.mw ccTLD Registrar Accreditation Form - Expression of Interest Send completed form to domains@registrar.mw with further details as below. Important Note: On submitting this form, Applicant (organization), expressing interest to be accredited as a Registrar on the Malawi .mw ccTLD, will be requested further, to submit to domains@registrar.mw, copies of the following documents: 1. Business Profile. 2. A certified copy of organization business registration. Note: You are required to complete ALL fields: A: GENERAL INFORMATION: Name of the applicant (organization) applying to be a .mw Registrar: Type of business of applicant (organization): Contact details of applicant (organization) Physical location: P.O. Box address: City: Country: Telephone number: Fax number: Cell phone number: E-mail address: Administrative contact: Name: Telephone number: E-mail address: Technical contact: Name: Telephone number: E-mail address: Website of applicant (organization) URL: Other locations where applicant (organization) operates such business: B: TECHNICAL CAPABILITIES: Applicant (organization) technical profile: List at least two(2) DNS servers that applicant operates, each with hostname and IP address: Hostname 1 : IP address 1 : Hostname 2 : IP address 2 : List of at least two (2) .mw domain names hosted on the DNS servers: Domain Name 1: Primary DNS Server: Secondary DNS Server: Domain Name 2: Primary DNS Server: Secondary DNS Server: List the static Public IPv4 and IPv6 addresses on subnets that applicant intends to use as a Registrar for accessing the .mw Registry on EPP connections IPv4 : IPv4 Subnet (mask or CDIR): IPv6 : IPv6 Subnet (mask or CDIR): Provide a list of at least two (2) staff members that will be providing and supporting Registrar services to the Registrants showing name, e-mail address and experience on DNS: 1st Staff member: Name 1: E-mail: Experience on DNS: 2nd Staff member: Name 2: E-mail: Experience on DNS: A digital certificate is required for a registrar to do EPP connections to the Registry. SDNP has set up a local Certification Authority (CA) to generate and provide digital certificates, however, registrars may choose to use their own. Does the Applicant have a digital certificate to use as .mw Registrar? Yes/No: If applicant chooses to use own certificate then applicant will need to supply the public digital certificate of the Certification Authority for the certificate of the applicant. Will applicant need to get a digital certificate from the Registry? Yes/No: C: ATTESTATION OF TRUTHFUL DISCLOSURE: By submitting this form, expressing interest to become accredited as a registrar on .mw domains, the applicant: i. Attests that the information contained in this application, and all supporting documents submitted on this application, are true and accurate to the best of Applicant's knowledge; ii. Confirms that they have read and understand the policy on .mw domains available at http://www.sdnp.registrar.mw/policy.php iii. Gives SDNP permission to contact third parties, investigate, request and obtain additional information and documentation, and otherwise verify the information contained in this application; iv. Waives liability on the part of SDNP for its actions in verifying the information provided in this application; v. Waives liability on the part of any third parties who provide truthful, material, relevant information about Applicant as requested in this application. D: DETAILS OF THE PERSON MAKING THIS EXPRESSION OF INTEREST (REQUESTER) ON BEHALF OF APPLICANT (ORGANIZATION) Name: Organization: Address: Physical, P.O. Box: City: Country: Telephone Number: Fax number: Email address: Send completed for to Malawi SDNP, P.O. Box 31762, CHICHIRI, BLANTYRE 3, MALAWI. TEL: +265-1 874979 / 999 888 461 / 882 089 166 CELL: +265-888 824 787 / 888 844 657 FAX: +265-1 873944 Email: domains@registrar.mw