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IPv4 sub-allocation Request Form

######################################
# IPv4 sub-allocation Request Form #
######################################

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

# MEMBER INFORMATION
#
# Please enter LIRs org_id and legal organisation name

org_id:
org_name:

# REQUESTOR DETAILS:
#
# Please enter the details of the person at your LIR who is
# submitting this request.

name:
phone:
fax-no:
e-mail:
nic-hdl:


# END-USER ORGANISATION:
#
# Organisation to which the space will be sub-alocated to.

organisation:
contact person:
e-mail:
phone:
country:
website:

# SUB-ALLOCATED PREFIX
#
# Provide the network being sub-allocated in CIDR notation
# for example: A.B.C.D/E

Network/Prefix:

# NETNAME:
#
# Provide a network name to identify the assigned prefix:

netname:

# ADDRESSING PLAN
#
# end-user 1-year addressing plan
#
# Addressing Plan: (List in CIDR Notation):
# __________________________________________________
# Immediate 0.5yr 1yr Purpose
# --------------------------------------------------

Totals:


# JUSTIFICATION:
#
# Explain why the site needs a sub-allocation for its network.

# ADDITIONAL COMMENTS:
#
# Please add any supplementary information that you think
# may facilitate the evaluation of this request below.

######################### END ###################################

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