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 MSRB. 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 MSRB 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.

Alternate Statistical Reporting Contact

Floor, suite, building, etc.

Accounts Payable Contact

Floor, suite, building, etc.