Reporting Portal

Are you willing to assume the Carrier Statistical Reporting Portal "Administrator" role. *

In the area below list the companies that you have been authorized by to report statistical data to the MRPIUA. If the company (s) is part of a group indicate the NAIC group number and the group name. For each company include the NAIC number and the Federal Employer Identification Number. Note that the MRPIUA requires separate company filing only, no grouping is allowed.

Company Entry

Company 1

Group NAIC *

If no Group NAIC, put "N/A" in the Group NAIC field.

Company NAIC *

Company Name *

FEIN *

Primary Statistical Contact

Floor, suite, building, etc.

Primary Statistical Contact choose a user name: *

Primary Statistical Contact choose a password: *

Alternate Statistical Reporting Contact

Floor, suite, building, etc.

Residual Market Reporting Officer or Senior Residual Market Manager Contact

Floor, suite, building, etc.

CFO or CEO Contact

Floor, suite, building, etc.