Use this form to apply to become an Insurer UMG Primary Administrator. Once you have completed the form,
press the "Submit" button to apply. You will receive a link to a printable version of the form, along with further instructions.
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Request New UMG/Carrier Group
Request New UMG Primary Admin User for Existing UMG
Update Contact Info for Existing UMG Primary Admin User
Desired User ID:
NOTE: Creating a new Carrier is not necessary if you are requesting a new UMG/Carrier Group in order to move an existing Carrier into it.
Existing UMG Name:
Carrier Group Name:
Carrier Group Number (not NAIC Number):
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