FORM NMD1

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