                                ZISPA

                       .CO.ZW Namespace Registry



             APPLICATION TO ESTABLISH A SUB-DOMAIN WITHIN

                 THE .CO.ZW NAMESPACE OF THE INTERNET



       ========================================================

      |        ZISPA manages Zimbabwe's .CO.ZW registry        |

      |                                                        |

      |       ** TERMS AND CONDITIONS OF REGISTRATION **       |

      |                                                        |

      | .CO.ZW domain registrations are subject to the terms   |

      | and conditions as published at http://www.zispa.org.zw |

      | from time to time.                                     |

      |                                                        |

      |              ** COSTS OF REGISTRATION **               |

      |                                                        |

      | The costs of registration will vary from time to time. |

      | Details of current charges may be obtained from ZISPA. |

      |                                                        |

      | This document is intended to be scanned electronically |

      | so please do not change its format or enter data other |

      | than in the specified locations.  The file must be     |

      | sent in plain ASCII format as an attachment and not as |

      | inline text.  It must not be uuencoded or MIME encoded |

      | or sent in any proprietary word processing file format |

      |                                                        |

      | Please send only ONE APPLICATION per e-mail message    |

      | to admin@zispa.org.zw, with the full domain name in    |

      | the Subject line.                                      |

      |                                                        |

      | All data must be entered on a single line following    |

      | the colon for the field concerned to facilitate data   |

      | capture.                                               |

      |                                                        |

      |  ** All fields with an asterisk must be completed **   |

      |                                                        |

       ========================================================



      0.  ZW DOMAIN TEMPLATE....: 3.3 - 28 Jan 2015



      1.  DOMAIN NAME and ACTION

    * 1a. Full domain name......: **domain_name**

    * 1b. (N)ew or (M)odify or (D)elete or (T)ransfer (N/M/D/T)..: **action**


      2.  DOMAIN OWNER

    * 2a. Domain Owner..........: **domain_owner**

    * 2b. Organisation Name.....: **organisation**

    * 2c. Physical Address......: **street_address**

    * 2d. Postal Address .......: **postal_address**

    * 2e. Town/City.............: **city**

    * 2f. Country...............: **country**

    * 2g. Voice Phone...........: **mobile**

      2h. Fax Number............:

    * 2i. E-mail Address........: **email**



      3.  ADMIN/BILLING CONTACT

    * 3a. ZISPA Handle..........: **admin_handle**

    * 3b. Contact Name..........: **admin_contact_name**

    * 3c. Organisation Name.....: **admin_org_name**

    * 3d. Physical Address .....: **admin_physical_address**
    * 3e. Postal Address .......: **admin_postal_address**

    * 3f. Town/City.............: **admin_city**

    * 3g. Country...............: **admin_country**

    * 3h. Voice Phone...........: **admin_phone**

      3i. Fax Number............:

    * 3j. E-mail Address........: **admin_email**



      4.  DESCRIPTION OF ORGANISATION/DOMAIN

    * 4a. Description of domain

          owner's organisation..: **purpose**

    * 4b. Proposed domain usage.: Website and Emails



      5.  TECHNICAL CONTACT

    * 5a. ZISPA Handle..........: **admin_handle**

    * 5b. Contact Name..........: **admin_contact_name**

    * 5c. Organisation Name.....: **admin_org_name**

    * 5d. Physical Address .....: **admin_physical_address**

    * 5e. Postal Address .......: **admin_postal_address**

    * 5f. Town/City.............: **admin_city**

    * 5g. Country...............: **admin_country**

    * 5h. Voice Phone...........: **admin_phone**

      5i. Fax Number............:

    * 5j. E-mail Address........: **admin_email**



      6.  PRIMARY NAMESERVER

    * 6a. Hostname..............: **ns1**

    * 6b. IP Address............: **ip1**



          SECONDARY NAMESERVER

    * 6c. Hostname..............: **ns2**

    * 6d. IP Address............: **ip2**



          SECONDARY NAMESERVER

      6e. Hostname..............: **ns3**

      6f. IP Address............: **ip3**



          SECONDARY NAMESERVER

      6g. Hostname..............: **ns4**

      6h. IP Address............: **ip4**



    * 7.  DOMICILIUM CITANDI ET EXECUTANDI

      The organisation specified

      in 2 above chooses as its

      address for the giving and

      serving of notices the

      following street address

      (Note: Post Office box or

      Post Office bag addresses

      are not acceptable).......: **domicilium_citandi_et_executive**