IPv6 request

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Who will use the requested address space*?

<legal name of organisation>
<website (if available)>

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Briefly describe the purpose for which the addresses will be used*:

<your description>

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Briefly describe why you are in need of PI addresses (as opposed to PA addresses). Note that
PI addresses may only be used for internal infrastructure and not to make assignments to
external parties.

<your description>

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Please specify your address plan as detailed as possible

When will you start using this PI assignment and for what purpose?*

Subnet size (/nn)       Within 	      Within        Within
			3 months      1 year	    2 years		Purpose
<size subnet1> 	  	<yes/no>      <yes/no>	    <yes/no>		<purpose>
<size subnet2> 		<yes/no>      <yes/no>	    <yes/no>		<purpose>
<total subnet size>

<total number of subnets>

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Contact details (this information will be published in the RIPE db):

Specify contact details for the administrative contact person(s)*:

<name>
<postaladress and city>
<e-mail adress>
<phone number>

<name>
<postaladress and city>
<e-mail adress>
<phone number>

Specify contact details for the technical contact person(s)*:

<name>
<postaladress and city>
<e-mail adress>
<phone number>

<name>
<postaladress and city>
<e-mail adress>
<phone number>

Please specify an e-mail address for handeling of abuse reports*:

<abusemailbox>

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Any requests for the inet6num object may be added below (will be published in the RIPE db):

inetnum:       <leave empty>
netname:       <add netname>
descr:         <add End User organisation name>
org:	       <add organisation object>
country:       <add country code>
admin-c:       <add nic-handle of administrative contact>
tech-c:        <add nic-handle of technical contact>
mnt-by:        RESILANS-MNT
mnt-routes:    <add mntner name>
source:        RIPE

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Please specify what name servers you wish to use for reverse DNS:

<name server>
<name server>
<name server>
<name server>

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Fields marked with * are mandatory.