Reporting Portal

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

List the NAIC Carrier Group, and/or individual company identification numbers and company names that have authorized you to report statistical data on their behalf to the MWUA.

Company Entry

Company 1

Group NAIC *

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

Group Name *

Company NAIC *

Company Name *

FEIN *

Primary Statistical Contact

Floor, suite, building, etc.

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.