This form is issued by Domain Name Commission Limited (DNC or Domain Name Commission) on behalf of Internet New Zealand Incorporated (InternetNZ). COMPLAINTS FORM More information regarding to the types of complaints that the Domain Name Commission handles can be found here. 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 complaints@dnc.org.nz 1. Contact Details of Complainant Name Address Work Ph: Fax: Home Ph: Mobile: Email: 2. Complaint against: 3. Nature of complaint: 4. Name of person dealt with regarding complaint: 5. Their contact details: 6. Correspondence and documentation: 7. Current status of complaint: (Please feel free to attach any additonal documentation you wish, or if additional space is needed this can be attached on additonal paper.) Signed: Print Name: Date: