Clarip DSR Submission Form

Is this request being made for yourself or someone else?

For Myself

For someone else (I am an authorized agent)

Please provide us with the following information associated with your Lemme account or that you have provided to us:

Please provide us with the following information related to the individual you are submitting a request on behalf of:

Authorized Agent Information

Proof of Authorization

We require that you provide evidence that you have been authorized to submit this request on the behalf of this individual. If a response is required, it will be sent to the customer's email on file, unless there is a legal instrument that instructs us otherwise.

Please identify your relationship with us

Country/Region of Residency

State of residence

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By clicking submit, I declare under penalty of perjury, that the information I have provided in this form is true and correct, and that I am the person whose personal information is the subject of the request, or that I am authorized to make a request on behalf of such person.

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