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                              European IP Address Space Request Form

                                                        1 March 1996
        ____________________________________________________________




                   European IP Address Space Request Form

                                  RIPE NCC
                                1 March 1996

                          Expiry Date: 31 May 1996


        To whom it may concern,

        Before  you  complete this form, please ensure that you read
        the  information  outlined  in  the  "Supporting  Notes  for
        European  IP  Address  Space  Requests"  (document ripe-128)
        carefully before  submitting  your  application  for  an  IP
        number.   The  form  will  be  accepted  by  local  Internet
        Registries across Europe.

        Please note that statements made in this form can be used in
        consideration of future requests that are made.

        Once  completed,  please  return this document to your local
        Internet Registry.

        IMPORTANT NOTE:

        This document is valid  until  May  31t,  1996.  An  updated
        document will be sent out when due.


        Part A - Administrative Details The information supplied for
        this section together with the assigned network numbers will
        be  entered  into a database of European network numbers and
        their contact information which is accessible by  the  whole
        Internet community.

        NETWORK TEMPLATE


        netname:
        descr:
        descr:
        country:
        admin-c:
        tech-c:
        changed:
        source:  RIPE




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                              European IP Address Space Request Form

                                                        1 March 1996
        ____________________________________________________________

        PERSON TEMPLATE

        person:
        address:
        address:
        address:
        address:
        phone:
        fax-no:
        e-mail:
        nic-hdl:
        changed:
        source:  RIPE


        PERSON TEMPLATE

        person:
        address:
        address:
        address:
        address:
        phone:
        fax-no:
        e-mail:
        nic-hdl:
        changed:
        source:   RIPE


        Please note that you will have to include a separate  person
        template  for each person referenced as a contact unless the
        information about the person in the RIPE database  is  still
        valid.

        The  information given above will be entered into a database
        of European network contacts  which  is  accessible  by  the
        whole  Internet  community.  Please  refer  to  the RIPE NCC
        leaflet on the "Network Management Database" for details  on
        how to query the database.













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                              European IP Address Space Request Form

                                                        1 March 1996
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        Part B - Technical Details

        Information supplied below helps us to evaluate and  process
        your  request.  It  will be kept in strict CONFIDENCE and is
        for internal use only. It will NOT be entered into the  RIPE
        Network Management Database.

        TECHNICAL TEMPLATE

        request-type:
        machine-0:
        machine-1:
        machine-2:
        subnet-0:
        subnet-1:
        subnet-2:
        inet-connect:
        country-net:



































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                              European IP Address Space Request Form

                                                        1 March 1996
        ____________________________________________________________

        Part C - Network Details


        Please submit a description of your network layout,  includ-
        ing all devices which will require unique IP addresses.  The
        more detail you supply in this section, the easier  it  will
        be  to  evaluate your case and allocate you the requested IP
        numbers.

        Current network layout:















        Network deployment plans: (year 1 & year 2)

        (Please ensure you have read the "Additional Hints"  section
        in  the "Supporting Notes" on organisations requesting addi-
        tional class C numbers or class B numbers). Please  describe
        your planned allocation of the requested address space.






















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                              European IP Address Space Request Form

                                                        1 March 1996
        ____________________________________________________________

        Addressing plan:

        Please give an overview of your addressing plan.

                           Number of hosts per subnet for
        Subnet  Subnet mask   Max      Now     Year-1     Year-2     Remarks
        --------------------------------------------------------------------









             Totals:





        Part D - Enterprise Allocation History

        If any part of your organisation (including subsidiaries and
        the  parent company) has received address space in the past,
        please specify the actual network numbers allocated.  Please
        also  give  details,  if  any  applications  for  additional
        address space have been rejected in the past. Finally please
        include  a brief overview of your company structure, includ-
        ing details of the parent company, subsidiaries and  contact
        persons. Please continue on a separate sheet if necessary.





















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                              European IP Address Space Request Form

                                                        1 March 1996
        ____________________________________________________________

        Part E - Contact Details Complete the  section  below  *ONLY
        IF*  you  are  making  an  application  on behalf of another
        organisation.


        This application is made by:

        name:
        organisation:
        country:
        phone:
        fax-no:
        e-mail:

        On behalf of the following organisation:

        name:
        organisation:
        country:
        phone:
        fax-no:
        e-mail:



        Part F - Non European Requests

        If your request is for the Asian-Pacific Region  you  should
        sent  your  application  form to: AP-NIC, c/o United Nations
        University, 3-70 Jingumae 5-chome,  Shibuya-ku,  Shibuya-ku,
        Tokyo   150,   Japan,   Telephone:   +81-3-5276-3973,   Fax:
        +81-3-5276-6239, Email: <hostmaster@apnic.net>

        The InterNIC serves as default for the rest  of  the  world.
        Their contact details are: Network Solutions Inc, Attention:
        InterNIC Registration Service, 505 Huntmar Park Drive, Hern-
        don,  VA 22070, USA. Telephone: +1 703 742 4777, fax: +1 703
        742 4811. Email: <hostmaster@rs.internic.net>















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