Registrar Details

Registrar Name (formal name of Registrar's legal entity)

Registrar Trading Name (if different to above, the trading name of the registrar)

URL (the registrar's web address)

Public Contact Details
(contact details about a Registrar that will be displayed in the public WHOIS queries)

Name (Registrar Trading Name)

Address Line 1

Address Line 2 (optional)

City

Province (optional)

Country Code

Post Code (optional)

Phone: CountryCode-AreaCode-LocalNumber

Fax: CountryCode-AreaCode-LocalNumber (optional)

E-mail Address

Contact Details
(contact details used by NZRS to communicate with the Registrar)

Name of main person dealing with the SRS

Address Line 1

Address Line 2 (optional)

City

Province (optional)

Country Code

Post Code (optional)

Phone: CountryCode-AreaCode-LocalNumber

Fax: CountryCode-AreaCode-LocalNumber (optional)

E-mail Address (s) more than one may be supplied for receiving Registry news, technical updates, outage info etc

Default Technical Contact Details
(Note: these contact details will be used as a default if domain name technical contact details are not supplied )

Name (Main person dealing with the SRS)

Address Line 1

Address Line 2 (optional)

City

Province (optional)

Country Code

Post Code (optional)

Phone: CountryCode-AreaCode-LocalNumber

Fax: CountryCode-AreaCode-LocalNumber (optional)

E-mail Address

Billing Contact Details
(Contact details used by the NZRS for invoicing the Registrar. Please complete if different to SRS contact details above)

Name

Address Line 1

Address Line 2 (optional)

City

Province (optional)

Country Code

Post Code (optional)

Phone: CountryCode-AreaCode-LocalNumber

Fax: CountryCode-AreaCode-LocalNumber (optional)

E-mail Address (s)

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

Yes / No

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

Yes / No

I have attached NZ bank account details and authorisation form for a direct debit

Yes / No

For Foreign Registrars: a foreign Authorised Registrar can choose between the Direct Debit of a NZ Bank Account option or a nominated NZRS bank account that NZRS operate on your behalf:

I would like details on the nominated NZRS bank account that NZRS operate.

Yes / No

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

Yes / No

I have attached two signed copies of the .nz Connection agreement

Yes / No

A soft copy of the Registrar Public Encryption Key has been sent to support@nzrs.net.nz as an attachment.

Yes / No

I have read and understood the NZRS Technical Statement.

Yes / No

([insert name of person signing]

(Date)

(Position)