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#######################################
# IPv6 First Allocation Request Form  #
#######################################

Document Name: 	afrinic-ipv6-first-alloc
Date: 		Jan. 2005
Ver: 		1.01

# 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 have'nt rceived yet your org_id)


# 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:

# CURRENT IPv6 ALLOCATION(s)
#
# List all your current IPv6 allocations. Include address and prefix.
# Duplicate line where necessary.

Existing_IPv6_allocation:


# SERVICES THAT WILL BE OFFERED:
#
# Describe what IPv6 services you expect to offer. If available,
# provide the URL that details the services.




# Provide a description of your organization's IPv6 network 
# topology using the following format. Include both internal and
# end-user site usage for /48 or larger assignments.
# ----------------------------------------------------------
#     Site/         Length of         
# Customer Name   Address Prefix   Description/Comments
# ----------------------------------------------------------



# Detail your organization's IPv6 requirements for the 1 year
#
#       Immediate       1year             Purpose

Totals:


# JUSTIFICATION IF REQUIREMENT IS GREATER THAN /32.
#
# Minimum allocation size is /32. Organizations may qualify for an 
# initial allocation greater than /32 by submitting documentation 
# that reasonably justifies the request.


# PREFIX REQUESTED
#

Initial_Prefix_Length_Requested:


#NETNAME
#
# provide a network name for this allocation

netname:


# AADIITIONAL INFORMATION:
#
# Please add any supplementary information that you think 
# may facilitate the evaluation of this request below.



# AFRINIC DATABASE TEMPLATE(S)
#
# Please fill in the necessary details below so that the 
# Hostmaster can create an inet6num object after allocating 
# a block to you. If it is necessary to create a maintainer object 
# please include that template too. 


inet6num:  
netname:   
descr:       Provider Local Registry
descr:       *specify the name of the LIR's organisation* 
country:     *specify the country code*
org:         *specify org ID here*
admin-c:     *insert nic-handle of administrative contact*
tech-c:      *insert nic-handle of technical contact*
status:      ALLOCATED-BY-RIR
mnt-by:      AFRINIC-MNT 
mnt-lower:   *specify mntner name here*
notify:      *specify e-mail address*
changed:     hostmaster@afrinic.net
source:      AFRINIC


mntner:      *specify mntner name here*
descr:       *descriptive comments*
admin-c:     *insert nic-handle of administrative contact*
tech-c:      *insert nic-handle of technical contact*
upd-to:      *specify e-mail address*
mnt-nfy:     *specify e-mail address*
auth:        *specify authorisation*
mnt-by:      *specify mntner name here*
changed:     hostmaster@afrinic.net
source:      AFRINIC

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