Disclosure Registration Form

	Massachusetts General Laws Ch. 175, §19X Disclosure Registration

	Please provide the following information about your policy to verify you are a policy holder with The Andover Companies whose property is located in Massachusetts. This registration will create a system account and allow you to login and view the MGL Ch. 175, §19X disclosure form.
	Policy Number (7 or 8 digits):
	Policyholder Last Name:
	Policyholder Zipcode (first 5):
	Property Address Digits:
	Property Zipcode (first 5):
	New Password:
	Verify Password:
		Passwords must be at least eight characters long and contain at least one number.


		Problems registering an account? Call our toll-free number at 1 (800) 225-0770.