Required Privacy Consent |
Your prior consent is required before I can begin assisting you with your application.
When you contact me to use my services you are agreeing to the following.
I give consent to give Sheron E Sidbury a Licensed Health Insurance Agent in the states of Maryland and Virginia permission to gather any private information necessary to assist me with analyzing and enrolling in a Health Insurance Plan through The Health Insurance Marketplace or any other insurance plan. By signing this consent form, I acknowledge that the agent Sheron E Sidbury has informed me the individual, employer, or employee of the functions and responsibilities that apply to her role an agent or broker working with the Federal Health Insurance Marketplace and Maryland Health Connection. Your consent indicates that the agent or broker Sheron E Sidbury has permission to 1) conduct an online person search, 2) assist with completing an eligibility application, 3) assist with plan selection and enrollment, and 4) assist with ongoing account/enrollment maintenance. I understand that during the enrollment process I will need to supply Personally Identifiable Information. This consent begins today and has no expiration date unless withdrawn by either party in writing via postal mail; by email, by fax, by text message or you cease being a client. All personal information will remain confidential. By submitting this privacy consent you agree that you have read and understand my Privacy Policy.
To end your business relationship with me please contact me using the information below. This notice is required by the Federally Facilitated Health Insurance Marketplace and is required by me for consumers who I assist in all Health Insurance Marketplaces.
Sheron E Sidbury
P.O. Box 6817
Alexandria, VA 22306
Phone: (703) 568-0654
Fax: (703) 997-8522
Email: sheron@sesinsureme.com
Website: http://www.sesinsureme.com
I give consent to give Sheron E Sidbury a Licensed Health Insurance Agent in the states of Maryland and Virginia permission to gather any private information necessary to assist me with analyzing and enrolling in a Health Insurance Plan through The Health Insurance Marketplace or any other insurance plan. By signing this consent form, I acknowledge that the agent Sheron E Sidbury has informed me the individual, employer, or employee of the functions and responsibilities that apply to her role an agent or broker working with the Federal Health Insurance Marketplace and Maryland Health Connection. Your consent indicates that the agent or broker Sheron E Sidbury has permission to 1) conduct an online person search, 2) assist with completing an eligibility application, 3) assist with plan selection and enrollment, and 4) assist with ongoing account/enrollment maintenance. I understand that during the enrollment process I will need to supply Personally Identifiable Information. This consent begins today and has no expiration date unless withdrawn by either party in writing via postal mail; by email, by fax, by text message or you cease being a client. All personal information will remain confidential. By submitting this privacy consent you agree that you have read and understand my Privacy Policy.
To end your business relationship with me please contact me using the information below. This notice is required by the Federally Facilitated Health Insurance Marketplace and is required by me for consumers who I assist in all Health Insurance Marketplaces.
Sheron E Sidbury
P.O. Box 6817
Alexandria, VA 22306
Phone: (703) 568-0654
Fax: (703) 997-8522
Email: sheron@sesinsureme.com
Website: http://www.sesinsureme.com