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 - OWN .NZ NAMES
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
Complete this section if you are requesting information on behalf of an organisation:
1. Name of Organsiation:
2. Trading Name (if applicable):
3. Name of contact person:
Complete this section if you are requesting information on behalf of an individual:
4. Name:
5. Date of birth
All applicants to complete the following:
6. Address
7. Phone (day):
8. Phone (mobile):
9. Phone (after hours):
10. Fax:
11. Email address:
12. 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.
13. Search criteria requested
Declarations - please tick the following boxes, and sign your declaration below.
I declare that the information is for the purposes as defined in the .nz policies only;
I confirm that the information gained from this search will not be misused;
I confirm that I am requesting this search to confirm domain names for which I am the registrant;
Or:
I have been authorised to make this search request on behalf of a client
Signed
Print name
Date