



APNIC-002.0                                                  APNIC Staff
Request Form                                               December 1993


                Asia Pacific Network Information Center
                    Network Address Application Form

                        Issued:  January 1, 1994
                        Expires: July 1, 1994


     Th form appended to this cover letter will allow you to request a
globally unique IP network number from the APNIC or your national or
local Internet Registry.  Your national or local registry may have a
form similar to this one in the local language.  If such a form exists,
you should use it in preference to this form if at all possible.

     It is assumed you have read and understood APNIC-001, the document
explaining the fields and formats for the application form below.  If
you have not read APNIC-001, please do so now before continuing with
this form.  APNIC-001 can be retrieved via anonymous FTP from apnic.net
as /apnic/docs/english/apnic-001.txt.

     The actual application form is broken up into five sections, not
all of which you are required to fill in:

        Part A - Administrative details
        Part B - Contact details
        Part C - Technical details
        Part D - Network details
        Part E - Proxy details

     Parts A and C are always required for an application.  Part B is
only required if one or both of the contacts do not already exist in the
APNIC database.  Part D is only required if you are applying for more
than 2 class C addresses (or a class B address) and Part E is only
necessary if you are requesting an address for another organization.

     The preferred method of application submission is via electronic
mail.  You may submit your application to your national or local regis-
try, or if no such organization exists, please return this completed
template to hostmaster@apnic.net.

     If you do not have access to electronic mail, or your electronic
mail system is not connected to the Internet, then the next best method
of application submission is via fax.  If you are also unable to fax
your request, we request you submit your application via postal mail.
If you submit your request via fax or postal mail, please ensure that



APNIC Staff                                                     [Page 1]

APNIC-002.0                                                December 1993


your application is typed in English and the characters are easily dis-
tinguishable.  Please mark your fax or postal mail to the attention of
"APNIC NETWORK REQUEST".  The APNIC can be reached at the following
(temporary) address and telephone/fax numbers:


                 Asia Pacific Network Information Center
                c/o University of Toyko, Computer Center
                       2-11-16 Yayoi, Bunkyo-ku
                           Tokyo 113 JAPAN
               Tel: +81-3-5684-7747  Fax: +81-3-5684-7256


Please allow up to 7 working days for your request to be processed.  If
you have any questions about any aspect of this form, please contact
your nearest Internet Registry or the APNIC.  Note that it is not neces-
sary to include this cover letter when submitting your application.


                                                    Yours sincerely,



                                                    hostmaster@apnic.net


                  Asia Pacific Network Information Center
c/o Univerity of Tokyo, Computer Center      Email: hostmaster@apnic.net
    2-11-16 Yayoi, Bunkyo-ku                        Tel: +81-3-5684-7747
    Tokyo 113 JAPAN       (Temporary address)       Fax: +81-3-5684-7256





















APNIC Staff                                                     [Page 2]

APNIC-002.0                                                December 1993


Part A - Administrative Details

     The information supplied for this section together with the
assigned network numbers will be entered into a database of Asia Pacific
network address(es) and their contact information which is accessible by
the whole Internet community.

descr:

descr:


country:


admin-c:


tech-c:
































APNIC Staff                                                     [Page 3]

APNIC-002.0                                                December 1993


Part B - Contact Details

     This information supplied in this section will provide contact
information to allow the APNIC or other organizations to contact the
administrative or technical contacts.  All individuals mentioned in Part
A need to be entered into the APNIC database via this section.  If an
individual mentioned above already exists in the APNIC database (i.e.
has an APNIC nic-handle), you are not required to resubmit this informa-
tion.  The information provide here will be entered into a database of
Asia Pacific region network contacts which is accessible by the whole
Internet community.

name:


address:

address:


phone:


fax-no:


e-mail:


nic-hdl:





















APNIC Staff                                                     [Page 4]

APNIC-002.0                                                December 1993


Part C - Technical Details

     Information supplied below helps us to evaluate and process your
request.  It will be kept in strict CONFIDENCE and is for internal use
only.  It will NOT be entered into the APNIC Network Management Data-
base.

form:           APNIC-002.0 (1/1/94 - 7/1/94)


request-type:


machine-0:


machine-1:


machine-2:


subnet-0:


subnet-1:


subnet-2:


inet-connect:


exist-IP-net:


net-country:













APNIC Staff                                                     [Page 5]

APNIC-002.0                                                December 1993


Part D - Network Details

     If you are applying for more than 2 Class C network addresses then
on this page please submit a description of your network plans.  Please
continue on a separate page if necessary.

Current network layout:





















Future network plans (next 2 years):






















APNIC Staff                                                     [Page 6]

APNIC-002.0                                                December 1993


Part E - Proxy Details

     Complete the section below ONLY IF you are making an application on
behalf of another organization.

This application is made by

name:


descr:

descr:


country:


phone:


fax-no:


e-mail:


On behalf of the following organization

name:


descr:

descr:


country:


phone:


fax-no:


e-mail:




APNIC Staff                                                     [Page 7]



