FORM DNA2

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

FORM OF ALLOCATION - DNA2

Where the domain name registration was facilitated through unaccredited agents, or through accredited providers who did not bill their customers directly

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.	The attached list is a true and accurate list of: (a) domain names; (b) name holder IDs; (c) the date and time if signing of the approved Terms and Conditions Agreement by each registrant; who wish it to become their registrar under the Shared Registry System.
2.	It has only contacted those registrants with whom it has an existing business relationship (as defined in the Domain Name Allocation Process Policy) as at October 2002.
3.	It included the following statement in its communications to all such registrants. You are under no obligation to sign this Agreement. If you decide not to sign, there will be no change to your current services, or terms and conditions of those services, provided by us.
4.	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