.
                              European IP Address Space Request Form


                ____________________________________________________




                       European IP Address Space Request Form

                               Document ID: ripe-137
                                Obsoletes: ripe-129
                            See also: ripe-136, ripe-138



    Overview


                This document contains the set of templates to be
                used when submitting an IP assignment request. This
                set of forms must be used by Internet Service
                Providers when submitting a request to the RIPE NCC.
                It may also be used by ISPs to collect information
                from those managing the networks that 
 % Provider Aggregatable (PA) Assignment Request Form


% RIPE NCC members can use this form to request a PA assignment. Please see 
% ripe-489 Link: /publications/docs/ripe-489/  for instructions on how to complete this form.


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

request-type: pa-ipv4
form-version: 1.2
x-ncc-regid: 


#[ADDRESS SPACE USER]#
%
% Who will use the
                address space. Instructions for filling out the tem-
                plates are found in the accompanying document "Sup-
                porting Notes for the European IP Address Space
                Request Form (ripe-138).

                Internet Service Providers: Submit the form via e-
                mail to "<[email protected]>."  (If the ISP is not
                a Local Internet Registry, the form should be sub-
                mitted to the upstream provider.)

                Network Administrators: Send the form to the Inter-
                net Service Provider from which you received it.


                     Warning (If submitted to the RIPE NCC):
                     Requests that are sent to the RIPE NCC which
                     lack a proper registry ID will be returned to
                     the sender. Further, any modifications to the
                     templates may result in a delay in handling.














                ____________________________________________________
                ripe-137.txt                                  Page 1
                              European IP Address Space Request Form


                ____________________________________________________

    I. General Information

    #[OVERVIEW OF ORGANIZATION TEMPLATE]#







    #[REQUESTER TEMPLATE]#

    reg-ID:
    name:
    organisation:
    country:
    phone:
    fax: (optional)
    e-mail:

    #[USER TEMPLATE]#

    name:
    organisation:
    country:
    phone:
    fax: (optional)
    e-mail:


    #[CURRENT ADDRESS SPACE USAGE TEMPLATE]#



                                         Addresses Used
    Prefix        Subnet Mask      Size  Current  1-yr  2-yr  Description

















                ____________________________________________________
                ripe-137.txt                                  Page 2
                              European IP Address Space Request Form


                ____________________________________________________

    II. The Request


    #[REQUEST OVERVIEW TEMPLATE]#

    request-size:
    addresses-immediate:
    addresses-year-1:
    addresses-year-2:
    subnets-immediate:
    subnets-year-1:
    subnets-year-2:
    inet-connect:
    country-net:
    private-considered:
    request-refused:
    PI-requested:
    address-space-returned:


    #[ADDRESSING PLAN TEMPLATE]#


    Relative                          Addresses Used
    Prefix#   Subnet Mask      Size  Immediate   1yr   2yr   Description




























                ____________________________________________________
                ripe-137.txt                                  Page 3
                              European IP Address Space Request Form


                ____________________________________________________

    III. Database Information

    #[NETWORK TEMPLATE]#

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

    #[PERSON TEMPLATE]#

    person:
    address:
    address:
    address:
    address:
    address:
    address:
    phone:
    fax:
    nic-hdl:
    changed:
    source: RIPE

    #[TEMPLATES END]#






















                ____________________________________________________
                ripe-137.txt                                  Page 4
                              European IP Address Space Request Form


                ____________________________________________________

    IV. Optional Information:




















































                ____________________________________________________
                ripe-137.txt                                  Page 5  requested address space?

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

% Does this End User already have address space that can be
% used for this assignment? (Yes/No)

space-available: 




#[ADDRESSING PLAN]#
% As of 1 January 2010 assignments are for a period of up to 12 months.
% As of 1 July 2010 assignments are for a period of up to 9 months.
% As of 1 January 2011 assignments are for a period of up to 6 months.
% As of 1 July 2011 assignments are for a period of up to 3 months.
%
% How will the End User use this address space?
%
%       Subnet       Immediate    Intermediate  Entire   Purpose
%       size (/nn)   Requirement  Requirement   Period        

subnet:
subnet:
totals:

number-of-subnets: 

% Which netname will you use for this assignment?

netname:

% Will the End User return any address space?

address-space-returned: 


#[EQUIPMENT DESCRIPTION]#
%
% What equipment will be used and how will it use the requested
% address space?

equipment-name:
manufacturer-name:
model-number:
other-data:

equipment-name:
manufacturer-name:
model-number:
other-data:


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


<add more information>


#[NETWORK DIAGRAM]#
%
% Have you attached a network diagram to this request? (Yes/No)

diagram-attached:


#[END of REQUEST]#