RIIVS
 

Insurance Company Registration Form

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

General Information
Insurance Company Name: NAIC Number:
Street Address: City:
State: Zip Code:
 
Rhode Island Policies
                     Does your company currently write automobile insurance in RI?
            Does your company issue ONLY commercial automobile policies in RI?
        Does your company cover less than 50 private passenger vehicles in RI? 
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:
(6-16 characters including one number,
and one alphabetic character)
Secret Question: Answer to Secret Question:
 

 
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