Access request to the Group Administrator's Centre

Note: Only the Policyholder or the Super Administrator, or both, 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 use.
  • If you are having problems to print the form, you must use another browser (Chrome or Firefox).  

Fields marked with * are mandatory.