FORM DNA1

This form is issued by the office of the Domain Name Commissioner on behalf of InternetNZ, the Internet Society of New Zealand Incorporated.

ALLOCATION FORM AND DECLARATION

Where domain names were registered on behalf of registrants by accredited .nz providers.

Part 1

Request and Indemnity

TO:	The Internet Society of New Zealand, Inc ("InternetNZ") Domainz Limited (t/a Domainz)
1.	(name of organisation) requests that the Domain Name Commissioner, on behalf of InternetNZ, transfer the attached names from Domainz to its Registrar Identification on the Shared Registry System.
2.	(name of organisation) indemnifies Domainz and InternetNZ in the event of a registrant making any claim against Domainz or InternetNZ as a result of, or in any way arising out of, the assignment of any one or more of the domain names on the attached list to it.
	duly authorised signatory
	Date

Part 2

Declaration

I , (full name) of (organisation) solemnly and sincerely declare that:

1.	(name of organisation) fits the description of an accredited .nz provider as defined in clause 2.4.1 of the Domain Name Allocation Process Policy.
2.	The attached list of domain names is a true and accurate list of domain names under its management.
3.	This declaration is made under the Oaths and Declarations Act 1957.

DECLARED at this day of 2003.

Duly authorised signatory

Solicitor of the Hight Court of New Zealand