<<< back

8<---------------------------------------------->8

######################################
#  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 ###################################