If
you are an Industry User and would like to obtain an id &
password for access to the On-Line Fraud Reporting System, or modify
an existing id please fill out the form below and click submit to
forward your information to the NAIC Help Desk. If you are requesting an
ID from somebody other than yourself please fill out this form, and click on
the button below to expand the form to send us your information so the
help desk can contact you directly. |
The asterisk * denotes required fields.
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Current User ID (if applicable): |
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First Name: |
* |
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Last Name: |
* |
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Position/Title |
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Company's Name: |
* |
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Company's Street Address: |
* |
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City: |
* |
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State: |
* |
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ZipCode: |
* |
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Phone Number: |
* |
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-
ext.
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Email Address: |
* |
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Company's Cocodes: |
* |
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