|
|
<<< Back to Bulletins
|
|
|
|
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. |
|
|
<<< Exit
|
MAIPF Home |
|
|
Michigan Automobile Insurance
Placement Facility | 17456 Laurel Park Drive N, Suite 130E | Livonia, MI 48152-3981
| 734.464.1100 |
|
|
|
|
|
|
|
|