Use the form below to create a new account.
A separate Member Company account is required for each NAIC Code as only one Form MB0116 submission is allowed per account.
Please email
accounting@mbpia.com
if you are having technical issues and are unable to create an account.
Passwords are required to be a minimum of 5 characters in length.
Registration Form
User name
Password
Confirm password
NAIC Code:
Group Number:
Company Name
Phone
First Name
Last Name
Street
City
State
Zip Code
Email address
Create your own Security Question
Security Answer