Page 1 of 3 (DNS1)
GITN
SDN BHD
Domain Name Service Form
Filled By Applicant
1.
Domain Name
Revision : 3.1
Date Issued : 12.03.2010
For GITN Used
:
. gov . my
Ticket No :
Others
Example
2.
:
mampu.gov.my / rakanmuda.org.my
Type Of Application
New Domain Registration
*Fill Form DNS03 & DNS 02
for Details
Domain Modification
*Fill Form DNS02 only
Date Register
:
Register or modify At :
dns1.gitn.net.my
dns2.gitn.net.my
Remarks :
3.
Received By:
Requestor
Name
:
Agency
:
Email
:
Phone ( off / hp)
:
Signature and
:
/
:
Expected Deliverable
:
:
Email
:
Phone
:
Implement By:
Stamp Pad
Date Request
Name
(dd/mm/yy)
*The applicant is responsible for the accuracy of the information contained in this form.
Name
:
Email
:
Phone
:
Date Received
:
Task Begin
:
GITN – Received By
GITN Verification
:
Name
Signature
Date
Name
Signature
Date
:
:
:
:
:
:
Approved / Not Approved
GITN
SDN BHD
Page 2 0f 3 ( DNS1)
DNS Configuration Form
Revision : 3.1
Date Issued : 12.03.2010
Filled By Applicant
Changes Mode
Add
Del
Edit
Add
Del
Edit
Add
x Del
Edit
For GITN Used
HostName
Domain Names
Type Of Server
Publish At
Hosting At
mail server
web server
apps server
Internet
Intranet
Both
Public DNS GITN
Private DNS GITN
Non Private DNS GITN
Non Public DNS GITN
*for non DNS GITN,please
provide IP DNS
IP Address
Public IP
Remarks
websvr
Ex: www.adk.gov.my
web server
Internet
Public GITN
10.20.20.200
202.187.32.32
dns1.gitn.net.my
exchange01
Ex: smsmtp.kem.gov.my
mail server
Both
Pub/Pri GITN
10.10.100.100
203.106.3.100
dns1 / dnsi2
appserver
Ex: pms01.icu.gov.my
apps server
Intranet
Internal DNS
10.31.54.74
Null
Amber
Filled by requestor
Add
Del
Edit
Add
Del
Edit
Add
Del
Edit
Add
Del
Edit
Add
Del
Edit
Remarks:
* Only 5 entries per page
Name
Date
Email
:
:
:
* Gived a copy to a requestor
Page 3 of 3 (DNS1)
GITN
SDN BHD
Domain Name Service Form
New Registration
Revision : 3.1
Date Issued : 12.03.2010
.
1.
Type Of Registration
New Domain Registration
Modify Domain
2.
3.
Domain Name
Example
:
:
mampu.gov.my/rakanmuda.org.my
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.