MAH - New Registration · Customer Self-Service

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A MAH Agreement must be signed by the MAH and IMVO. The MAH agreement will be prepopulated with the details entered on this form and will automatically be sent to the MAH’s nominated Authorised Signatory for electronic signature.

Details of MAH

Primary Contact for MAH

This will be the person who is responsible for the day to day communications with IMVO regarding this registration.

Primary Contact Name

Job Title

Primary Contact Email

Primary Contact Country Code

Primary Contact Phone Number

General

Name of MAH (full legal name)

Type of Company

(e.g. 'Limited Company')

Company Number (or equivalent)

Country in which MAH is established

Official Address

Note: The official address will be used in the MAH agreement (e.g. registered office address)

Official Address Line 1

Official Address Line 2

Official Address City/Town

Official Address County/State

Official Address Country

Official Address ZIP/Eircode/Postal Code

Is Business Address the same as Official Address?

NoYes

Business Address Line 1

Business Address Line 2

Business Address City/Town

Business Address County/State

Business Address Country

Business Address ZIP/Eircode/Postal Code