This RIPE Document is available in ASCII document has been obsoleted due to the RIPE NCC reaching the last /8 of IPv4 address space. Link: /about-us/news/ripe-ncc-begins-to-allocate-ipv4-address-space-from-the-last-8/

% Provider Independent (PI) Assignment Request Form

% RIPE NCC members (LIRs) and Direct Assignment Users can use this form
% to request a PI assignment. Please see "Supporting Notes for the 
% Provider Independent (PI) Assignment Request Form" for instructions on 
% how to complete this form.
% http://www.ripe.net/ripe/docs/pi-requestsupport.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: pi-ipv4
form-version: 1.3
x-ncc-regid: 

#[ADDRESS SPACE USER]#
%
% Who will use the requested address space?

legal-organisation-name:      
organisation-location: 
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:

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

space-available: 

#[INITIAL INFORMATION]#
%
% Why is PI address space required rather than PA address space?

why-pi:

% Is the End User requesting extra address space for routing and/or 
% administrative reasons? (Yes/No)

routing-reasons:

% Is the End User aware of the consequences and disadvantages 
% of PI address space? (Yes/No)

confirmation:


#[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: 

% 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>

#[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. 

inetnum:       <leave empty>
netname:       <add netname>
descr:         <add End User organisation name>
country:       <add country code>
org:           <add org-ID>
admin-c:       <add nic-handle of administrative contact>
tech-c:        <add nic-handle of technical contact>
status:        ASSIGNED PI
mnt-by:        RIPE-NCC-END-MNT
mnt-lower:     RIPE-NCC-END-MNT
mnt-by:        <add mntner name>
mnt-routes:    <add mntner name>
mnt-domains:   <add mntner name>
changed:       [email protected]
source:        RIPE


#[END of REQUEST]#