MIFDRA Contact Form

Please complete the following and click the submit button to send to CAOM.  The person filling out this form will act as a contact between his/her employer and CAOM for purposes of coordinating and accomplishing timesly and accurate submissions of financial data for all carriers included within the indicated group.

The contact person does not have to be responsible for filling out financial calls, but will be responsible for seeing that calls are submitted on a timely basis, and securing responses to questions posed by CAOM with respect to their group's financial calls.  Only one contact person form needs to be submitted per carrier group.  Your carrier's MIFDRA user name and password can be used by more than one person submitting financial calls from your company.

* Required