Before completing this form, please familiarise yourself with the procedures and our charges.

Domain

Name: Domain Name Requested

Representing: What the domain represents. If it is an acronym, please put what it stands for.

Owner Organisation

Enter Information about the organisation that will own the domain

• Organisation Name:
• Are you a registered organisation? (e.g. Company House, OFS)
• What is the role and objective of this organisation?
• What qualifications do you offer?
• Does your organisation already own an ac.uk domain name?

Eligibility of Organisation

• Specify which of the criteria (a) to (r) of section 3 of the ac.uk eligibility policy that you meet. If you are unsure of which one you meet, please provide evidence e.g., level of education provided.

Funding

How is your organisation funded? Please provide evidence.

Purpose of Domain/Project

• What do you want the domain for? Including primary purposes and planned content (In line with your organisation name, project).
• What is the intended audience?
• Is this domain for a project? If yes, what is the duration of the project and the longevity of confirmed funding.

Registrant Contact

Enter registrant information from the owner organisation. This will be publicised in the public whois records available here.

• *Name
• *Address Line 1
• Address Line 2
• Address Line 3
• *Town
• *County
• *Postcode
• *Email
• *Telephone
• Fax

By providing these details, you give consent for the above registrant data to appear in public whois records.

If you wish to use alternative registrant details for the whois, please provide the details below:

• Name
• *Address Line 1
• Address Line 2
• Address Line 3
• *Town
• *County
• *Postcode
• *Email
• *Telephone
• Fax

Admin and Technical Contact

• admin-c: Name of the person submitting the domain request (should be a Janet registered contact or person from the Registrar)
• address: full postal address of contact
• phone: telephone number of contact
• fax-no: fax number of contact
• e-mail: e-mail address of contact
• tech-c: Name of the person technically responsible for the domain (can be a person from the domain owning organisation or from the Registrar)
• address: full postal address of contact
• phone: telephone number of contact
• fax-no: fax number of contact
• e-mail: e-mail address of contact

Nameservers

Enter your Name Server information. We require a Primary and at least one Secondary.

You will only be able to use Janet Primary or Secondary Nameservers if the registrant or registrar is a Janet-connected Customer (Jisc Member). If you wish to find out if you are eligible to use the Janet Primary Nameservers please click here.

nserver name & ip address: name and corresponding IP address of primary nameserver

nserver name & ip address: name and corresponding IP address of secondary nameserver

DS Keys

Please leave blank if you do not use DNSSEC. Further information on DNSSEC is available here.

Paste the DS key(s) you wish to use on your domain below: