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5/18/2012  
  Ballot for Bulletin 168  

Election of MAIPF Board of Governors for 2012

2012 Vote Weights (PDF) | Vote Weights (interactive)  | Ballot/Proxy (paper ballot)
 Online Voting Deadline is March 23, 2012.

Member Company:  
NAIC#:  
# of Votes:  

Complete any blank fields.  If information is incorrect, please update our records.
Name:  
Company Name:  
Title:  
Address  
City, State, Zip Code:         
Telephone Number:   xxx-xxx-xxxx       
  Fax:   xxx-xxx-xxxx  
Email Address:     
Any change in ownership or status?    
Completed By:              
 
  IMPORTANT!  Please Verify:

Please record our company weighted vote as follows: 
 
     
Before submitting your vote, enter text to match the image:
   


Submit one ballot for each company.



Be sure to Reset Form before voting
for your next company.


.

If you have any problems with this form, please call 734.464.1100 x 222 or send an email message.
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Michigan Automobile Insurance Placement Facility | 17456 Laurel Park Drive N, Suite 130E |  Livonia, MI 48152-3981 |  734.464.1100