PORTAL / CCPA-CPRA / ccpa-request

lock AES-256 ENCRYPTED FORM lock CAL. CIV. CODE § 1798.100 COMPLIANT lock 3-POINT IDENTITY VERIFICATION MANDATED verified 3-POINT IDENTITY

State of California Official Rights

California Consumer Privacy Act (CCPA) Request Form

Under the California Consumer Privacy Act (CCPA) and the California Privacy Rights Act (CPRA), California residents have the right to request access to, correction of, or deletion of their personal information collected by Nexa Optimum Solutions.

Notice: This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.

1 Step 1 of 5: Request Details

20% Completed

Section A: Request Details

Define representation status and statutory scope of inquiry under Cal. Civ. Code § 1798.100

Required

Field 1: Are you submitting this request for yourself or as an Authorized Agent? *

I am submitting this request for myself.California resident self-represented inquiry I am an Authorized Agent submitting on behalf of a California resident.open_in_new Activates Step 3: Authorized Agent Uploads

Field 2: Request Type *

Right to Know (Categories)What categories of personal information Nexa has collected, the sources, and the purposes for collecting it. Right to Know (Specific Pieces)Triggers Step 4: Penalty of Perjury DeclarationThe specific pieces of personal information Nexa has collected about me. Right to DeleteRequest deletion of my personal information, subject to statutory exemptions. Right to CorrectRequest correction of inaccurate personal information.

Step 1 of 5 • Next: 3-Point Identity Verification

Section B: Consumer Identity Verification

verified 3-Point Match

Facilitates the mandated 3-point statutory identity verification protocol

Cal. Civ. Code § 1798.140

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MANDATED 3-POINT IDENTITY VERIFICATION PROTOCOL 4 REQUIRED FIELDS (*)

Under California Civil Code § 1798.140 & 11 CCR § 7002, Nexa Optimum Solutions verifies consumer identity to a reasonable or high degree of certainty by matching at least three authoritative data points: First & Last Name, Date of Birth, and Last 4 Digits of SSN against internal debt servicing vaults.

First Name * Point 1 Match

Middle Initial Optional

Last Name * Point 1 Match

Date of Birth (MM/DD/YYYY) * Point 2 Match

Last 4 Digits of SSN * Point 3 Match

Four numeric digits only

Nexa Account or Ref # Optional

Found on formal notices

Section C: Consumer Contact Information & California Residency Match

Address of residence where formal acknowledgment records will be dispatched

RESIDENCY MATCH

Email Address *

Phone Number *

Street Address *

Apt/Suite Optional

City *

State *

Zip Code (5 Digits) *

Step 2 of 5 • Next: Authorized Agent Verification

Section D: Authorized Agent Information & Mandated Proof

Mandated legal identity validation & proof of representation records

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Authorized Agent Notice

If submitting on behalf of a California consumer, you must provide your legal contact information and upload valid documentation establishing legal authority to act under California regulations. If self-filing, you may bypass required uploads using the toggle below.

Skip I Am Submitting for Myself (Skip this step) Submitting for yourself? You may skip this agent verification step and continue straight to Attestation.

Agent / Entity Name *

Agent Phone Number *

Agent Email Address *

Agent Verification Uploads (Accepted formats: PDF, JPG, PNG) MAX: 10MB EACH

assignment_ind Proof of Authorization *

Please upload a valid Power of Attorney OR a written, signed permission document from the consumer.

cloud_upload Click or drag document to attach PDF, JPG, or PNG

badge Proof of Agent Identity *

Please upload a copy of a valid Government-Issued ID for the agent (or California Secretary of State entity registration if a business).

cloud_upload Click or drag credential file PDF, JPG, or PNG

Step 3 of 5 • Next: Penalty of Perjury Declaration

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Section E: Penalty of Perjury Statutory Declaration

CAL. CIV. CODE § 1798.140 / 11 CCR § 7002

Mandatory statutory affirmation for disclosure of consumer file records

shield MANDATORY FOR SPECIFIC PIECES REQUESTS

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STATE OF CALIFORNIA • OFFICIAL STATUTORY ATTESTATION

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"Under penalty of perjury under the laws of the State of California, I declare and affirm that I am the consumer whose personal information is the subject of this request (or an Authorized Agent legally authorized to act on their behalf), and that the information provided in this form is true, correct, and complete."

By checking this box, I declare under penalty of perjury under the laws of the State of California that I am the consumer whose personal information is the subject of this request (or an Authorized Agent legally authorized to act on their behalf), and the information provided in this form is true and accurate. *

draw TYPE FULL LEGAL NAME TO SIGN ELECTRONICALLY * DIGITAL SIGNATURE

Acts as the legally binding electronic signature under Cal. Civ. Code § 1633.1 (Uniform Electronic Transactions Act)

event DATE OF DECLARATION Synced to institutional compliance server clock

Step 4 of 5 • Next: Final Review & Submission

Step 5: Verification & Final Review

Confirm CCPA submission details before final cryptographic dispatch

Ready to Submit

Request Scope

Right to Know (Categories)

Filer: California Resident (Self)

3-Point Match Credentials

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Contact & Delivery

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Legal Attestation

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SHA-256: 8f4e•••9a01 (UTC-08:00)

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Statutory Verification Guarantee Cal. Civ. Code § 1798.140 Your encrypted request package will be timestamped and dispatched straight into Nexa Optimum Solutions' compliance clearinghouse. Written acknowledgement will be dispatched within 10 statutory days.

Step 5 of 5 • Submit encrypted request

check STEP 5 OF 5: SUBMISSION COMPLETE

100% Completed

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STATE OF CALIFORNIA • STATUTORY FILING SUCCESSFUL

Request Received

Thank you. Your CCPA request has been successfully submitted to the Nexa Optimum Solutions Compliance Department.

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What happens next?

We will review your submission and email you an official acknowledgement within 10 days. If we require additional information to verify your identity or process your request, we will contact you at the email address provided. We aim to fulfill all verifiable requests within 45 days.

support_agent If you have any immediate questions, please contact us at 877-501-0303 or privacy@nexaoptimum.com.

fact_check All submissions logged and cross-referenced with statutory timelines under Cal. Civ. Code § 1798.100 et seq.

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