| 1. First name* |
|
| 2. Surname* |
|
| 3. Organization name |
|
| 4. Sector type (e.g., finance, energy, private individual) |
|
| 5. Domain (e.g., xyz.gov, 123.qa) |
|
| 6. Your position in the organization (e.g., system manager, security officer) |
|
| 7. Contact email address* (e.g., myaddress@home.qa) |
|
| 8. Contact office telephone number* (include country code if outside Qatar) |
|
| 9. Contact mobile/cell phone number* (include country code if outside Qatar) |
|
| 10. Contact home telephone number if private individual (include country code if outside Qatar) |
|
| 11. Contact fax number (include country code if outside Qatar) |
|
| 12. Description of the incident*, including dates, methods of intrusion, intruder tools involved, software versions and patch levels, intruder tool output, details of vulnerabilities exploited, source of attack, or any other relevant information). If you cannot provide these details, simply give us as much information as you can about this incident. |
|
If you have it, provide information about each affected machine:
|
| 13. Hostname and IP (e.g., 207.142.131.235 or 2001:0db8:85a3:08d3:1319:8a2e:0370:7334)
| |
| 14. Time zone (UTC/GMT + x hours - Qatar is +3 hrs)
| |
| 15. Purpose or function of the host (please be as specific as possible)
| |
Source(s) of the attack (for each host) |
| 16. Hostname and IP (e.g., 207.142.131.235 or 2001:0db8:85a3:08d3:1319:8a2e:0370:7334)
| |
| 17. Time zone (UTC/GMT + x hours - Qatar is +3 hrs) | |
| 18. Have you made any attempt to determine the source of the attack? (e.g., used IP lookup or contacted the ISP) |
|
| 19. Estimated cost of handling the incident (if known)? (This is used by Q-CERT to assess the category of the incident.) |
|
|
|
