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Domestic Violence/Abuse Confidentiality Request

Protocols | Request Form

 

Confidentiality Request for Victims of Domestic Violence and Other Endangered Individuals

Thank you for submitting your request.
Your request will be processed within 3 business days.

If you are a victim of domestic violence or other abuse, you may request that MetLife send communications of claim-related or policy-related information to you by alternative means or at alternative locations. If so requested, we will keep confidential all claim or billing information relating specifically to you to the extent permitted by law, including your name, address, any services received, and the name and address of the provider of any services (such as your doctor or dentist). Your request will remain in effect until you revoke it in writing.

Please complete this form by providing as much information as you can so that we can properly identify you in our systems. * Required Fields
Individual Requesting Confidentiality I am a victim of domestic violence or other abuse, and I request confidentiality.
Invalid Zip Code
Invalid Date
Alternative Contact Information(Please select one)
Invalid Zip Code
Protective Order
Product Information
(Separated by commas if there are multiple)
Joint Brokerage Accounts: If you own a joint brokerage account, the broker-dealer is unable to keep your information secure from the other joint owner. As such, the broker-dealer will NOT change the address on its records if you have a joint brokerage account.
Primary Insured Person For group coverage, including Group Life, Dental, and Vision, please provide:
Invalid Date
Parents, Guardians, or Legal Representatives
Parent or Guardian
Must contain numbers (XXX-XXX-XXXX)
Invalid Email
For Guardians, please send guardianship documentation as soon as possible to MetLife’s Compliance Department at AskCompliance@metlife.com Please send Power of Attorney documentation as soon as possible to MetLife’s Compliance Department at AskCompliance@metlife.com
Notes:
  1. This request for confidentiality applies only to certain MetLife-issued products. If you have insurance, investment or advisory products issued by another company, you must contact that company directly to request confidential treatment.
  2. Joint Brokerage Accounts: If you own a joint brokerage account, the broker-dealer is unable to keep your information secure from the other joint owner. As such, the broker-dealer will NOT change the address on its records if you have a joint brokerage account.
  3. Online Service Accounts: If you do business online, we recommend that you change your password and all other security settings.
  4. If you need to revoke this request, please call 1-800-MET-LIFE (1-800-638-5433).
  5. MetLife may take up to three business days to implement this request.
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