Request for access to the Group Administrator's Centre

Note: Only the Policyholder and/or the Super Administrator can fill out this form.

  • Fill out the form and click on the Next button. You can then revise the information on the form.
  • Then print the form and send it to us.
  • If you are having problems printing this form, try using another browser  (ex. : Chrome or Firefox).

Fields marked with * are mandatory.