(a) The identity of the individual who is the subject of the personal information.
(b) A general description of the categories of personal information to be disclosed.
(c) General descriptions of the parties to whom the licensee discloses personal information, the purpose of the disclosure and how the personal information may be used.
(d) The signature of the individual who is the subject of the personal information or the individual who is legally empowered to grant authority and the date signed.
(e) Notice of the length of time for which the authorization is valid, that the individual may revoke the authorization at any time and the procedure for making a revocation.
(2) An authorization is not valid for more than 24 months.
(3) An individual who is the subject of personal information may revoke an authorization provided pursuant to this section at any time, subject to the rights of any individual who acted in reliance on the authorization prior to notice of the revocation.
(4) A licensee must retain the authorization of an individual or a copy thereof in the record of the individual who is the subject of the personal information.
(5) A disclosure authorization obtained by an insurer, insurance producer or insurance-support organization from an individual prior to January 1, 1983, is considered to be in compliance with this section. [1981 c.649 §8; 2001 c.377 §27; 2003 c.87 §12; 2003 c.364 §157]