Application For Pre-Registration For Registrant Info Service Searches For DRS Complaint Assistance

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

APPLICATION FOR PRE-REGISTRATION FOR REGISTRANT INFO SERVICE SEARCHES FOR DRS COMPLAINT ASSISTANCE

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 infor@dnc.org.nz


1. Name of Organisation:

2. Trading Name (if applicable):

3. Name of contact person:


4. Names and details of employees if seeking to pre-register more than one person :

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

5. Name:

6. Date of birth

7. Occupation


All applicants to complete the following:

 

8. Address

9. Phone (day):

10. Phone (mobile):

11. Phone (after hours):

12. Fax:

13. Email address:


14. Evidence provided in support of the applicant's role in DRS cases and why you are seeking pre-registration;

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

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 will only request information where I am duly authorised to act.

 

Signed ____________________

Print name ____________________

Date ____________________