To Be Issued on Company Letterhead

To Be Issued on Company Letterhead

DISCLOSURE OF CROSS-OWNERSHIP INTERESTS

[Date]

To Be Issued on Company Letterhead

To Be Issued on Company Letterhead

ICANN

12025 Waterfront Drive, Suite 300

Los Angeles, CA 90094

RE: Disclosure of Cross-Ownership Interests – [Insert TLD]

To Whom It May Concern:

Please be advised that as of the date of this letter, [Insert Applicant Name] (“Applicant”) hereby discloses the following cross-ownership interests in registrars and/or registrar resellers for services to be provided under the New gTLD Registry Agreement (the “Registry Agreement”) for the top-level domain ______(the “TLD”):

Entity Type (e.g., reseller or registrar):
Applicant Ownership/Relationship to Entity:
Entity Name (legal name and type):
Entity Accreditation(s):
Entity Contact Name (e.g., CEO, CFO, etc.):
Title:
Mailing Address:
Mailing Address:
Phone: / ( ) -
Fax: / ( ) -

*Copy and paste this section as needed to identify additional Cross-Ownership interests

Applicant represent that the cross-ownership interests identified herein include any and all: (i) ownership interest Applicant holds in any registrar or reseller of registered names, (ii) ownership interest that a registrar or reseller of registered names holds in the Applicant, and (iii) relationships under common control with, control or controlled by any registrar or reseller of registered names.

Applicant acknowledges that for the purposes of this disclosure, "control" (including the terms “controlled by” and “under common control with”) means the possession, directly or indirectly, of the power to direct or cause the direction of the management or policies of a person or entity, whether through the ownership of securities, as trustee or executor, by serving as a member of a board of directors or equivalent governing body, by contract, by credit arrangement or otherwise.

Applicant further acknowledges that ICANN retains the right to refer an application to a competition authority prior to entry into the Registry Agreement if it is determined that any such cross-ownership interests could raise competition issues.

Sincerely,

[APPLICANT NAME]

To Be Issued on Company Letterhead

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AUTHORIZED SIGNATURE

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AUTHORIZED SIGNATURE

To Be Issued on Company Letterhead

______

NAME

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NAME

To Be Issued on Company Letterhead

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TITLE

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TITLE

To Be Issued on Applicant Letterhead