Privacy Web Form

Park Avenue Securities is a participant of the Protocol for Broker Recruiting (“Protocol”) which permits your financial advisor to retain your name, address, phone number, email address, and account title if your advisor joins another firm that has also signed the Protocol and continues to service your account. If you would like to opt-out from your financial advisor retaining your contact information, please complete this form. If you have more than one account or relationship with us, please specify the accounts to which you would like us to apply your privacy choices.

I am a

First Name

Enter the first name of the data subject

Last Name

Enter the last name of the data subject

Address

City

Zip Code

State

Country

Enter country of residence.

Enter email for correspondence with the data request.

Phone Number

Social Security Number (Last 4 Digits Only)

Park Avenue Securities Account Number 1

Please only enter your Park Avenue Securities account number. Your account number can be found on your statement, or by contacting your Financial Advisor or our customer service desk at (888) 600-4667 or by email at PASCS@glic.com

Park Avenue Securities Account Number 2

Park Avenue Securities Account Number 3