CCTLD MODIFICATION TEMPLATE v.1.3

1.  Purpose/Description.............:

2.  Top-Level Domain Name...........:

Sponsoring Organization
3a. Organization Name (Registrant)..:
3b. Street Address..................:
3c. City............................:
3d. State...........................:
3e. Postal Code.....................:
3f. Country Code (2 letter).........:

Administrative Contact
4a. (omitted)
4b. (I)ndividual or (R)ole?.........:
4c. Name............................:
4d. Organization Name...............:
4e. Street Address..................:
4f. City............................:
4g. State...........................:
4h. Postal Code.....................:
4i. Country Code (2 letter).........:
4j. Phone Number....................:
4k. Fax Number......................:
4l. Email Address...................:

Technical Contact
5a. (omitted)
5b. (I)ndividual or (R)ole?.........:
5c. Name............................:
5d. Organization Name...............:
5e. Street Address..................:
5f. City............................:
5g. State...........................:
5h. Postal Code.....................:
5i. Country Code (2 letter).........:
5j. Phone Number....................:
5k. Fax Number......................:
5l. Email Address...................:

Primary Name Server
6a. Primary Server Hostname.........:
6b. Primary Server Netaddress.......:

Secondary Name Server (repeat as needed)
7a. Secondary Server Hostname.......:
7b. Secondary Server Netaddress.....:

8.  URL for Registration Services...:

9.  Whois Server....................: