| receives the money, tell us where to send
the money, show your government-issued ID, show us your driver's license,
or order a commodity futures or option trade. Covered entities that
collect personal information from their affiliates, credit bureaus,
or both, must include after the bulleted list the following statement:
"We also collect your personal information from others, such as credit
bureaus, affiliates, or other companies." Covered entities that do
not collect personal information from their affiliates or credit bureaus
but do collect information from other companies must include the following
statement instead: "We also collect your personal information from
other companies." Only covered entities that do not collect any personal
information from affiliates, credit bureaus, or other companies can
omit both statements.
(iv) "Why can't I limit all sharing?" Covered entities
that describe state privacy law provisions in the "Other important
information" box must use the bracketed sentence: "See below for more
on your rights under state law." Other covered entities must omit
this sentence.
(v) "What happens when I limit sharing for an account
I hold jointly with someone else?" Only covered entities that provide
opt out options must use this question. Other covered entities must
omit this question. Covered entities must choose one of the following
two statements to respond to this question: "Your choices will apply
to everyone on your account," or "Your choices will apply to everyone
on your account-unless you tell us otherwise." Covered entities that
provide insurance products or services and elect to use the model
form may substitute the word "policy" for "account" in these statements.
(B) General instructions for the definitions. The covered
entity must customize the space below the responses to the three definitions
in this area of the form. This specific information must be in italicized
lettering to set off the information from the standardized definitions.
(i) Affiliates. As required by §22.10(b)(3) of
this title, where (affiliate information) appears, the covered entity
must:
(I) if it has no affiliates, state: "(name of covered
entity) has no affiliates";
(II) if it has affiliates but does not share personal
information, state: "(name of covered entity) does not share with
our affiliates"; or
(III) if it shares with its affiliates, state, as applicable:
"Our affiliates include companies with a (common corporate identity
of covered entity) name; financial companies such as (insert illustrative
list of companies); nonfinancial companies, such as (insert illustrative
list of companies); and others, such as insert illustrative list."
(ii) Nonaffiliates. As required by §22.10(d) of
this title, where (nonaffiliate information) appears, the covered
entity must:
(I) if it does not share with nonaffiliated third parties,
state: "(name of covered entity) does not share with nonaffiliates
so they can market to you"; or
(II) if it shares with nonaffiliated third parties,
state, as applicable: ''Nonaffiliates we share with can include (list
categories of companies such as mortgage companies, insurance companies,
direct marketing companies, and nonprofit organizations)."
(iii) Joint marketing. As required by §22.17 of
this title, where (joint marketing) appears, the covered entity must:
(I) if it does not engage in joint marketing, state:
"(name of covered entity) doesn't jointly market"; or
(II) if it shares personal information for joint marketing,
state, as applicable: "Our joint marketing partners include (list
categories of companies, such as credit card companies)."
(C) General instructions for the "Other important information"
box. This box is optional. The space provided for information in this
box is not limited. Only the following types of information may appear
in this box:
(i) State, international privacy law information, or
both; or
(ii) Acknowledgment of receipt form; or
(iii) Both (i) and (ii).
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