IPv4 First Allocation Request Form

#######################################
# IPv4 First Allocation Request Form
#######################################


Document Name: afrinic-ipv4-first-alloc
Date: Jan. 2005
Ver: 1.01


# MEMBER INFORMATION:
# Please enter an org_handle and the legal organisation name.
# In case you do not have an organisation handle but if you are still
# in the new-membership application process, please indicate below
# the ticket number of the relevant membership application requests.

org_id:
org_name:
new_member_ticket_number: (If you have'nt received yet your org_id)


# UPSTREAM ISPs:
#
# List ISPs providing your connectivity in the format below.
# Duplicate the entry if necessary.
#
# ISP Block (a.b.c.d/e)


# RETURNING ADDRESS SPACE:
#
# If any address space is being returned, please list
# the prefixes below and return date(duplicate this line
# if necessary):
#
# format: a.b.c.d/e yyyymmdd

address-space-returned:


# REQUESTED PREFIX SIZE:
#
# What size of initial allocation would you require?

prefix_requested:

# NETNAME
#
# Which network name (net_name) will be used when registering
#this network in the AfriNIC WHOIS?

netname:

# NETWORK DESCRIPTION:
#
# Network Description - Any additional Info that will help
# Hostmaster to understand your addressing plan. This would
# quicken the process within which request is evaluated.


# ADDITIONAL COMMENTS:
#
# If you have any other comments that you would like to put
# to the hostmaster's attention, please include them below:


#######################################################
# LIR First PA Assignment Request Form
#######################################################
#
# PLEASE REPEAT THE FIRST THREE SECTIONS OF BELOW IF
# REQUESTING FOR MORE THAN ONE ORGANISATION.
#

# END-USER ORGANISATION:
#
# Organisation to which the requested address space
# will be assigned. If it is for your own infrastructure
# please use your organisation name.


organisation:
country:
website:


# ADDRESSING PLAN:
#
# Addressing Plan: (List in CIDR Notation):
# __________________________________________________
# size Immediate 1yr Purpose
# --------------------------------------------------
# /24 /24 /24 Dynalic Dialup - Flic en Flac
# /23 /24 /23 Dynamic Dialup - Port Louis
# /24 /24 /24 Point-2-Point LS
# totals: /23,/24 /22
# __________________________________________________
#


# NETNAME:
#
# Which netname will be used when registering this assignment in
# the AfriNIC WHOIS?

netname:

# NOTE: after approval of the Assignment request, you should enter it
# yourself in the WHOIS DB by filling the inetnum form which can be
# found at: http://


#########################################################
# AfriNIC Database Templates for IPv4 First Allocation
#
# Please fill in the necessary details below so that the
# Hostmaster can create an inetnum object after allocating
# a block to you. If it is necessary to create a maintainer object
# please include that template too. Please duplicate the person
# Template for several contacts.

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########### END OF REQUEST ##################################


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