New York Information Network (NYIN)

Primary and Secondary Intelligence/Information Officers Designation Form

Pursuant to Insurance Circular Letters No. 5 (2019) and Circular Letter No. 6 (2019), please complete all fields in the form below to enter or update your company's Designated Primary and Secondary Intelligence/Information Officers data in the New York Information Network (NYIN).

Mandatory Fields are indicated with *

 

I. Company Information

*NAIC No:   
  If your company does not have an NAIC number assigned, please enter 00000.

*Name of Insurer:   

*Insurer Type:   

*Address 1:   

 Address 2:   

*City:   

*State:   

*Zip:   

*Country:   

 

II. Company CEO Information

*CEO Last Name:   

*CEO First Name:   

 CEO Middle Initial:   

*CEO Phone No.:   ()

*CEO email address:   

*Verify CEO email address:   

 

III. Primary Intelligence/Information Officer

*Last Name:   

*First Name:   

 Middle Initial:

*Title:   

*Work Phone No.:   ()

 Extension:   

*Fax No.:   ()

 Cell No.:   ()

*1st email address:   

*Verify email address:   

 Backup email address:   

 

IV. Secondary Intelligence/Information Officer:

*Last Name:   

*First Name:   

 Middle Initial:   

*Title:   

*Work Phone No.:   (   )

 Extension:   

*Fax No.:   (   )

 Cell No.:   (    )

*1st email address:   

*Verify email address:   

 Backup email address:

 

Select "Submit Form" to transmit. To clear all fields, select "Reset Form".

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After submitting this e-form, you will be re-directed to the NYIN Home Page and receive a confirmation email from the Department.