I. General Information

#[ OVERVIEW OF ORGANISATION TEMPLATE ]#

Please fill in a description of your company and what the addresses will be used for.
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#[ REQUESTER TEMPLATE ]#

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Requester Name
RequesterOrganisation
RequesterCountry
Requester Telephone Number
Fax Number
Email Address

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#[ USER TEMPLATE ]#

Please fill in contact information about your organisation.
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Contact Name
UserOrganisation
UserCountry
User Telephone Number
Fax Number
Email Address

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#[ CURRENT ADDRESS SPACE USAGE TEMPLATE ]#

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				Addresses Used
	Prefix	Subnet Mask	Size	Current	One Year	Two Year	Description
Please use this section if you find it easier to just paste in your current usage. It will also be put in the 141 form and syntax checked.

II. The Request

#[ REQUEST OVERVIEW TEMPLATE ]#

Please answer the following questions about your request.
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When will you connect to the Internet and to whom ?
What country is the headquarters located ?
Have you considered using private addresses ?	YesNo
Has the request been refused in the past ?	YesNo
If yes, why, and how has the situation changed ?
Are you requesting Provider Independent addresses ?	YesNo
Are you returning addresses ?	YesNo
If yes, please fill in what range will be returned on what dates to what provider ?

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#[ ADDRESSING PLAN TEMPLATE ]#

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	Relative Prefix	Subnet Mask	Size	Hosts Immediate	Hosts Year One	Hosts Year Two	Description
	0.0.0.0
Please use this section if you find it easier to just paste in your addressing plan. It will also be put in the 141 form and syntax checked.

III. Database Information

#[ NETWORK TEMPLATE ]#

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Net Name
Description
Country
Administrative Contact
Technical Contact
Notify
Mnt-By

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#[ PERSON TEMPLATE ]#

Please fill in one template for each person that is not yet registered in the RIPE database and does not have a nic handle.
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	Nic-Hdl	Nic Handles will not be looked up
	Name
	Address
	Email	Phone     Fax
	Notify	Mnt-by     Changed

IV. Optional Information

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Any additional information may be entered here. It will not be checked by the robot.