Insurance Company Registration Form

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

General Information
Insurance Company Name:   NAIC Number:    
Street Address:   City:  
State: Zip Code:    
Illinois Policies
                       Does your company currently write automobile insurance in IL?
              Does your company issue ONLY commercial automobile policies in IL?
                                   Does your company cover less than 1000 vehicles in IL? 
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)
(8-20 characters including one number,
one upper case, one lower case, and one special character)
Secret Question:   Secret Question Answer:    

This website is operated exclusively by MV Solutions, Inc. and authorized by the Illinois Secretary of State to verify compliance with Illinois mandatory insurance requirements.

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