GITN



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|GITN |Domain Name Service Form |Page 1 of 3 (DNS1) |

|SDN BHD | | |

| | |Revision : 3.0 |

| | |Date Issued : 20.09.2007 |

|Filled By Applicant |For GITN Used |

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|1. |Ticket No : |

|Domain Name | |

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|. gov . my | |

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| |Date Register |

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|Others | |

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|Example |Register or modify At : |

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|.my / .my |dns1..my |

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|2. | |

|Type Of Application | |

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| |dns2..my |

|New Domain Registration | |

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|*Fill Form DNS03 & DNS 02 for Details | |

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|Domain Modification | |

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|*Fill Form DNS02 only | |

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| |Received By: |

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| |Name |

|Remarks : |: |

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| |Email |

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| |Phone |

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| |Implement By: |

|3. | |

|Requestor | |

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| |Name |

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|Name |Email |

|: |: |

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| |Phone |

|Agency |: |

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|Email | |

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| |Date Received |

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|Phone ( off / hp) | |

|: |Task Begin |

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|/ | |

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|Signature or | |

|Stamp Pad | |

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|Date Request | |

|: | |

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|Expected Deliverable | |

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|(dd/mm/yy) | |

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|*The applicant is responsible for the accuracy of the information contained in this form. | |

|GITN – Received By |GITN Verification |: |Approved / Not Approved |

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|Name |: | |Name |: | |

|Signature |: | |Signature |: | |

|Date |: | |Date |: | |

| |DNS Configuration Form | |

|GITN | |Page 2 0f 3 ( DNS1) |

|SDN BHD | | |

| | |Revision : 3.0 |

| | |Date Issued : 20.09.2007 |

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|Filled By Applicant |For GITN Used |

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|Changes Mode |Public IP |

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|HostName | |

|Domain Names | |

|Type Of Server | |

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|mail server |Remarks |

|web server | |

|apps server | |

|Publish At | |

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|Internet | |

|Intranet | |

|Both | |

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|Hosting At | |

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|Public DNS GITN | |

|Private DNS GITN | |

|Non Private DNS GITN | |

|Non Public DNS GITN | |

|*for non DNS GITN,please provide IP DNS | |

|IP Address | |

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|[pic] | |

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|[pic] | |

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|[pic] | |

| |Name |

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| |Date |

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|Filled by requestor |Email |

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|[pic] | |

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| |* Gived a copy to a requestor |

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|[pic] | |

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|Remarks: | |

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|* Only 5 entries per page | |

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|GITN |Domain Name Service Form |Page 3 of 3 (DNS1) |

|SDN BHD |New Registration | |

| | |Revision : 3.0 |

| | |Date Issued : 20.09.2007 |

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|1. |

|Type Of Registration |

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|New Domain Registration |

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|Modify Domain |

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|2. |

|Domain Name |

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|Example |

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|.my/.my |

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|3. |

|Registrant Details |

|(Fill up by Requestor) |

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|Registrant Must have a local presence in Malaysia |

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|3a. |

|Organisation Name |

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|3b. |

|Organisation Registration No |

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|3c. |

|Organisation Address |

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|3d. |

|Organisation Phone Number |

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|3e. |

|Organisation Fax Number |

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|4. |

|Administrative Contact |

|(Fill up by Requestor) |

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|The Administrative Contact must be an authorised employee of the Registrant |

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|4a. |

|Name |

|: |

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|4b. |

|Phone Number |

|: |

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|4c. |

|Fax Number |

|: |

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|4d |

|Email Address |

|: |

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|Important : |

|This page is only for new registration and modification domain in MYNIC. |

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