---------------------------------------------------------------------------- ID&A Corporation - Domain Registration SAFE GUARD EXPLANATION .NL DOMAIN ---------------------------------------------------------------------------- Desired Domainname : .nl Name company : Address : Postcode/Residence : Name of contact person : Phone number : Fax number : Email address : Chamber of Commerce : Place of registration : Number of registration : Following the regulations for registration of . NL domainnames To be able to request the domainname you desire, in addition to the data asked above, we will need the following documents: 1. A document from the Chamber of Commerce or register,not older then 6 months. 2. Completely filled in form of the Safe guard explanation. ---------------------------------------------------------------------------- SAFE GUARD EXPLANATION This explanation must be signed by the applicant( future holder ) for every domainname that will be requested,and must be put in at his Provider. ---------------------------------------------------------------------------- Safe guard explanation belonging with the application of a domainname. Undersigned declares to accept the knowledge of the current conditions of the Regulations of Domainnames (NL) and to accept this. Undersigned declares also that the data on the copy of this application attached to this statement, are correct and completed. Undersigned declares that he is qualified to use the requested domainname. Undersigned declares that: a The domainname does not contain an indication that will be misleading according to the purpose or function of the domainname or the thereby presented information. b The domainname agrees with a mark or (trade)name of the applicant. c The domainname does not violate the rights of a third party. Undersigned safequards 'the Dutch foundation for internet domainname registration' ("the Foundation"), the committee members of the Foundation, and the participants at the Foundation in case of,and will indemnify them for all costs and damage, resulting from a claim of a third party, in respect of any and all usage of the domain by the Undersigned. Undersigned will notify the Foundation immediately of any notification from a third party that the domainname violates his rights. Undersigned accepts and agrees that should the Foundation be involved in a matter of rights connected with the domainname, the Foundation will be free to choose it's own lawyer. Domainname: ____________________________________ Organisation/company: ____________________________________ Address: ____________________________________ Name of contact person: ____________________________________ Function: ____________________________________ Date: ____________________________________ Signature: ____________________________________ ---------------------------------------------------------------------------- ID&A Corporation - Domain Registration Adress: Heymansstraat 15, 3076 CD, Rotterdam, NL Fax: +31-(0)10-4920800 ----------------------------------------------------------------------------