Authorized Agent Form

Last updated: 2026-10-26

This is the form that gives numbi legal permission to act on your behalf with data brokers. It is a Limited Power of Attorney scoped strictly to privacy requests under the California Consumer Privacy Act (CCPA), California Civil Code §1798.105 et seq., and analogous statutes.

You complete and sign the form digitally inside the numbi app. The text below is identical to what you sign there.

---

Limited Authorized Agent Appointment — Privacy Requests

I, the undersigned ("Consumer"), hereby designate numbi ("Agent") as my Authorized Agent under the California Consumer Privacy Act (CCPA), California Civil Code §1798.105 et seq., and any other state or federal data-protection statute that permits an authorized agent to act on a consumer's behalf, for the limited purposes set out below.

1. Scope of authority

I authorize the Agent to take the following actions on my behalf, and no others, with any business that processes my personal information:

(a) Submit a Request to Delete my personal information. (b) Submit a Request to Know what personal information they have about me. (c) Submit a Request to Correct inaccurate personal information. (d) Submit a Request to Opt Out of the sale or sharing of my personal information. (e) Submit a Request to Limit the Use of my sensitive personal information. (f) Receive and review the responses to those requests. (g) Escalate non-responses or non-compliance, including filing complaints with the California Privacy Protection Agency (CPPA), the California Attorney General, or other competent regulator.

2. Permitted disclosures to brokers

To carry out the requests above, I authorize the Agent to share with each broker:

• My full legal name
• My phone number
• My email address
• My current mailing address (when needed for identity verification)
• This signed Authorized Agent Form
• Any additional identifier reasonably required by a broker's verification process, provided the Agent first determines such disclosure is necessary

The Agent must use my information solely to act on my behalf and may not retain or use it for any other purpose.

3. Term

This appointment is effective from the date of my signature and remains in effect until I revoke it. I may revoke it at any time, with or without reason, by:

• Toggling Settings → Authorized Agent → Revoke in my numbi dashboard, or
• Emailing legal@numbi.app from the email address on my account.

Revocation takes effect immediately for new requests. Requests already in flight will complete unless I specifically request they be withdrawn.

4. What this form does NOT authorize

For the avoidance of doubt, this form does not authorize the Agent to:

• Open or close financial accounts in my name.
• Sign legal documents other than CCPA-format privacy requests on my behalf.
• Enter contracts with third parties on my behalf.
• Make medical, financial, or property decisions for me.
• Communicate with any party other than businesses processing my personal information, except as needed to escalate non-compliance to a regulator.

This is a limited appointment. Any action outside the categories in §1 is unauthorized and void.

5. Verification

I confirm that:

• The information I have provided to the Agent (name, phone, email, address) is true and refers to me.
• I am at least 18 years old.
• I am a California resident, or I am exercising rights under a state/federal statute that recognizes authorized agents.
• I have read this form and understand what I am authorizing.

6. Liability

The Agent agrees to act with reasonable care and to use my information only as described here. The Agent is not liable for a broker's failure to comply with a request — that is the broker's violation, and the Agent will, where permitted, file complaints on my behalf.

7. Governing law

This appointment is governed by the laws of the State of California.

8. Signature

Signed digitally inside the numbi app by:

• Typed full legal name: _(captured at signing time)_
• Email address: _(captured at signing time)_
• Phone number: _(captured at signing time)_
• Date and time: _(captured at signing time)_
• IP address of signer: _(captured at signing time)_

This digital signature constitutes a valid electronic signature under the federal E-SIGN Act (15 U.S.C. §7001 et seq.) and the California Uniform Electronic Transactions Act (Cal. Civ. Code §1633.1 et seq.).

A signed copy of this form is included with each request the Agent files on the Consumer's behalf, so the receiving broker can confirm the appointment.

---

v1.0