GWRS Canada Life - New User Page


One Source Registration

Canada Life Insurance Company of America (“CLICA”) has been merged with Great-West Life & Annuity Insurance Company (“Great-West”) effective September 30, 2009. Any contract of insurance that was issued and administered by CLICA has been assumed by operation of law by Great-West Life & Annuity Insurance Company as of September 30, 2009, provided that the contract was in-force on this date.
Change the appropriate information on the provided form and then click on the SAVE CHANGES button at the bottom of the page when you are done. An asterisk () indicates REQUIRED* information.
User Registration

PERSONAL INFORMATION

Select a User Name*

(Any combinations of letters or numbers. Must be 6 or more characters long.)

First Name*

Last Name*

Company Name

Mailing Address *

City*, State *

ZIP Code *

Country *

Telephone Number

E-Mail Address *

Relationship to Canada Life:

Producer or Agency Code:

Request Access to Annuity Online. By selecting this box, I also accept and agree to the terms and conditions for use of Canada Life's Annuity Online. To read and review the terms and conditions click here.

List all producer SS#s and/or
Tax Id #s applicable:

Request Access to Life Online. By selecting this box, I also accept and agree to the terms and conditions for use of Canada Life's Life Online. To read and review the terms and conditions click here.

List all producer SS#s and/or
Tax Id #s applicable:

* I currently have and will continue to maintain a valid resident life insurance license.
* I currently carry and will continue to maintain "Errors and Omissions" insurance coverage.

Mailings

Agree to Periodic Postal Mailings
Agree to Periodic e-Mail

PASSWORD

New Password *

, retype *:
(Password cannot be blank. The password must be 6 to 19 characters long, and contain at least 1 number and 1 letter.)

Password Hint