Request for access

Please fill in this form to create a profile for your company.

I wish to have access to *

the Corporate Customer Area

the GMP Portal for pension solutions

Further information on the Corporate Customer Area or the GMP Portal

Company data

I am *

an employee of the below company

a partner with a mandate for the below company (broker, consultancy firm, trustee, etc.)

Company name *

Client No. (can be found on your Groupe Mutuel contract) *

Authorised person

(i) If you need to authorise more than one person, please submit this form again.

Title *

Mrs

First name *

Name *

Adress

Date of birth (dd.mm.yyyy) *

Email *

Position *

Language *

Connection via *

E-mail

SMS

If SMS text message, please enter your telephone No.

I wish to have access to the following contracts (Your contract number can be found on your insurance policy) *

Type of user

Role to be assigned *

User (enter details of a report)

Super User (enter details of a report, complete a report and enter salary details, view payments and contracts)

Administrator (enter details of a report, complete a report and enter salary details, confirm a report, view payments and contracts, set up the account)

Customer Areas are platforms of Groupe Mutuel. By making a request to create an account, I agree to: *

the general terms and conditions of use

and : *

the privacy policy of Groupe Mutuel

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