APPENDIX B DATA REQUIRED FOR EACH SECOND LEVEL DOMAIN Complete Domain Name......: Entity or Individual Using Domain Name Name..........: Postal Address.............: City.......................: State......................: Postal Code................: Country ..................: Country Code...............: E-mail Address.............: State or Country of Incorporation or Partnership (if applicable)................: Name and Address of a designated agent for service of process where the Registrar is located (Applicant may designate the Registrar).............: Administrative Contact NIC Handle (if known)......: (I)ndividual (R)ole........: Name.......................: Organization Name..........: Postal Address.............: City.......................: State......................: Postal Code................: Country......................: Country Code...............: Phone Number...............: Fax Number.................: E-Mail Address...............: Technical Contact NIC Handle (if known)......: (I)ndividual (R)ole........: Name.......................: Organization Name..........: Postal Address.............: City.......................: State......................: Postal Code................: Country....................: Country Code...............: Phone Number...............: Fax Number.................: E-Mail Address..............: Primary Name Server Primary Server Hostname....: Primary Server Netaddress..: Secondary Name Server(s) Secondary Server Hostname..: Secondary Server Netaddress: APPENDIX C REGISTRATION AGREEMENT AND APPLICATION FORM FOR ASSIGNMENT OF SECOND LEVEL DOMAIN NAME IN A GENERIC TOP LEVEL DOMAIN 1. Pursuant to the terms and conditions of the Memorandum of Understanding on the Generic Top Level Domain Name Space of the Internet Domain Name System ("gTLD-MoU") signed in Geneva on May 1, 1997, as amended, this is a request for registration of the following domain name (provide complete and exact domain name....: 2. Entity or Individual Requesting Registration of Domain Name ("Applicant") 2a. Name................: 2b. Postal Address..: 2c. City...................: 2d. State..................: 2e. Postal Code.......: 2f. Country..............: 2g.Country Code.....: 2h. E-mail Address..: 2g. State or Country of Incorporation or Partnership (if applicable)................: 2h: Name, address, fax and e-mail address of a designated agent for (i) notifications concerning any Administrative Domain Name Challenge Panel ("ACP"), Mediation or Expedited Arbitration procedure to be administered by the WIPO Arbitration and Mediation Center and (ii) service of process where the Registrar is located. Applicant may designate the Registrar.............: 3.Administrative Contact 3a. NIC Handle (if known)......: 3b. (I)ndividual (R)ole........: 3c. Name.......................: 3d. Organization Name..........: 3e. Postal Address.............: 3f. City.......................: 3g. State......................: 3h. Postal Code................: 3i. Country ..................: 3j. Country Code...............: 3k. Phone Number...............: 3l. Fax Number.................: 3m. E-mail Address...............: 4.Technical Contact 4a. NIC Handle (if known)......: 4b. (I)ndividual (R)ole........: 4c. Name.......................: 4d. Organization Name..........: 4e. Postal Address.............: 4f. City.......................: 4g. State......................: 4h. Postal Code................: 4i. Country.................: 4j. Country Code...............: 4k. Phone Number...............: 4l. Fax Number.................: 4m. E-mail Address.............: 5.Billing Contact 5a. NIC Handle (if known)......: 5b. (I)ndividual (R)ole........: 5c. Name.......................: 5d. Organization Name..........: 5e. Postal Address.............: 5f. City.......................: 5g. State......................: 5h. Postal Code.............: 5i. Country....................: 5j. Country Code...............: 5k. Phone Number...............: 5l. Fax Number.................: 5m. E-Mailbox..................: 6. Primary Name Server 6a. Primary Server Hostname....: 6b. Primary Server Netaddress..: 7. Secondary Name Server(s) 7a. Secondary Server Hostname..: 7b. Secondary Server Netaddress: 8. Invoice Delivery (E)mail (P)ostal...........: 9. FEES: An initial charge of __________will be made to register the domain name. This charge covers any updates required during the first ________ years. This application will not be processed unless and until the Registrar has received payment of the initial charge; the application and the CORE fee must be received by the Repository Operator before the registration takes effect. 10. RIGHTS OF THIRD PARTIES: Applicant certifies that, to her/his/its knowledge, the registration and use of the requested domain name does not violate any trademark or other rights of any other party. Applicant will indemnify Registrar, CORE, the Repository Operator, POC and WIPO against, and hold them harmless from, all costs, claims, liabilities and expenses (including attorneys fees) arising out of or in connection with any such violations. 11. INTENT TO USE THE DOMAIN NAME: Applicant affirms that he, she or it has a bona fide intent to use the domain name publicly within 60 days of registration, and to continue such use in the foreseeable future. 12. PURPOSE OF USE OF THE DOMAIN NAME: Applicant intends to use the domain name for the following purpose ............................................................................................................................... 13. REASON FOR REQUESTING THE PARTICULAR DOMAIN NAME: Applicant requests this domain name for the following reason (check one): _____ Conforms to Applicant's name or variation thereof _____ Conforms to Applicant's trademark or variation thereof _____ Other (provide explanation) 14. OPTIONAL 60-DAY WAITING PERIOD: _____ Applicant requests the 60-day waiting period. 15. DISPUTES BETWEEN APPLICANT AND A THIRD PARTY THAT ARE SUBMITTED BY THE THIRD PARTY TO THE ACP PROCEDURE: Applicant acknowledges that, by virtue of the provisions of the gTLD-MoU, any third party may challenge the assignment to, and registration and use by Applicant of the domain name before an Administrative Domain Name Challenge Panel ("ACP") in accordance with the WIPO ACP Rules. Applicant further acknowledges that the decisions of an ACP may determine rights of Applicant and/or other parties with respect to the assignment, registration and use of a particular domain name, and agrees to be bound by the ACP decisions. 16. DISPUTES BETWEEN APPLICANT AND A THIRD PARTY THAT ARE BROUGHT BY THE THIRD PARTY TO MEDIATION AND/OR ARBITRATION: Applicant agrees that any dispute, controversy or claim ("Claim") between Applicant and a third party, arising out of or relating to this application for, and registration and use of, the domain name shall, upon the filing of a Request for Mediation by the third party with the WIPO Center, be submitted to on-line mediation in accordance with the WIPO On-Line Mediation Rules. Applicant further agrees that, to the extent (a) any such Claim has not been settled pursuant to such mediation within 30 days of the commencement of the mediation, or (b) before the expiration of such 30 day period, either party fails to participate or to continue to participate in the mediation, the Claim shall, upon the filing of a Request for Arbitration by the third party, be referred to and finally determined by on-line arbitration in accordance with the WIPO On-Line Expedited Arbitration Rules. Such arbitration procedure shall not be implemented if Applicant declines mandatory submission to arbitration by checking the box below. The language to be used in the mediation or arbitration shall be English, unless the parties agree otherwise. Whether or not the parties decide that an in-person hearing is necessary, the place of arbitration shall be deemed to be, unless the parties agree otherwise, either the location of Applicant as indicated in the Registration Agreement or the location of the Registrar, at the option of the third party. __ Applicant declines mandatory submission to arbitration in the case of Claims referred to in the paragraph above. 17. DISPUTES BETWEEN APPLICANT AND A THIRD PARTY THAT ARE SUBMITTED BY THE THIRD PARTY TO COURT JURISDICTION: Applicant submits to the personal and subject matter jurisdiction and venue of a competent tribunal in the country where the Registrar resides for purposes of any action brought under applicable trademark law, unfair competition laws, or similar/related laws arising out of actual or intended use of the domain name applied for; and Applicant waives all rights to challenge such personal jurisdiction, subject matter jurisdiction and/or venue. 18. DISPUTES BETWEEN APPLICANT AND REGISTRAR AND/OR CORE: Applicant agrees that any dispute, controversy or claim between Applicant and Registrar and/or CORE arising out of or relating to this application or registration made upon this application are to be settled by arbitration in accordance with the WIPO On-Line Expedited Arbitration Rules. Unless otherwise agreed, the arbitral procedure shall be conducted in the English language. Whether or not the parties decide that an in-person hearing is necessary, the place of arbitration shall be deemed to be, unless the parties agree otherwise, the location of the Registrar. Applicant acknowledges that the Registrar and CORE are bound by the decisions and results of the ACP, Mediation and Arbitration procedures administered by the WIPO Arbitration and Mediation Center. 19. LAME DELEGATION: The domain name registration is subject to cancellation for lame delegation. 20. SURVIVAL OF OBLIGATIONS If this application is accepted, all obligations of Applicant pursuant to this application shall survive acceptance of the application and shall remain binding upon Applicant after the registration takes effect. 21. CERTIFICATION Applicant certifies that it has read the above Registration Application Form and completed it truthfully and accurately. Applicant agrees that the registration of the domain name is subject to the provisions of this Registration Application Form, and any other applicable registration conditions as may be established by CORE.