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