AKIVS
 
Insurance Company Registration Form

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

General Information
Insurance Company Name: NAIC Number:
Street Address: City:
State: Zip Code:
 
Alaska Policies
                     Does your company currently write automobile insurance in AK?
            Does your company issue ONLY commercial automobile policies in AK?
                                Does your company cover less than 500 vehicles in AK? 
 
Main/Functional Contact Details
First Name: Last Name:
Middle Initial: Phone Number:
Fax Number: Email Address:
Do you want to add a technical contact?
Do you want to add a compliance contact?
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: Secret Question Answer:
 

 
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