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Get Massachusetts Property Insurance Underwriting Association Consumer Guide Form

ASSISTANCE PLAN TWO CENTER PLAZA, BOSTON, MA 02108-1904 PHONE: (617) 723-3800 UND INITIALS DATE (800) 392-6108 (MA ONLY) FAX: (800) 932-6717 VISIT OUR WEB SITE - www.mpiua.com THIS APPLICATION IS NOT A BINDER OF INSURANCE APPROVED REJECTED PLEASE TYPE OR PRINT CLEARLY. PROVIDE ALL THE INFORMATION REQUESTED. SEE ACORD 61 MA FOR THE INSPECTION NOTICE, CREDIT REPORTING NOTICE AND INSTRUCTIONS TO COMPLETE APPLICATION POLICY # IMPORTANT: SIGN HERE IF REQUESTING CONSIDERATION BY MASS.

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