Organic Law on the Protection of Personal Data.

In accordance with the Directive 15/1999. Of 13 December, the organic Law on the Protection of Personal Data (LOPD), and Law 26/2006 of Private Insurance and Reinsurance Intermediation. The client is informed and expressly authorizes that the personal data requested by the Insurance broker will be treated and registered in a file or files. The provision of requested personal data is obligatory in order to enable the Client´s access to referred services as this data is considered necessary for their maintenance and fulfilment. The purpose of collecting and treating personal data is to maintain the established relationship between the Client and the Insurance broker: consultation and information on buying an insurance policy or financial product and during the validity period, assistance and consultation in the event of a claim.

The personal data may also be used to send information by mail or email on the products and services offered by the Insurance broker, during the policy period of the purchased service(s) and/or product(s) and after it, except if the Client marks box “I do not consent” in “Information and Offers” in this form.

Likewise, the Client consents that the data may be ceded to Insurance Entities for the following purposes: making offers and projects, issuing insurance contracts and managing their payment policy, subjective modification by the Insurer after the policy has expired. Except if, the Client marks the box “I do not consent” in “Policy Expiration” in this form.

Likewise, the Client is informed of their right, in respect to the personal data supplied to Insurance Entities, to access, correct, cancel and oppose it at any moment. This can be done in writing to the person responsible of the file at Mesag. S.L. Correduría de Seguros, located in Av. Puerto 189, 3 A1, 46022, Valencia, and by attaching a copy of the DNI, address and a signature.

In order to accomplish what is outlined in LOPD and in the Royal Legislative Decree 1720/2007 of 21 December, which approves the Security Measures for the Authorized Files which contain Personal Information, the broker has adopted necessary technological and organizational measures to guarantee the safety of the personal data provided by the Client, and to avoid its modification, loss or non-authorized usage.

DESIGNATION: By signing this form I declare to have read the information above and I appoint the Insurance Broker as the Intermediary of my policies, enabling them to make, modify and rescind the policies that are in my name and in the name of companies that I represent, in accordance with the needs that arise.

I hereby AUTHORIZE MESAG SEGUROS SL, with identification number B96894860, as of today and with an indefinite duration, provided that there is a commercial relationship, to draw on my bank account, with an account number specified in this authorization, services outlined in the bill, collective membership, derived costs and the requested insurance policy of the amount specified in this form, in accordance with Law on Payment Services 16/2009.