Section 1: Your organisation

Organisation Data Service (ODS) Code *

Organisation name *

Type of organisation *

Address *

Postcode *

Telephone number * Enter the phone number without any spaces

Section 2: The domain name administrator

Before completing this section read the description of a domain name administrator.

Refer to this web page for more information https://digital.nhs.uk/services/health-and-social-care-network/hscn-technical-guidance/domain-name-service-dns-guidance/domain-standards-and-guidance/management#the-trusted-domain-name-administrator-and-technical-contacts

Name * First and last name

Telephone number * Enter the phone number without any spaces

Email *

Section 3: The technical contact

A description of the technical contact is available using the web link below

www.digital.nhs.uk/services/health-and-social-care-network/hscn-technical-guidance/domain-name-service-dns-guidance/domain-standards-and-guidance/management#the-trusted-domain-name-administrator-and-technical-contacts

Name * First and last name

Telephone number * Enter the phone number without any spaces

Email *

Section 4: For domain names visible on HSCN

You do not need to complete this section if you are only requesting a record with an off-infrastructure target. If you do complete this section, all fields are required to allow us to process your application.

Domain name

Nameserver IP addresses * Include the IP addresses of at least 2 nameservers accessible from HSCN

Describe how your DNS service will comply with CAF and DSPT

Describe how your DNS service will comply with the standards and policies for HSCN DNS

Describe how your DNS service will collect query response data and provide it to CSOC

Section 5: For domain names visible on the public internet

Domain name

Nameserver IP addresses

Describe how your DNS service will comply with CAF and DSPT

Describe how your DNS service will comply with the standards and policies for HSCN DNS

Describe how your DNS service will collect query response data and provide it to CSOC

Section 6: For records visible on HSCN

You do not need to complete this section if you are only requesting an off-infrastructure delegation. If you do complete this section, all fields are required to allow us to process your application.

Domain name

Record name

Record type Record must be of type CAA, CNAME, DNAME, DS, MX, PTR, SRV, TXT or URI

Describe how your DNS service will comply with the standards and policies for HSCN DNS

Section 7: For records visible on the public internet

You do not need to complete this section if you are only requesting an off-infrastructure delegation. If you do complete this section, all fields are required to allow us to process your application.

Domain name

Record name

Record type Record must be of type CAA, CNAME, DNAME, DS, MX, PTR, SRV, TXT or URI

Record data Provide the record data appropriate for this record type

Describe how your DNS service will comply with the standards and policies for HSCN DNS

Section 8: Declaration

I confirm that in requesting this service, I will comply with the HSCN naming standards and policies, guidance for domain name administrators and technical contact, and adhere to the schedule of activities for domain name administrators and technical contacts.

I agree

*required field

Any personal information you provide will be processed in accordance with the UK General Data Protection Regulation (GDPR). We will use the information to: process your request; and contact you in the even that there is an issue with the domains under your remit; and provide any further relevant information or services you have requested; and support our service development activities