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###############################################  
# Autonomous System (AS) Number Request Form #  
############################################### 

Document Name: afrinic-as
Date: Jan. 2005 Version: 1.02
# 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 haven't received an org_id yet)
# REQUESTOR DETAILS #
# Please enter the details of the person in your organisation # who is submitting this request. Also provide the technical # contact of this AS number. You must provide a nic-hdl. # To create a nic-hdl, please create a person object in # AfriNIC Whois DB (for details please go to: # http://www.afrinic.net/db/nic-hdl-howto.htm
name: phone: fax-no: e-mail: admin-c: tech-c: website:
# 4-BYTE OR 2-BYTE AS NUMBER ? # # Please indicate what length (in bytes) of AS Number # you are requesting. (example, 2-byte or 4-byte). Please note # that 4-byte ASNs are a new standard and that some equipment # may need a firmware upgrade in order to support 4-byte ASNs.
# ADDRESS SPACE TO BE ANNOUNCED # # Please list the address prefixes that will originate from # the new AS Number. Please specify each prefix in a # separate "prefix" field below. Repeat "prefix" if necessary.
prefix:
# # PENDING FIRST ALLOCATION TICKETS/REQUESTS: # # If the organisation wishing to be multi-homed does not # have address space yet but has a pending request sent to # <hostmaster@afrinic.net>, please include the ticket number # of the request below.

pending_ticket_ID:
# AS NUMBERS AND CONTACT EMAIL ADDRESSES OF UPSTREAM PROVIDERS
#
# Provide the AS numbers and e-mail contact addresses of your upstream provider or peers.
AS_Number: contact e-mail:
AS_Number: contact e-mail:
# DATABASE TEMPLATE # # Please include database template(s) here so that the # Hostmaster can register the assignment in the AFRINIC # Database upon approval. If it is necessary to create a maintainer
# object, please include that template too.
aut-num:       ASNEW as-name:       *specify a name for the AS* descr:         *specify the name of the organisation* org:           *specify org ID here* admin-c:       *insert nic-handle of administrative contact* tech-c:        *insert nic-handle of technical contact* mnt-by:        AFRINIC-HM-MNT changed:       hostmaster@afrinic.net source:        AFRINIC
# ADDITIONAL COMMENTS: # # Please add any supplementary information that you think # may facilitate the evaluation of this request below.
######################## END OF TEMPLATE ##########################
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