If you wish to request more than 4 IP addresses, we require a RIPE justification form to be completed.
Please complete the form below and then include it within a support ticket. (If you require help, please still submit it to us with as much information completed as possible).
On a successful allocation, your details will be published into a public IP WHOIS database.
% Provider Aggregatable (PA) Assignment Request Form % RIPE NCC members can use this form to request a PA assignment. Please see % ripe-584 for instructions on how to complete this form. #[GENERAL INFORMATION]# % % Please add your RegID. request-type: pa-ipv4 form-version: 1.3 x-ncc-regid: #[ADDRESS SPACE USER]# % % Who will use the requested address space? legal-organisation-name: organisation-location: website-if-available: % Does this End User already have address space that can be % used for this assignment? (Yes/No) space-available: #[ADDRESSING PLAN]# % How will the End User use this address space? % % Subnet Immediate Intermediate Entire Purpose % size (/nn) Requirement Requirement Period subnet: subnet: totals: number-of-subnets: % Which netname will you use for this assignment? netname: % Will the End User return any address space? address-space-returned: #[EQUIPMENT DESCRIPTION]# % % What equipment will be used and how will it use the requested % address space? equipment-name: manufacturer-name: model-number: other-data: equipment-name: manufacturer-name: model-number: other-data: #[NETWORK DESCRIPTION]# % % Please add more information if you think it will help us understand % this request. <add more information> #[NETWORK DIAGRAM]# % % Have you attached a network diagram to this request? (Yes/No) diagram-attached: #[END of REQUEST]#