Request UCAA Id and Password Form

UCAA Id and Password Form

If you are a new user of the UCAA Company Licensing system and would like to obtain an id & password, please fill out the form below and click on the Submit Button.
* Required fields
First Name: *
Last Name: *
Position/Title: *
If Consultant, Firm Name:
Phone Number (999) 999-9999 : *	ext.
Your Email Address: *
Company Information
NAIC Cocode: *
Company Name: *
Company Street Address:*
City: *
State: *
ZipCode: *
Corporate Secretary or General Counsel
Name: *
Email Address: *
Phone Number (999) 999-9999 : *	ext.

Valid UCAA Roles: * For an explanation of roles click link

Display Role Information

UCAA_COMPANY_ANALYST_EXAMINER

UCAA_COMPANY_MANAGER