APPLICATION FOR CONNECTION TO .NZ REGISTRY

Please complete this form then print, sign, and return to the Registry Manager, at:

Registry Manager

NZ Registry Services

PO Box 24361

Wellington

New Zealand

1,

Organisations Name:                                                                       

Address:                                                                                         

Telephone:                                                                                     

Fax:                                                                                               

2,

Application Contact Name:                                                                     

Email Address:                                                                                       

Contact Telephone:                                                                                

3,

Technical Contact Name:                                                                       

Email Address:                                                                                      

Contact Telephone:                                                                               

4,

Is this application for an Authorised Registrar connection?

4a,

I affirm that Domain Name Commission has approved the organisation as an Authorised Registrar.

4b,

I understand that the Registry Manager will require demonstration of ability to use the registry system.

4c,

I have attached information regarding our NZ bank account details.

5,

Is this application for a provisional connection?

5a,

I understand that approval of this provisional access application only allows access for my organisation to the registry systems for testing and orientation purposes.

5b,

I have submitted a completed AOR1 to the Domain Name Commission.

5c,

I have submitted the non-refundable Authorisation application fee to the Domain Name Commission.

6,

I agree to report any material issue, technical or non technical, in a timely manner to the Registry Manager with regard to the registry system.

(signed)

(Date)

(name)