10.07.2015 Views

IESO System Access Request and Identity Management Form

IESO System Access Request and Identity Management Form

IESO System Access Request and Identity Management Form

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<strong>IESO</strong> <strong>System</strong> <strong>Access</strong> & <strong>Identity</strong> <strong>Management</strong> – (<strong>Form</strong> 1276)USERID_______________Part 2: Market Participant <strong>and</strong> User InformationMP NameMP ID NumberMP Short NameMailing Address – We will mail your access information to this addressStreet AddressCity/TownProvince/StatePostal/Zip CodeCountry<strong>Request</strong>or’s Email AddressIf this request involves an Individual User Account please supply the user information hereLast NameFirst NameBusiness PhoneFax NumberPositionBusiness E-mailIf this request involves an API Account please supply the Custodian information hereCustodian’s Last NameCustodian’s First NameBusiness PhoneFax NumberPositionBusiness E-mailFOR <strong>IESO</strong> USE ONLY:Individual Account User ID:PKI User ID:Digital Certificate Serial # Replaces Serial #API Account User ID:PKI User ID:Digital Certificate Serial # Replaces Serial #MPRO Reference #Part 3: Change User Information (indicate changes to information foran existing user or the custodian of an API)Existing USERIDNew Information: (include only the information you are changing)User’s Last NameCustodian’s Last NameBusiness PhonePositionStreet AddressCity/TownPostal/Zip CodeUser’s First NameCustodian’s First NameFax NumberBusiness E-mailProvince/StateCountryIMO-FORM-1276 v.18.0 1REV 09-0312 Confidential Page 2

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