Form I – Deployment Confirmation For IBN Assignment For Shared HNI

Step 1 of 3

Form Name *

IMSI Block Number(s) *

Company Assigned to *

Enter Company Name associated with the selected HNI code

Effective Deployment Date *//

Date of deployment

Provide complete billing contact information for annual code holder fee:

Name *

First

Last

Company *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Certification Statement *

By submission of this form via the IMSI Admin website, the submitter certifies the accuracy of the information provided.