NASK allocates addressing space only to its customers or organizations who are the customers of operators that are connected to NASK.

• Addresses are allocated only following a correctly completed application,
• Entered data should be actual and reflect real address needs,
• Please read cerefully instructions how to complete this form,

NOTE:
Assignment is valid as long as the original criteria on which the assignment was based are still valid. We have the right to reassign the address space to another user upon termination of this agreement or an agreed period thereafter.

If you have any questions concerning IP address allocation, please contact:registry@nask.pl.

Contact e-mail address*:
A short description of the applicant organization*:

The Applicant
First and last name*:
Organization*:
Phone* (+48 22 1234567 ext. 110):
Fax:
E-mail*:

The Address User Leave empty, if the data is the same as the applicants data.
First and last name:
Organization:
Phone (+48 22 1234567 ext. 110):
Fax:
E-mail:

Currently Used Addresses In the table below, please enter the subnets you are currently using.
Subnet address	Mask	Description

Returnet addresses (optional) In the table below, please enter the subnets you are returning.
Subnet address	Mask	Description

Application
Requested addresses space:	8
Immediate Requirement *:
Intermediate Requirement *:
Entire Period *:
Your Internet Service Provider*:
Do you need Point-to-Point subnet(/30)?:	NO YES

Enter Data to the RIPE Database: The data below will be entered to the public internet address database. The form should not contain encoded Polish extended characters.
Accept conditions included in the form*:	NO YES
Netname: (only letters and digits)*:
Description*:
Remarks:
Administrative Contact Fields should consist of proper and actual contact data.
First and last name*:
Address (Full postal address)*:
Address (Full postal address)*:
Phone (+48 22 1234567 ext. 110)*:
Fax:
E-mail*:
nic-hdl (only if the person is registered in the RIPE database):
Technical Contact Leave empty, if the data is the same as the administrative contact data. Fields should consist of proper and actual contact data.
First and last name:
Address (Full postal address):
Address (Full postal address)
phone (+48 22 1234567 ext. 110):
Fax:
E-mail:
nic-hdl (only if the person is registered in the RIPE database):

Notes:

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