Application For Registrant Info Service Search - .nz Names For Dispute Resolution Service Complaint

 

This form is issued by Domain Name Commission Limited (DNC or Domain Name Commission) on behalf of Internet New Zealand Incorporated (InternetNZ).

APPLICATION FOR REGISTRANT INFO SERVICE SEARCH -.NZ NAMES FOR DISPUTE RESOLUTION SERVICE COMPLAINT

Please complete this form electronically, then print, sign, and return to The Domain Name Commission, at:

Domain Name Commission Limited
P O Box 11881
Wellington 6142
New Zealand

Or email to info@dnc.org.nz


1. Domain name/s to be subject to a DRS Complaint (maximum of 5)

Complete this section if you are requesting information on behalf of an organisation:

2.Name of Organsiation:

3. Trading Name (if applicable):

4.Name of contact person:


Complete this section if you are requesting information on behalf of an individual:

5. Name:

6. Date of birth


All applicants to complete the following:

7. Address

8. Phone (day):

9. Phone (mobile):

10. Phone (after hours):

11. Fax:

12. Email address:


13. Evidence as to the applicant's identity and contact details (for example, a photocopy of a driver's licence) and, where appropriate, evidence as to the applicant's authority to apply for a search on behalf of a company (for example, written authorisation signed by a director of the relevant company);

Please describe the evidence that you are enclosing here, then attach to the hard copy of this form.


 Search criteria requested

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 confirm that the information gained from this search will not be misused;

If Applicable

 I have been authorised to make this search request on behalf of a client in relation to a .nz Dispute Resolution Service complaint

 

Signed

Print name

Date