IMO Remote Server - Request Form for Login Data by mallorycarlson

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									IMO Remote Server - Request Form for Login Data
(Members of IMO Country Offices may request the login data collectively)


1. Name, First Name:    þÿ


For IMO Country Offices only:

2. Name, First Name:    þÿ


3. Name, First Name:    þÿ


4. Name, First Name:    þÿ


5. Name, First Name:    þÿ


6. Name, First Name:    þÿ


7. Name, First Name:    þÿ


8. Name, First Name:    þÿ


9. Name, First Name:    þÿ


Organisation:           þÿ


Address, Country:       þÿ


Phone Number:           þÿ


Fax number:             þÿ


Email address:          þÿ

What is the login needed for (please tick one):
           Employee(s) of an IMO Country Office
           Inspector of IMO
           Public Authority needing access to IMO’s Quality Management Handbook
           Other, please specify:
            þÿ

Contact Person at IMO Group Office, Switzerland:      þÿ


Contact Person at IMO Country Office:                 þÿ

I/we herewith declare that I/we am/are aware that the login data to the IMO Remote Server are to be treated
strictly confidential and must not be forwarded to any third party.


Place, Date: þÿ                                       1. Signature: __________________________________

For IMO Country Offices only:


2. Signature: __________________________________      3. Signature: __________________________________


4. Signature: __________________________________      5. Signature: __________________________________


6. Signature: __________________________________      7. Signature: __________________________________


8. Signature: __________________________________      9. Signature: __________________________________
Please print the filled out form and sign it and return the scanned form to: it@imo.ch

								
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