Generali Request Inc.

Edgemoor Research Institute

Developing voluntary technical solutions to complex data-related public policy challenges.

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Project Jake | Requestor Group Membership Application

⚠️ Important Legal Notice: By submitting this application, you agree to the Requestor Agent – Data Holder Agreement. Material breaches may result in immediate termination and legal action.

Step 1 of 6

A. Agreement Acceptance

Requestor Agent – Data Holder Agreement v3.0

Purpose (Section 1): This Agreement establishes a legally compliant framework under which a Requestor may submit requests for Domain Name Registration Data...

[Full agreement available at /agreement-full]

I have read and accept the RqA-DHA Agreement Terms and Conditions (Parts 1-6) *

I understand that disclosed data will be used exclusively for stated purposes only per Section 3.1 *

I confirm we will not sell, license, share, or disclose data to third parties without authorization *

✏️ Required for Section 2.1 compliance (Requestor Group membership eligibility)

B. Legal Entity Information

Legal Entity Name *

Official registered business/trust/entity name

Trading Name (if different)

Registration/Incorporation Number *

Jurisdiction of Incorporation *

Date of Establishment *

Primary Business Activity *

Max 500 characters

C. Contact Information

Authorized Representative (Per Section 4.1)

Full Name *

Email Address *

Phone Number *

Physical Address *

Technical Contact

Name

Email *

Phone

Compliance Officer (Required per Section 5)

Name *

Email *

D. Requestor Agent Assignment

📋 Per Section 2.1: You must have a separate signed RqA-Rq Agreement with your Requestor Agent before proceeding.

Requestor Agent Organization Name *

Existing RqA-Rq Agreement ID *

Agreement Version *

Authorization Date *

Upload Signed RqA-Rq Agreement (PDF) *

Max file size: 10MB

E. Purpose Statement

⚖️ Per Sections 1.4 & 3.1: Registrant Data disclosed under this Agreement may be used exclusively for the specific purpose stated below. Bulk or speculative requests are prohibited.

Intended Use Case 1 *

Description of Need *

Explain why data is strictly necessary (max 500 words)

Relevant Jurisdiction(s)

Statement of Necessity, Lawfulness & Proportionality *

Demonstrate strict necessity and proportionality (max 1000 words)

F. Compliance Acknowledgments

☑️ Acknowledge each provision by checking the box below

Sec 3.1: Exclusive use for stated purpose only

Sec 3.2(a): No secondary use of data

Sec 3.2(b): No sale/sharing with third parties

Sec 3.3: No bulk/speculative requests

Sec 4.1(a): Accurate identity representation

Sec 4.1(b): No safeguard circumvention

Sec 5: Recourse & enforcement cooperation

Sec 6.2: Acknowledge potential fees

G. Data Security Commitments

✓ Confirm implementation of each security measure (per Section 1.4)

Security Measure	Implemented?	Evidence Reference
Access controls and authentication
Data encryption (at rest & in transit)
Logging and audit trail capability
Incident response procedure
Staff training on data handling
Data retention/deletion policy

H. Declarations & Digital Signature

I hereby declare that:

The information provided is accurate and complete
I have authority to bind the Requestor entity to the RqA-DHA Agreement terms
The Requestor will comply with all applicable data protection and due process requirements
Material breach may result in immediate exclusion from the Requestor Group

Full Name (Digital Signature) *

Title/Position *

Date *

I confirm I have authority to sign on behalf of the Requestor entity *

I. Supporting Documents

Upload scanned copies of supporting documents (PDF, JPG, PNG - max 10MB each)

Certificate of Incorporation *

Proof of Authorized Signatory Authority *

Data Protection Policy Summary

Past Use Cases (if applicable)

J. For Requestor Agent Use Only 🔒

Application Received By

Date Received

Eligibility Assessment

Notes

Agent Signature

🔐 Project Jake Requestor Group Application