Kindly Note

The application form must be completed online.
A hand written application form will not be considered.
Press the "submit" button at the bottom of the page and correct errors if any.


Application to establish an Organisational Sub-domain within the .GOV.ZA namespace (Government VPN)
 

1. Domain Name

Give the name of the proposed organisational sub-domain. This name will be used in tables and lists associating the domain with the domain server and with IP addresses. Organisational sub-domain names within the .gov.za namespace must be kept as short as possible and should be meaningful. Unsuitable names may be rejected by the .gov.za administrators.

 
.gov.za
 
 

2. Department / Organisation

Provide the name and postal address of the government department or organisation establishing this sub-domain.
 
2a. Department Name / Registrant
2b. Postal Address
2c. Postal Code
 
3. Administrative Contact (This person must not be the same as the technical contact)
 
Please provide details of a person who will carry the responsibility for administrative and policy matters of the sub-domain to be established.
 
3a. Name (last, first)
3b. Title / Position
3c. Department
3d. Telephone number x
3e. Fax number x
3f. Postal Address
3g. Postal Code
3h. Cellular number
3i. E-mail address
 
4. Technical Contact (This person must not be the same as the administrative contact)
 
Please provide details of a person who will carry the responsibility for all technical matters of the sub-domain to be established. This is the person or group who will be doing the actual DNS administration. If your nameservers are housed at a commercial ISP then the details here will be those of the person or team at that ISP.
 
4a. Name (last, first)
4b. Title / Position
4c. Department
4d. Telephone number x
4e. Fax number x
4f. Postal Address
4g. Postal Code
4h. Cellular number
4i. E-mail address
 
NOTE: The e-mail address given here MUST be the same as that listed in the SOA record of the sub-domain to be established.
 

5. Nameservers (The nameservers must be operational at the time of submission.)

Sub-domain administrators must provide details of at least two independant nameserver hosts for the requested sub-domain. Establishing these nameservers in physically seperate locations and on different networks is strongly recommended.

 
Primary nameserver within your network.
 
5a. Primary server domain name
5b. Primary server IP address
 
Secondary nameserver within your network.
 
5c. Secondary server domain name
5d. Secondary server IP address
 

6. Other nameservers

If you plan on having other/additional nameservers, these must be listed in your zone file with the appropriate NS records. They will not be referenced by this delegation. Please take note that having too many NS records can have a serious negative impact on performance.
 
7. Mail Exchanger (The service must be active at the time of submission.)

Please provide details of at least one server which will act as mail exchanger (MX) for the sub-domain to be established. The use of a mail exchanger is mandatory for all sub-domains of the .gov.za domain. Additional mail exchangers are recommended for fallback purposes but are not mandatory.
 
7a. Primary MX domain name
7b. Primary MX IP address
 

8. Terms and conditions

The applicant, acknowledges that he/she has read and accepted the terms and conditions hereto and declares that he/she has the approval of the department or organisation to be the administrator of this sub-domain.

 
Place
Date (dd/mm/yyyy)
/ /
Name of applicant
     
Signature
(To be signed after submission)		 ______
_____________