This form is issued by Domain Name Commission Limited (DNC or Domain Name Commission) on behalf of Internet New Zealand Incorporated (InternetNZ).
APPLICATION FOR PRE-REGISTRATION FOR REGISTRANT INFO SERVICE SEARCHES FOR DRS COMPLAINT ASSISTANCE
Please complete this form electronically, then print, sign, and return to The Domain Name Commission, at:
Domain Name Commission Limited
P O Box 11881
Or email to firstname.lastname@example.org
1. Name of Organisation:
2. Trading Name (if applicable):
3. Name of contact person:
4. Names and details of employees if seeking to pre-register more than one person :
Complete this section if you are requesting information on behalf of an individual:
6. Date of birth
All applicants to complete the following:
9. Phone (day):
10. Phone (mobile):
11. Phone (after hours):
13. Email address:
14. Evidence provided in support of the applicant's role in DRS cases and why you are seeking pre-registration;
Please describe the evidence that you are enclosing here, then attach to the hard copy of this form.
Declarations - please tick the following boxes, and sign your declaration below.
I confirm that I am requesting this search in order to complete a .nz Dispute Resolution Service complaint;
I will only request information where I am duly authorised to act.
Print name ____________________