Provider Aggregatable (PA) Assignment Request Form

This document is obsoleted by ripe-583

% Provider Aggregatable (PA) Assignment Request Form


% RIPE NCC members can use this form to request a PA assignment. Please see
% ripe-489 for instructions on how to complete this form.


#[GENERAL INFORMATION]#
%
% Please add your RegID.

request-type: pa-ipv4
form-version: 1.2
x-ncc-regid:


#[ADDRESS SPACE USER]#
%
% Who will use the requested address space?

legal-organisation-name:
organisation-location:
website-if-available:

% Does this End User already have address space that can be
% used for this assignment? (Yes/No)

space-available:




#[ADDRESSING PLAN]#
% As of 1 January 2010 assignments are for a period of up to 12 months.
% As of 1 July 2010 assignments are for a period of up to 9 months.
% As of 1 January 2011 assignments are for a period of up to 6 months.
% As of 1 July 2011 assignments are for a period of up to 3 months.
%
% How will the End User use this address space?
%
% Subnet Immediate Intermediate Entire Purpose
% size (/nn) Requirement Requirement Period

subnet:
subnet:
totals:

number-of-subnets:

% Which netname will you use for this assignment?

netname:

% Will the End User return any address space?

address-space-returned:


#[EQUIPMENT DESCRIPTION]#
%
% What equipment will be used and how will it use the requested
% address space?

equipment-name:
manufacturer-name:
model-number:
other-data:

equipment-name:
manufacturer-name:
model-number:
other-data:


#[NETWORK DESCRIPTION]#
%
% Please add more information if you think it will help us understand
% this request.


<add more information>


#[NETWORK DIAGRAM]#
%
% Have you attached a network diagram to this request? (Yes/No)

diagram-attached:


#[END of REQUEST]#