Insurance Confidentiality Agreement

INSURANCE CONFIDENTIALITY AGREEMENT

This Insurance Confidentiality Agreement (the Agreement) is entered into between:

Disclosing Party:    Tax/ID (if applicable):

Receiving Party:    Relationship:

Insured and Policy Information

Date of Birth:    Policy Number:

Policy Type:    Coverage Amount:

Deductible:    Premium:

Policy Period From:   To:

Confidential Information

For purposes of this Agreement, Confidential Information means all non-public information disclosed by the Disclosing Party or relating to the Insured or the Policy, whether disclosed orally, visually or in writing, including but not limited to policy terms, claims history, underwriting files, loss runs, medical records, financial information, beneficiary designations, and other proprietary data.

Exclusions

Confidential Information does not include information that:

Is or becomes publicly available through no wrongful act of the Receiving Party;

Was lawfully in the Receiving Party's possession prior to disclosure by the Disclosing Party as shown by written records;

Is received from a third party without breach of any obligation of confidentiality;

Is required to be disclosed by applicable law, regulation, or valid order of a court or governmental authority (subject to the notice obligations below).

Obligations of Receiving Party

The Receiving Party shall:

(a) hold all Confidential Information in strict confidence and use at least the same degree of care it uses to protect its own confidential information, but in no event less than reasonable care;

(b) use Confidential Information solely for the Permitted Purpose of underwriting, claims handling, reinsurance, auditing, or other insurance-related evaluation expressly authorized in writing by the Disclosing Party;

(c) restrict disclosure of Confidential Information to employees, agents or advisors who have a strict need to know and who are bound by confidentiality obligations no less protective than those set forth herein; and

(d) promptly notify the Disclosing Party in writing upon discovery of any unauthorized use or disclosure and cooperate to mitigate any harm.

Return or Destruction of Materials

Upon written request or upon termination of any business relationship between the parties, the Receiving Party shall, at the Disclosing Party's election, promptly return or destroy all materials, copies and extracts containing Confidential Information and certify in writing that such return or destruction has been completed, except to the extent retention is required by law or internal record retention policies.

Certification of destruction to be provided: I certify that retained copies will be restricted and maintained in accordance with this Agreement.

Term; Survival

This Agreement shall commence on the Effective Date and continue for a period of years, unless earlier terminated by mutual written agreement. Notwithstanding termination, the Receiving Party's obligations with respect to Confidential Information shall survive for a period of years from the date of disclosure, or for as long as such information remains a trade secret under applicable law, whichever is longer.

Remedies and Indemnity

The Receiving Party acknowledges that unauthorized disclosure or use of Confidential Information will cause irreparable harm to the Disclosing Party for which monetary damages may be inadequate. The Disclosing Party shall be entitled to seek injunctive relief and any other remedies available at law or in equity. The Receiving Party shall indemnify and hold harmless the Disclosing Party from losses resulting from the Receiving Party's breach of this Agreement caused by its negligence or willful misconduct.

No Grant of Rights; No Waiver

Nothing in this Agreement grants any license in, or right to use, the Confidential Information except as expressly provided herein. The failure or delay of either party to enforce any provision shall not be construed as a waiver of that provision or any other rights.

Governing Law; Jurisdiction

This Agreement shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that state for resolution of disputes.

Notices

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses below by certified mail, overnight courier, or hand delivery and shall be deemed effective upon receipt.

Beneficiary Information (If Confidential Information Relates to Beneficiaries)

Relationship:    Percentage:

Certification

The Receiving Party certifies that it has read and understands this Agreement, that it will treat all Confidential Information in accordance with the terms set forth herein, and that it will not disclose or use Confidential Information except as permitted by this Agreement.

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