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Resources Return Form

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# Resource return Form #

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Document Name: afrinic-returc

Date: Jan. 2005

Ver: 1.01

# DETAILS ABOUT YOUR ORGANISATION

#

org: *if applicable

org_name:

contact person:

e-mail:

phone:

country:

website:

# DETAILS ABOUT THE RESOURCES TO BE RETURNED:

#

address_space: # Duplicate where necessar

AS_Number: # Duplicate where necessary

# DETAILS ABOUT CURRENT RESOURCES

where did you get this address space from:

When did you get this address space?

Do you still have other resource allocated

by AfriNIC: Yes/No

Space in use:

Additional information:

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