Application for IPv4 Address Space

This application will be processed in accordance with the IPv4 Address
Allocation and Assignment Policy which is documented in the RIPE docuement
ripe-492 (http://www.ripe.net/ripe/docs/ipv4-policies.html).

Should you have any queries regarding the form please contact noc@heanet.ie.

Name of Organisation:

Location of Organisation: 

Description of Organisation:


Requester contact details

Name:
Title:
Postal address:
Phone:
Fax:
E-mail address:
NIC or RIPE handle (if known):


Administrative contact

Name:
Title:
Postal address:
Phone:
Fax:
E-mail address:
NIC or RIPE handle (if known):

 
Technical contact

Name:
Title:
Postal address:
Phone:
Fax:
E-mail address:
NIC or RIPE handle (if known):

 
Network name:
 
Purpose of network:

Does the organisation already have address space that can meet the needs 
for this request? Enter "Yes" or "No".
space-available: 

ADDRESSING PLAN

Please repeat the subnet line for each subnet required.

	Size  in CIDR    Immediate   1month   3months   Purpose
subnet:
totals:



Current service from HEAnet:


Signed:

Date:

 

Please note that assignments of any kind of address space are valid only as long as the 
original criteria on which the assignment was based are still valid. After that time, 
addresses must be returned to this registry. 

Once your application as been approved an entry will be registered in the RIPE whois 
database regarding your assignment which will contain your contact details.

When completed and signed, this form should be sent to

E-mail: noc@heanet.ie		or	Post:	The IPv4 Registry,
Fax: +353 1 660 3666				HEAnet Ltd.,
						1st Floor,
						5 George's Dock,
						IFSC,
						Dublin 1.

© HEAnet Ltd.