This form is issued by Domain Name Commission Limited (DNC or Domain Name Commission) on behalf of InternetNZ, Internet New Zealand Incorporated.

APPLICATION FOR MODERATED 2LD

1. Applicant Details

Name:

Name of organisation (if applicable):

Trading Name (if applicable):

Address:

Email address:

Phone number (business):

Phone number (mobile):

Phone number (after hours):

2. The 2LD extension applied for:

3. Define the community of interest for the new 2LD:

4. Explain how your proposed 2LD meets the criteria set out in clauses 5.4 and 6.2 of the 2LD policy:

5. Why does this second level domain have to be moderated?

Please return this form along with the payment set out in Schedule 2, to the following address:

Domain Name Commission Limited
PO Box 11-881
Wellington 6142
NEW ZEALAND