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					                                   Government of the Peoples Republic of Bangladesh
                                 Bangladesh Telegraph and Telephone Board


                     .bd DOMAIN NAME REGISTRATION FORM
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:
n Review the Domain Name Registration Agreement and Domain Name Dispute Policy.
n Have your Name Server Information ready.
Registrant Information:
Domain’ Name
       s                                   :
Registrant Name                            :
Address                                    :
City                                       :
State/Province (if applicable)             :
Postal/Zip Code                            :
Country Code                               :
Email:                                          Phone:                              Fax:


Contact Information:
A) Administrative Contact Information:
.bd Handle (Registration office)           :
Full Name                                  :
Title/Occupation                           :
Organization (if applicable)               :
Address                                    :
City                                       :
State/Province (if applicable)             :
Postal/Zip Code                            :
Country Code                               :
Email:                                          Phone:                              Fax:
Signature:                                 :                                        Date:
B) Technical Contact Information:
If this information is the same as the Administrative Contact information, you may keep it blank.
Otherwise, please complete this section with the appropriate information.
Full Name                                 :
Title/Occupation                          :
Organization (if applicable)              :
Address                                   :
City                                      :
State (outside Bangladesh only )          :
Postal/Zip Code                           :
Country Code                              :
Email:                                         Phone:                              Fax:
Signature:                                :                                      Date:


Name Server Information:
Please enter the Primary and Secondary Name Server information below. This information is available from your Internet
Service Provider (ISP). 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.
 Primary Domain Name Server
Desired Domain Name
Whether this Domain Name is registered
under any of the generic Ltd.                           q   Yes                            q    No

Hostname                                  :
Netaddress                                :
 Secondary Domain Name Server
Hostname                                  :
Netaddress                                :
Hostname (optional)                       :
Netaddress (optional)                     :


                                              FOR OFFICIAL USE ONLY

Registration Information:
Registration Number                       :
Date                                      :
.bd Handle                                :
Signature of Authorized Personnel         :                                     Date: