Thank you for doing business with Utica National Insurance Group. Your policy(s) was issued on an estimated exposure basis. At the end of each policy term, your policy is subject to a final audit. To make the appropriate adjustments to your policy(s), we need you to complete this form.
Please complete this reporting within TWENTY business days from policy expiration. This will ensure that any adjustment is processed accurately and in a timely fashion. Failure to cooperate may result in applying a non-compliance charge up to two times the premium, as specified in the policy or cancellation.