Boeing Employees’ Credit Union California Privacy Authorized Agent Form

Complete this form to submit a request under the California Consumer Privacy Act (CCPA). Proper authentication is critical to protect your personal information. You may be required to provide proof of identity before your request is fulfilled.

The California Consumer Privacy Act (CCPA) allows a consumer to authorize an agent to exercise the CCPA privacy rights to delete, request to correct, or a request to know on behalf of a California consumer.

If a California consumer has authorized you to submit a request pursuant to the CCPA, BECU is required to verify your identity and authority.

Please complete and submit this California Privacy Authorized Agent Form.

Consumer Information

I am exercising privacy rights of the following California consumer (full legal name):

The California consumer is: Current BECU Member Former BECU Member Current BECU Employee or Independent Contractor Former BECU Employee or Independent Contractor BECU Job Applicant (Current or Former) Other

If you selected Other above, then please explain:

Your Information

Your Full Legal Name:

Your Email Address:

Your Confirmation of Authorization

By submitting this California Privacy Rights Authorized Agent Form, I hereby certify to BECU that I have written authorization from the California consumer named above to submit a privacy rights request on his/her/their behalf and that the information I have provided is complete, accurate, and up-to-date and that I am authorized by the California consumer to act on his/her/their behalf.

I understand that BECU may require me to further verify my identity by providing evidence sufficient to verify my identity (or proof of registration with the California Secretary of State if the agent is a business), and authority to act on behalf of the California consumer and at least one of the following evidencing proof of my legal authority to act on behalf of the California consumer: (i) a Power of Attorney granted under the Probate Code that BECU can reasonably verify; or (ii) a signed, written permission by the California consumer. I also understand that any privacy rights request that I submit will not be valid until BECU receives all of the information that BECU deems necessary related to my authorization to act on behalf of the California consumer.

Authorized Agent Signature: Date Signed: