Create Authorised Representative Account

Your Details

1. Email *
2. Password
   (Case sensitive. Minimum 5 characters) *
3. Retype Password *
4. Title *
5. Forename *
6. Surname *
7. Job Title
8. Company Name *
9. Supplier Type
10. Address 1 *
11. Address 2
12. Town/City *
13. County
14. Post code *
15. Country
16. Telephone *
17. Fax

Manufacturer Details

1. Provide details of one manufacturer you are designated to represent. If you represent more than one manufacturer you will be able to add further manufacturers to the system once your account has been activated.

2. Contact name *
3. Company name *
4. Address 1 *
5. Address 2
6. Town/City *
7. County
8. Post Code *
9. Country *
   United Kingdom GB Unknown ZZ Afghanistan AF Albania AL Algeria DZ American Samoa AS Andorra AD Angola AO Anguilla AI Antarctica AQ Antigua and Barbuda AG Argentina AR Armenia AM Aruba AW Australia AU Austria AT Azerbaijan AZ Bahamas BS Bahrain BH Bangladesh BD Barbados BB Belarus BY Belgium BE Belize BZ Benin BJ Bermuda BM Bhutan BT Bolivia BO Bosnia and Herzegovina BA Botswana BW Bouvet Island BV Brazil BR British Indian Ocean Territory IO British Virgin Islands VG Brunei Darussalam BN Bulgaria BG Burkina Faso BF Burundi BI Cambodia KH Cameroon CM Canada CA Cape Verde CV Cayman Islands KY Central African Republic CF Chad TD Chile CL China CN Christmas Island CX Cocos(Keeling)Islands CC Colombia CO Comoros KM Congo CG Cook Islands CK Costa Rica CR Croatia HR Cuba CU Cyprus CY Czech Republic CZ Democratic People's Republic of Korea KP Denmark DK Djibouti DJ Dominica DM Dominican Republic DO East Timor TP Ecuador EC Egypt EG El Salvador SV Equatorial Guinea GQ Eritrea ER Estonia EE Ethiopia ET Falkland Islands (Malvinas) FK Faroe Islands FO Federated States of Micronesia FM Fiji FJ Finland FI France FR French Guiana GF French Polynesia PF French Southern Territories TF Gabon GA Gambia GM Georgia GE Germany DE Ghana GH Gibraltar GI Greece GR Greenland GL Grenada GD Guadeloupe GP Guam GU Guatemala GT Guinea GN Guinea-Bissau GW Guyana GY Haiti HT Heard and Mc Donald Islands HM Holy See (Vatican City State) VA Honduras HN Hong-Kong HK Hungary HU Iceland IS India IN Indonesia ID Iraq IQ Ireland IE Islamic Republic of Iran IR Israel IL Italy IT Ivory Coast CI Jamaica JM Japan JP Jordan JO Kazakstan KZ Kenya KE Kiribati KI Kuwait KW Kyrgyzstan KG Latvia LV Lebanon LB Lesotho LS Liberia LR Libyan Arab Jamahiriya LY Liechtenstein LI Lithuania LT Luxembourg LU Macau MO Madagascar MG Malawi MW Malaysia MY Maldives MV Mali ML Malta MT Marshall Islands MH Martinique MQ Mauritania MR Mauritius MU Mayotte YT Mexico MX Monaco MC Mongolia MN Montenegro ME Montserrat MS Morocco MA Mozambique MZ Myanmar MM Namibia NA Nauru NR Nepal NP Netherlands NL Netherlands Antilles AN New Caledonia NC New Zealand NZ Nicaragua NI Niger NE Nigeria NG Niue NU Norfolk Island NF Northern Mariana Islands MP Norway NO Oman OM Pakistan PK Palau PW Panama PA Papua New Guinea PG Paraguay PY People's Democratic Republic of Laos LA Peru PE Philippines PH Pitcairn PN Poland PL Portugal PT Puerto Rico PR Qatar QA Republic of Korea KR Republic of Moldova MD Reunion RE Romania RO Russian Federation RU Rwanda RW Saint Helena SH Saint Kitts and Nevis KN Saint Lucia LC Saint Pierre and Miquelon PM Saint Vincent and The Grenadines VC Samoa WS San Marino SM Sao Tome and Principe ST Saudi Arabia SA Senegal SN Serbia RS Seychelles SC Sierra Leone SL Singapore SG Slovakia SK Slovenia SI Solomon Islands SB Somalia SO South Africa ZA South Georgia and the South Sandwich Isl GS Spain ES Sri Lanka LK Sudan SD Suriname SR Svalbard and Jan Mayen SJ Swaziland SZ Sweden SE Switzerland CH Syrian Arab Republic SY Taiwan TW Tajikistan TJ Thailand TH The Democratic Republic of the Congo CD The Former Yugoslav Republic of Macedoni MK Togo TG Tokelau TK Tonga TO Trinidad and Tobago TT Tunisia TN Turkey TR Turkmenistan TM Turks and Caicos Islands TC Tuvalu TV Uganda UG Ukraine UA United Arab Emirates AE United Republic of Tanzania TZ United States US United States Minor Outlying Islands UM Uruguay UY Uzbekistan UZ Vanuatu VU Venezuela VE Viet Nam VN Virgin Islands, U.S. VI Wallis and Futuna WF West Bank and Gaza Strip (provisional co PS Western Sahara EH Yemen YE Yugoslavia YU Zambia ZM Zimbabwe ZW
10. Telephone *
11. Fax

Supporting Documentation

Please provide a copy of the letter of designation from the manufacturer who’s details you have provided above if you do not already hold a registration with MHRA for this manufacturer.

MDD Letter of designation Letter of designation

IVD Letter of designation IVD Letter of designation

If you are replacing an Authorised Representative, attach a copy of their dedesignation letter from the manufacturer if available

MDD Manufacturer cancellation of service Manufacturer cancellation of service

IVD Manufacturer cancellation of service IVD Manufacturer cancellation of service

1.  
   Check this box to agree to the Terms and Conditions *

   Yes