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| % 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]#
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