Register for someone else

If you are registering someone who is a current employee of the organization, please complete the request form below.

Important Notice: If your organization uses spam filtering software, please allow incoming messages from ColonialLife.com. If you have any questions, please contact your systems administrator.

Who are you registering?

First name

Last name

Phone number

Extension number

Email address

Access level

Please also provide your details

First name

Last name

Email address

Access levels explained

Primary Plan Administrator

The Primary Plan Administrator has the same level of access as the Standard Plan Administrator access level with the additional ability to add, remove, and edit access for other users that have access to the portal.

Standard Plan Administrator

The Standard Plan Administrator access level allows the user to edit employees, edit invoices, make payments and send files.

View Only

View Only Access allows the user to view employees, view invoices and send files but they cannot edit employees, edit invoices, or make payments.

Are they replacing someone else?

Yes No

Who is being replaced?

First name

Last name

Email address (if known)

Note: User access can be viewed on Colonial Life for Clients under Manage My Account. To make edits to users' access, you will need to have Primary Plan Administrator access.

What Billing Control Number(s) do they need access to? Add up to 10 BCNs.

Note: Your BCN can be found on your invoice.

BCNs should be formatted with no special characters. For example: "E1234567". Starting with the letter E followed by seven digits with no spaces or hyphens.

Tax ID numbers should be formatted with no hyphens.

Billing control number 1

EIN/tax ID number

Billing zip code

Billing control number 2

EIN/tax ID number

Billing zip code

Billing control number 3

EIN/tax ID number

Billing zip code

Billing control number 4

EIN/tax ID number

Billing zip code

Billing control number 5

EIN/tax ID number

Billing zip code

Billing control number 6

EIN/tax ID number

Billing zip code

Billing control number 7

EIN/tax ID number

Billing zip code

Billing control number 8

EIN/tax ID number

Billing zip code

Billing control number 9

EIN/tax ID number

BIlling zip code

Billing control number 10

EIN/tax ID number

BIlling zip code

I certify that all of the above information is true, and I authorize the user listed above to be given access to Colonial Life for Clients with the access level that I have selected above. I understand that I am responsible for notifying Colonial Life immediately in the event that any user given access to Colonial Life for Clients changes jobs or leaves the company. I also understand that, until I notify you, the user will continue to have access to this website. Upon receipt of notification, Account Services will immediately revoke access.

I certify that the above information is true

Is the person you wish to register not currently an employee of the organization or a third-party administrator? If so, please download and fill out the following form and email it to service@coloniallife.com.

Download the General service provider form for Colonial Life, or if you are a resident of NY, download the General service provider form for Paul Revere (NY).