CTIVS System
New Users! Click here to register and get an account with the CTIVS website.
Insurance Company Registration Form

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

General Information
Company Name:   NAIC Number:    
Street Address:   City:  
State: Zip Code:    
                       Does your company currently write automobile insurance in CT?
              Does your company issue ONLY commercial automobile policies in CT?
                                  Does your company cover less than 500 vehicles in CT? 
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)
Secret Question:   Secret Question Answer:    

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