Notification
By selecting the “I understand and agree to the Electronic Signature Conditions and the Terms and Conditions of the electronic delivery.” button, you are signing this registration form electronically, thereby providing your electronic signature. You agree your electronic signature is the legal equivalent of your manual signature and that your electronic signature constitutes your acceptance and agreement as if this registration form was signed by you in writing. Furthermore, you consent to be legally bound by all statements made by you in this registration form for insurance. You also agree that no certification authority or other third party verification is necessary to validate your electronic signature and that lack of any such certification or verification will not in any way affect the enforceability of your electronic signature.
In order for CO-ORDINATED BENEFIT PLANS, LLC (hereinafter referred to as “we” or “us) to send you your insurance-related documents and communications electronically, to the extent permitted by law, you must first consent to us doing so. The insurance-related documents and communications you will receive in electronic format will have the same contractual force and effect as insurance-related documents and communications sent to you in paper format. We reserve the right, in our sole discretion, to provide any insurance-related documents and communications to you in paper form instead, and / or to discontinue this service or modify the terms of this agreement at our option. If we do, we will provide you with reasonable notice and you will have the option to withdraw your consent at that time.
YOUR CONSENT: By indicating I ACCEPT, you:
YOUR RIGHT TO WITHDRAW YOUR CONSENT: If you consented to receiving insurance-related documents and communications electronically, you may withdraw your consent at any time. After we process your withdrawal of consent, you will begin receiving your insurance documents and correspondence in paper form. Contact us at 1- 800-753-1000, option 6, or via email to info@cbpinsure.com to request to withdraw your consent.
YOUR RIGHT TO RECEIVE PAPER COPIES: You have the right to obtain paper copies of your insurance-related documents and communications at any time. Contact us at 1-800-753-1000, option 6, or via email to info@cbpinsure.com to request paper copies.
YOUR OBLIGATIONS: If you consent to receive insurance documents and correspondence electronically, you are responsible for (i) providing Nationwide with an updated and active e-mail address through the contact listed below. You should be diligent in updating your email address with us in the event that your address changes; (ii) maintaining or having access to a computer capable of connecting to the internet; (iii) maintaining internet access; (iv) installing software on your personal computer to receive, access, store, and print in accordance with the Technical Requirements listed below; (v) an email service account that allows you to read, write, and send email; (vi) an active email address.
UPDATING YOUR CONTACT INFORMATION: It is your responsibility to provide us with a current, valid email address and to promptly update any changes to this information by contacting us at 1-800-753-1000, option 6, or via email to info@cbpinsure.com.
UNDELIVERABLE AND RETURN EMAILS: Any e-mails returned as undeliverable will result in a suspension of electronic document delivery and a return to paper copies sent via U.S. mail.
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