IMEI Status Change Request Form This form should be used when requesting to add or remove an IMEI from the Iridium Blacklist Register. Date of Request:* Date Format: MM slash DD slash YYYY Partner Name:*Please enter the full company namePartner Account Number:*Please enter the 6 digit Iridium account numberRequest Type:*Add IMEI to Blacklist Register - Equipment LostAdd IMEI to Blacklist Register - Equipment StolenRemove IMEI from Blacklist Register - Equipment RecoveredDocumentation Required in Support of the Blacklist Request:*For LOST equipment: Attach a letter from the subscriber with a verifiable contact (email address/phone number) detailing the circumstance and confirming the equipment has been reported lost. Documentation Required in Support of the Blacklist Request:*For STOLEN equipment: Attach a Police Report confirming the equipment has been reported stolen; or a copy of Insurance Claim/Credit Card chargeback confirming the equipment has been reported stolen; or a letter from the subscriber with a verifiable contact (email address/phone number) detailing the circumstance and confirming the equipment has been reported stolen. Equipment Type:*Iridium ExtremeIridium GO!Iridium 9555Iridium 9505AIridium 9500Iridium OpenportIridium 9523Iridium 9522BIridium 9602Iridium 9603Equipment IMEI (Serial Number):*Terms & Conditions*Blacklisting Iridium-enabled equipment is a serious action. Iridium Satellite LLC is solely reliant on the accuracy of information provided by Service Provider in requesting blacklisting of Iridium-enabled equipment. Therefore, by requesting blacklisting, Service Provider warrants the accuracy of the information and agrees to defend, indemnify, and hold Iridium Satellite LLC harmless from any and all causes of action, claims, liabilities, losses, or damages arising from the blacklisting of the Iridium-enabled equipment or from any errors or omissions in the information provided. Service Provider also represents and warrants that the blacklisting is requested due to lost or stolen equipment and for no other purpose, such as a billing dispute. Further, Service Provider acknowledges that SBD devices once blacklisted require an unlock key to be physically entered into the device in order to un-blacklist the IMEI, this action cannot be carried out on the device remotely. *The Iridium Service Partner is responsible for suspending, deactivating, activating subscriber SIM Card in SPNet Pro. Accept Form completed by:*Name:*Email: *Phone:PhoneThis field is for validation purposes and should be left unchanged.