This RIPE Document is only available in PDF format.

% AS Number Request Form

% RIPE NCC members (LIRs) and Direct Assignment Users can use this form
% to request an Autonomous System (AS) Number. For instructions on how to
% complete this form see:
%"Supporting Notes for the Autonomous System Number Request Form"
% http://www.ripe.net/ripe/docs/asnsupport.html Link: http://www.ripe.net/ripe/docs/asnsupport.html 
%
% Please note that the End User should have a signed "End User 
% Assignment Agreement" with either the sponsoring LIR or the RIPE NCC.

#[GENERAL INFORMATION]#
%
% Please add your RegID

request-type: as-number
form-version: 1.2
x-ncc-regid: 

#[AS NUMBER USER]#
%
% Who will use the AS Number being requested?

legal-organisation-name:      
website-if-available: 

% Is this request being sent by a sponsoring LIR on behalf of an 
% End User? (Yes/No)

end-user-of-sponsoring-lir: 

% If yes, please confirm that the "End User Assignment Agreement" 
% contains all of the elements listed in paragraph 2.0 of 
% "Contractual Requirements for Provider Independent Resource Holders 
% in the RIPE NCC Service Region". (Yes/No)

confirmation:

#[ADDRESS SPACE TO BE ANNOUNCED]#
%
% Which address prefix will originate from the new AS number?

prefix:
 
% If the address assignment is waiting for approval, please 
% include the ticket number of the request below.

pending-ticket-ID:

#[PEERING CONTACTS]#
%
% Please list the email contact addresses of peering 
% partners for the requested AS Number.

peering:
peering:

#[SUPPLEMENTAL COMMENTS]#
%
% Please add more information if you think it will help us understand 
% this request.



% If you require a 16-bit AS Number instead of a 32-bit AS Number, 
% please indicate this below and tell us why. For more information,
% see http://www.ripe.net/news/asn-32-guide.html

AS Number Type: 32-bit [change as required]

Why 16-bit:

#[SUPPORTING DOCUMENTATION]#
%
% If this request is being sent by a sponsoring LIR on behalf of 
% an End User, please attach a copy of the signed 
% "End User Assignment Agreement" and the company registration papers 
% of the End User.
% You can also attach a network diagram or other supporting documentation.
%
% Have you attached any files/documents to this request? (Yes/No)

file-attached:

#[DATABASE TEMPLATE(S)]# 
%
% Please complete all of the fields below

aut-num:       ASNEW 
as-name:       <add name for the AS>
descr:         <add AS Number User name>
org:           <add org-ID>
import:        <specify the outgoing routing policy for the first peer>
export:        <specify the incoming routing policy for the first peer>  
import:        <specify the outgoing routing policy for the second peer>
export:        <specify the incoming routing policy for the second peer>   
admin-c:       <add nic-handle of administrative contact>
tech-c:        <add nic-handle of technical contact>
mnt-by:        RIPE-NCC-END-MNT
mnt-by:        <add mntner name>
mnt-routes:    <add mntner name>
changed:       hostmaster@ripe.net
source:        RIPE

#[END of REQUEST]#