acting on behalf of the company)*Email Address*Mailing address*State of residence

Contact information for the consumer on whose behalf you are making the CCPA request:Your contact information

*First Name*Last Name*Email Address*Mailing address*State of residence

Your relationship to the consumer on whose behalf you are making the CCPA request:

Legal counsel

Power of attorney

Other authorized agent

Prove Your Identity

Option 1

If an individual is exercising right on his/her behalf, please follow the following procedure to verify your identity by responding to CCPA Form confirmation of receipt email.

Option 2

If an individual is designating another to exercise CCPA rights on his/her behalf, the individual essentially needs to present a power of attorney compliant with CA’s probate code that identifies that individual has been authorized by the requestor to act on his/her behalf. A power of attorney is legally sufficient if all of the following requirements are satisfied:

(a) The power of attorney contains the date of its execution.
(b) The power of attorney is signed either (1) by the principal or (2) in the principal’s name by another adult in the principal’s presence and at the principal’s direction.
(c) The power of attorney is either (1) acknowledged before a notary public or (2) signed by at least two witnesses who satisfy the requirements of California Probate Section 4122.

*Please select one of the two options below submit the required documentation by emailing us at privacy@ctd.ai:

Option 1

Option 2

Choose a Request Type

*What type of request would you like to make?

Obtain an explanation on how we collect, used and shared your personal information from the past 12 months

Obtain a copy of your personal information from the past 12 months

Delete my account (personal information we collected from you)

Please let us know if there are any details about your request that may help us fulfil it :

Request Frequency

*Have you made any similar requests to CTD in the last 12 months?

Yes

No

Your contact information

Prove Your Identity

Option 1

Option 2

*Please select one of the two options below submit the required documentation by emailing us at privacy@ctd.ai:

Choose a Request Type

*What type of request would you like to make?

Request Frequency

*Have you made any similar requests to CTD in the last 12 months?

Thank you for your request

Your contact information

Contact information for the consumer on whose behalf you are making the CCPA request:Your contact information

Your relationship to the consumer on whose behalf you are making the CCPA request:

Prove Your Identity

Option 1

Option 2

*Please select one of the two options below submit the required documentation by emailing us at privacy@ctd.ai:

Choose a Request Type

*What type of request would you like to make?

Request Frequency

*Have you made any similar requests to CTD in the last 12 months?

Thank you for your request