Sun Life EDI and Integration Form

This form is used to capture any data connection requests for this employer.

1. Employer Name *This question is required.

2. What is the Advisor's contact information for this employer? *This question is required.

Advisor Name

Advisor Email

3. What is the Data Discrepancy contact information for this employer? *This question is required.This is the contact (broker or employer) who will be responsible for resolving discrepancies between Maxwell and the carriers' system(s)

Data Discrepancy Contact Name

Data Discrepancy Contact Email

4. How many active lives does this Employer have? *This question is required.

Sun Life EDI and Integration Form

Basic Employer Information