Insurance Consent Form

I, [primary applicant], give my permission to Federico Cortez / SonFed Insurance Services ("Agent") to serve as my insurance Agent or broker for any and all insurance products I apply for, enroll in, or currently hold through the Agent — including but not limited to health/ACA Marketplace, Medicare, life, auto, homeowners, renters, property, liability, umbrella, and any other insurance product the Agent offers. This authorization covers obtaining coverage, servicing policies, and providing ongoing assistance with my insurance needs. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by phone only for one or more of the following:

1. Obtaining quotes and comparing coverage options from insurance carriers
2. Completing and submitting applications for insurance coverage on my behalf
3. Providing ongoing policy maintenance, endorsements, and enrollment assistance
4. Processing claims and responding to inquiries from my insurance carrier(s) regarding my coverage

I understand that the Agent will not use or share my personally identifiable information (PII) or protected health information (PHI) for any purposes other than those listed above. The Agent will ensure that my PII and PHI is protected when creating, collecting, disclosing, accessing, maintaining, storing, and using my information for the stated purposes.

I understand that I do not have to share additional PII or PHI with my Agent beyond what is required for application, eligibility, and enrollment purposes. I understand that this consent is valid for one (1) year from the date signed, after which it must be renewed annually. I may revoke or modify my consent at any time before expiration by contacting my Agent.

I confirm that the information I provide for entry on my insurance applications will be true to the best of my knowledge.