AU REGISTRANT TRANSFER from New Registrant (Transferee)

.AU REGISTRANT TRANSFER FROM – New Registrant (Transferee)

(Please print clearly)

Domain Name:

______

Registrant Name:

______

Eligibility Type (check one):

o  Charity

o  Child Care Centre

o  Citizen/Resident

o  Club

o  Commercial Statutory Body

o  Company

o  Government School

o  Higher Education Institution

o  Incorporated Association

o  Industry Body

o  National Body

o  Non-Government School

o  Non-Profit Organization

o  Partnership

o  Pending TM Owner

o  Political Party

o  Pre School

o  Registered Business

o  Religious/Church Group

o  Research Organization

o  Sole Trader

o  Trade Union

o  Trademark Owner

o  Training Organization

o  OTHER

*The following three fields are optional:

*Eligibility Name: ______

(The name on the eligibility ID document. Enter the name of the registrant eligible to register the domain).

*Eligibility ID: ______

The identifier of the eligibility document. Only use if it differs from the registrant's own corresponding ID such as when the registrant is using a registered business name or trademark to make themselves eligible for the domain name.

*Registrant ID: ______

o  ABN

o  CAN

o  Other

(The identifier of the registrant (e.g. the business or trade license number).

Owner Contact Information (please complete in full):

First Name: ______

Last Name:______

Organization Name: ______

Street Address: ______

City: ______

State/Prov.(if appl.): ______

2 Letter Country Code: ______

Postal Code: ______

Phone Number: ______

Email: ______

DECLARATION BY PROPSED TRANSFEREE

I/We declare and warrant to the Registrar and to .au Domain Administration Ltd that:

·  I am authorized to submit this form for or on behalf of the proposed new registrant of the domain name; and

·  The proposed new registrant is eligible to hold the domain name license under auDA’s published policies from time to time; and

·  All information contained in this transfer form are, complete and correct and not misleading.

The proposed new registrant hereby accepts the transfer of the domain name licence subject to the terms and conditions on which the current registrant held the domain name license at the time of transfer.

(Signature of Owner Contact stated above)