Disclosure Reset Form

	Massachusetts General Laws Ch. 175, §19X Disclosure Reset Passwords


	Please provide the following information about your policy to verify your account to reset your password.
	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.