The information contained on this form replaces any privacy notifications, notice of insurance information practices and investigative consumer reports notices which may appear on the application.


We want to inform you that as part of normal insurance procedures, we obtain personal information about you from sources other than you, such as consumer reports including motor vehicle reports, prior loss reports and insurance scoring information* in order to determine your eligibility or your rating tier. Any information which we have or may obtain about you or other individuals listed as insureds on your policy will be treated confidentially. However, this information, as well as other personal or privileged information subsequently collected, may, under certain circumstances, be disclosed without prior authorization to third parties such as insurance support organizations and our affiliated businesses for claims handling, servicing, rating, underwriting and marketing.

You have the right to see personal information collected about you, and you have the right to correct any information that may be wrong. Detailed information regarding the privacy of your personal information is contained in PCD 4220, which is included in your policy package.

* Insurance scoring information will be considered, along with other information about your driving record, in the determination of your Automobile policy premium.

Additional information regarding insurance scoring may be found on the New Jersey Department of Banking and Insurance website at:

High Point reserves the right to request additional information or documentation during the underwriting process.

PAC 4601 CI Ed. 2/09