European IP Address Space Request Form 1 March 1996 ____________________________________________________________ European IP Address Space Request Form RIPE NCC 1 March 1996 Expiry Date: 31 May 1996 To whom it may concern, Before you complete this form, please ensure that you read the information outlined in the "Supporting Notes for European IP Address Space Requests" (document ripe-128) carefully before submitting your application for an IP number. The form will be accepted by local Internet Registries across Europe. Please note that statements made in this form can be used in consideration of future requests that are made. Once completed, please return this document to your local Internet Registry. IMPORTANT NOTE: This document is valid until May 31t, 1996. An updated document will be sent out when due. Part A - Administrative Details The information supplied for this section together with the assigned network numbers will be entered into a database of European network numbers and their contact information which is accessible by the whole Internet community. NETWORK TEMPLATE netname: descr: descr: country: admin-c: tech-c: changed: source: RIPE ____________________________________________________________ ripe-129.txt Expires 31-May-96 Page 1 European IP Address Space Request Form 1 March 1996 ____________________________________________________________ PERSON TEMPLATE person: address: address: address: address: phone: fax-no: e-mail: nic-hdl: changed: source: RIPE PERSON TEMPLATE person: address: address: address: address: phone: fax-no: e-mail: nic-hdl: changed: source: RIPE Please note that you will have to include a separate person template for each person referenced as a contact unless the information about the person in the RIPE database is still valid. The information given above will be entered into a database of European network contacts which is accessible by the whole Internet community. Please refer to the RIPE NCC leaflet on the "Network Management Database" for details on how to query the database. ____________________________________________________________ ripe-129.txt Expires 31-May-96 Page 2 European IP Address Space Request Form 1 March 1996 ____________________________________________________________ Part B - Technical Details Information supplied below helps us to evaluate and process your request. It will be kept in strict CONFIDENCE and is for internal use only. It will NOT be entered into the RIPE Network Management Database. TECHNICAL TEMPLATE request-type: machine-0: machine-1: machine-2: subnet-0: subnet-1: subnet-2: inet-connect: country-net: ____________________________________________________________ ripe-129.txt Expires 31-May-96 Page 3 European IP Address Space Request Form 1 March 1996 ____________________________________________________________ Part C - Network Details Please submit a description of your network layout, includ- ing all devices which will require unique IP addresses. The more detail you supply in this section, the easier it will be to evaluate your case and allocate you the requested IP numbers. Current network layout: Network deployment plans: (year 1 & year 2) (Please ensure you have read the "Additional Hints" section in the "Supporting Notes" on organisations requesting addi- tional class C numbers or class B numbers). Please describe your planned allocation of the requested address space. ____________________________________________________________ ripe-129.txt Expires 31-May-96 Page 4 European IP Address Space Request Form 1 March 1996 ____________________________________________________________ Addressing plan: Please give an overview of your addressing plan. Number of hosts per subnet for Subnet Subnet mask Max Now Year-1 Year-2 Remarks -------------------------------------------------------------------- Totals: Part D - Enterprise Allocation History If any part of your organisation (including subsidiaries and the parent company) has received address space in the past, please specify the actual network numbers allocated. Please also give details, if any applications for additional address space have been rejected in the past. Finally please include a brief overview of your company structure, includ- ing details of the parent company, subsidiaries and contact persons. Please continue on a separate sheet if necessary. ____________________________________________________________ ripe-129.txt Expires 31-May-96 Page 5 European IP Address Space Request Form 1 March 1996 ____________________________________________________________ Part E - Contact Details Complete the section below *ONLY IF* you are making an application on behalf of another organisation. This application is made by: name: organisation: country: phone: fax-no: e-mail: On behalf of the following organisation: name: organisation: country: phone: fax-no: e-mail: Part F - Non European Requests If your request is for the Asian-Pacific Region you should sent your application form to: AP-NIC, c/o United Nations University, 3-70 Jingumae 5-chome, Shibuya-ku, Shibuya-ku, Tokyo 150, Japan, Telephone: +81-3-5276-3973, Fax: +81-3-5276-6239, Email: The InterNIC serves as default for the rest of the world. Their contact details are: Network Solutions Inc, Attention: InterNIC Registration Service, 505 Huntmar Park Drive, Hern- don, VA 22070, USA. Telephone: +1 703 742 4777, fax: +1 703 742 4811. Email: ____________________________________________________________ ripe-129.txt Expires 31-May-96 Page 6