Application form to register domains ending .gov.uk or .ac.uk

Stage 1: Complete this form

Please note that to register one of these names with us you must purchase a hosting or forwarding package. The domain must reside on the Vantech nameservers.

Before completion ensure that you read the data protection statements. All fields on this form are mandatory.

Domain name required:	.
[Ensure that you have read the naming guidelines]
To represent:
[The full, official name of the organisation, project,or initiative for which the domain is being registered]
Domain owner:
[If representing a project or initiative, please state who the domain owners will be]
Description:
[The full description of the organisation in support of the name request, clearly indicating its eligibility for a domain name under ac.uk or gov.uk.] You must include, as concisely as possible, the following information: The status of the organisation, eg, central government executive agency, borough council The role and objective of the organisation The status of the staff (eg, civil servants, local government officials) The source of funding To whom the body is accountable Leaving out information here will cause your request to fail.
Your name:
Position held:
Admin contact:
[The name of the person or the official job title in your organisation responsible for administering the domain, the person to whom enquiries relating to the domain should be addressed]
Admin address:
[The full postal address of the admin contact including postcode]
Admin phone:
[The telephone number of the admin contact including dialling code but not country code]
Admin fax:
[The fax number of the admin contact including dialling code but not country code]
Admin email:
[The email address of the admin contact]
Hosting plan:
[Select the hosting package you require. You will be invoiced annually for this at the current rate. See pricelist.] Professional hosting and forwarding includes free email administration. The DIY options allow you to configure POP3 accounts and aliases through a personal control panel.
Additional notes:
[Any additional information that will help us process your request.] What to include here If you have selected the forwarding option we need the destination url. If your billing address differs from the admin contact details we need that too. Declaration I declare that I have read the naming conventions, eligibility guidelines and data protection statements and believe to the best of my knowledge that this application is valid and accurate. I declare that I have the authority to represent the organisation requesting the domain name above. I authorise Vantech Media to process my request for a UKERNA domain name and create a web hosting account for which I will pay an annual fee. I agree to pay Vantech Media the domain registration fee within 14 days of invoice and the two-yearly maintenance fee. When asked to do so by Vantech Media I will fax a confirmatory letter on my organisation's official stationery to UKERNA using the number given later.
Tick to agree:

Application form to register domains ending .gov.uk or .ac.uk

Stage 1: Complete this form

What to include here

Declaration