Page 1 of 3 (DNS1)

GITN Domain Name Service Form

Revision : 3.0
SDN BHD Date Issued : 20.09.2007

Filled By Applicant For GITN Used

1. Domain Name : . gov . my

Ticket No :
Others
Example : mampu.gov.my / rakanmuda.org.my

2. Type Of Application
Date Register :
*Fill Form DNS03 & DNS 02
New Domain Registration for Details
Register or modify At :
dns1.gitn.net.
Domain Modification *Fill Form DNS02 only
my

dns2.gitn.net.
my

Remarks :

3. Requestor
Received By:
Name :
Name :
Agency :
Email :
Email : Phone :
Phone ( off / hp) : /
Signature or :
Implement By:
Stamp Pad
Name :
Email :
Phone :
Date Request :
Expected Deliverable : (dd/mm/yy)
*The applicant is responsible for the accuracy of the information contained in this form.

Date Received :
Task Begin :

GITN – Received By GITN Verification : Approved / Not Approved

Name : Name :
Signature : Signature :
Date : Date :
 Page 2 0f 3 ( DNS1)
GITN DNS Configuration Form
SDN BHD Revision : 3.0
Date Issued : 20.09.2007

Filled By Applicant For GITN Used

Changes Mode HostName Domain Names Type Of Server Publish At Hosting At IP Address Public IP Remarks

mail server Internet Public DNS GITN

web server Intranet Private DNS GITN
apps server Both Non Private DNS GITN
Non Public DNS GITN
*for non DNS GITN,please
provide IP DNS

Add Del Edit

Add Del Edit

Add xDel Edit

Filled by requestor

Add Del Edit

Add Del Edit

Add Del Edit

Add Del Edit

Add Del Edit

Name :
Date :
Remarks:
Email :

* Gived a copy to a requestor

* Only 5 entries per page
 Page 3 of 3 (DNS1)
GITN Domain Name Service Form
New Registration Revision : 3.0
SDN BHD Date Issued : 20.09.2007

.
1. Type Of Registration

New Domain Registration

Modify Domain

2. Domain Name :
Example : mampu.gov.my/rakanmuda.org.my

3. Registrant Details (Fill up by Requestor)

Registrant Must have a local presence in Malaysia

3a. Organisation Name :

3b. Organisation Registration No :
3c. Organisation Address :

3d. Organisation Phone Number :

3e. Organisation Fax Number :

4. Administrative Contact (Fill up by Requestor)

The Administrative Contact must be an authorised employee of the Registrant

4a. Name :
4b. Phone Number :
4c. Fax Number :
4d Email Address :

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