T-Com Croatia Internet network
Croatian Telecom Inc., Zagreb, Croatia

Based on RIPE-NCC document: ripe-489


% 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: [filled by T-Com]


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

legal-organisation-name: [filled by customer]    
organisation-location: [filled by customer]
website-if-available: [filled by customer]

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

space-available: [filled by customer]




#[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: [filled by customer]
subnet: [filled by customer]
totals: [filled by customer]

number-of-subnets: 

% Which netname will you use for this assignment?

netname: [filled by customer]


% Will the End User return any address space?

address-space-returned: [filled by customer]


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

equipment-name: [filled by customer - on request]
manufacturer-name: [filled by customer - on request]
model-number: [filled by customer - on request]
other-data: [filled by customer - on request]

equipment-name: [filled by customer - on request]
manufacturer-name: [filled by customer - on request]
model-number: [filled by customer - on request]
other-data: [filled by customer - on request]



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


<add more information>
[filled by customer]


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

diagram-attached:
[filled by customer]



#[NETWORK TEMPLATE]#

inetnum:       [filled by T-Com]
netname:       [filled by customer]
descr:         [filled by customer]
country:       HR
admin-c:       [filled by customer - Name and Last name]
tech-c:        [filled by customer - Name and Last name]
status:        ASSIGNED PA
notify:        [filled by customer - not mandatory]
mnt-by:        HPT-MNT
mnt-lower:     [filled by T-Com]
mnt-domains:   [filled by T-Com]
mnt-routes:    [filled by T-Com]
mnt-irt:       [filled by T-Com]
changed:       [filled by T-Com]
source:        RIPE


#[PERSON TEMPLATE]#

person:        [filled by customer - Name and Last name]
address:       [filled by customer]
phone:         [filled by customer]
fax-no:        [filled by customer - not mandatory]
e-mail:        [filled by customer]
nic-hdl:       AUTO-1
notify:        [filled by customer - not mandatory]
mnt-by:        HPT-MNT
changed:       [filled by T-Com]
source:        RIPE


#[END of REQUEST]#

[Customers Name, Last name and Address - filled by customer]