Bangladesh Telecommunications Company Limited

Bangladesh Telecommunications Company Limited Telejogajog Bhaban, 37/E, Eskaton Garden, Dhaka-1000.

Registration Form for Domain Name under .bd

Please read the following note before filling out this form.

Note: All Domain Name Registration Fees must be paid in advance. By completing this registration form and submitting it to us, you are agreeing to be bound by the terms and conditions set forth in the Registration Agreement and the Domain Name Dispute Policy.

To make your registration process easy, please follow the steps below:  Review the Domain Name Registration Agreement and Domain name Policy.  Have your Name Server Information ready.

Desired Domain Name : (without www part & in block letters)

Registrant Information

Registration Name : Address : City : State/Province (If applicable) : Postal/Zip Code : Country : Phone : Fax : Email Address :

Contact Information

[A] Administrative Contact

.bd handle (Registration Office) : Full Name : Title/Occupation : Organisation (If applicable) : Address : City : State/Province (If applicable) : Postal/Zip Code : Country : Phone & Fax : Email Address :

Signature : Date :

of 2 [B] Technical Contact

If this information is the same as the Administration Contact information, you may keep it blank. Otherwise, Please complete this section with the appropriate information.

Full Name : Title/Occupation : Organisation (If applicable) : Address : City : State/Province (If applicable) : Postal/Zip Code : Country : Phone & Fax : Email Address :

Signature : Date :

NAME SERVER INFORMATION Please enter the Primary and Secondary Name Server information below. This information will be available from the DNS/Web Site hosting Company where you are going to host/already have hosted your web site. Please contact them for the appropriate Hostnames and Network addresses. If you do not know your name server information and want only reservation of the domain name applied for, you may update it later.

[a] Primary Domain Name Server

Host Name : Network address : [b] Secondary Domain Name Server(s)

Host Name : Network Address : Host Name (optional) : Network Address (optional) :

FOR OFFICIAL USE ONLY Registration Information Registration number : Date :

Signature of Authorized Personnel : Date :