Application to register a Dispute entry for a .lu domain name

Claimant :

The application form must be sent to DNS-LU, accompanied with supporting documentation

The undersigned applies for a Dispute entry ("Dispute" ) on behalf of following claimant :

The dispute concerns following domain name :

Dispute application All rights reserved Fondation RESTENA October 2015 Fondation RESTENA 2, avenue de l'Université L-4365 Esch-sur-Alzette

Tel. +352 42 44 091 Fax: +352 42 24 73 e-mail: admin@restena.lu

Conditions to be met to file a Dispute application : I. I confirm hereby that I have submitted a claim in writing to the domain Holder (its administrative contact), but I received no response / the response received was not satisfactory. II. I certify that formal measures* have been instigated against present domain Holder in order to solve the dispute. (*legal action, alternative dispute resolution or arbitration procedure) III. In my opinion the claimant has a right to the domain and/or these rights are being infringed by the domain name and the claimant is calling upon his rights on the use of a name recorded as domain name. Supporting documentation proving the claimant's rights and nature of formal actions taken, written (or translated) in French, German or English language, is joined to present application, without prejudice to the discretion of DNS-LU as regards the merits of such documentation received.

Phone / fax :

Name, forename (if of private holder) :

E-mail :

PO Box, ZIP code, city :

Organisation, holder :

Address :

Present domain Holder :

I join pieces, consisting of page(s) as supporting evidence for point II and point III. of present form.

Fondation RESTENA DNS-LU 2, avenue de l'Université L-4365 Esch-sur-Alzette

Phone: +352 42 44 091 Fax: +352 42 24 73 e-mail: domreg@dns.lu

Dispute application All rights reserved Fondation RESTENA October 2015 Fondation RESTENA 2, avenue de l'Université L-4365 Esch-sur-Alzette

Tel: +352 42 44 091 Fax: +352 42 24 73 e-mail: admin@restena.lu

The only purpose of registering a domain name Dispute is to assist the claimant in finding an agreement through formal measures taken against the domain Holder. Acceptance of the dispute application by DNS-LU will block the domain name which cannot be transferred to anyone else, but the claimant, subject to the resolution of the underlying conflict. The undersigned shall be informed when the Dispute request is accepted. DNS-LU reserves the right to reject any uncomplete or incorrect Dispute application form. The undersigned, if he is not the claimant himself, declares that he has the power to represent the above mentioned claimant and is mandated to submit present Dispute application. The undersigned accepts that DNS-LU may request presentation of this mandate. DNS-LU reserves the right to refuse to process the Dispute application until reception of the mandate. I accept, in the name and on behalf of the claimant, in the event of a claim, the claimant is definitively responsible for any damages and/or court costs resulting from the processing of present Dispute application. The claimant indemnifies DNS-LU and holds the latter harmless in this regard. I am informed that the Dispute is valid for an initial period of one year and will expire without further notice. DNS-LU will, however, extend it for an additional period of six months, provided the claimant submits another application form, accompanied by documentation showing that the disagreement with the domain holder has still not been solved. The extension request must be provided at least four weeks prior to the initial expiration date. I am informed that I may ask at any time the cancellation of the Dispute by submitting the standard cancellation form to DNS-LU. I accept that DNS-LU may cancel the Dispute at its own initiative in case DNS-LU becomes aware of evidence which do not justify the Dispute anymore. I accept that the cancellation of the domain domain terminates the dispute period without further notice and that at the end of the quarantine the domain name is not automatically transferred to the claimant. I acknowledge and agree that the deleted domain will then immediately be available for registration by anyone else who might be interested in doing so as set forth in applicable terms and conditions. In the event that the claimant should become the future holder subsequent to the resolution of the conflict, I undertake to inform

About this request :

Name, forename:

E-mail:

in his function as future administrative contact about his obligation to instruct DNS-LU or any accredited .lu registrar of his choice to initiate a trade request. All documents proving the resolution of the dispute must be submitted to DNS-LU and are an integral part of the trade request. Documents have to be written (or translated) in French, German or English language. DNS-LU reserves the right to reject the approval of any uncomplete or incorrect trade request. I certify that to my knowledge the information contained in this request is complete and accurate, and that present Dispute application is not being submitted abusively.

E-mail:

Date:

Phone / fax:

Place of signature:

Signature : _____________________________

Date:

Signature : _____________________________

This document was prepared and submitted by (entity, name, forename) :