Use this form to apply to become an Insurer UMG Primary Administrator for a new UMG. 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.
Return to the CDX home page
Request New Carrier UMG (User Management Group)
NOTE: The ability to change the current Primary Administrator's contact information or assign a new Primary Administrator to an existing UMG is available to logged-in users via the Admin menu item.
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.
Carrier UMG Name:
Carrier Group Name:
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