NCIVS
 

Insurance Company Registration Form

Please fill out this form only if your company is licensed to provide automobile liability insurance in the State of North Carolina.

General Information
Insurance Company Name: NAIC Number:
Street Address: City:
State: Zip Code:
 
North Carolina Policies
                     Does your company currently write automobile insurance in NC?
            Does your company issue ONLY commercial automobile policies in NC?
                                   Does your company cover less than 500 vehicles in NC? 
Main/Functional Contact Details
First Name: Last Name:
Middle Initial: Phone Number:
Fax Number: Email Address:
Technical Contact Details
First Name: Last Name:
Middle Initial: Phone Number:
Fax Number: Email Address:
Compliance Contact Details
First Name: Last Name:
Middle Initial: Phone Number:
Fax Number: Email Address:
 
Web Login Information
User Name:
(Same as your Naic No)
 Password:
(8-20 characters including one number,
one upper case, one lower case, and one special character)
Secret Question: Answer to Secret Question:
 

 
  © 2023 MV Solutions, Inc. All rights reserved.