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Digital Signature Certificate Subscription Form

This document is a digital signature certificate subscription form for obtaining a Class 2 or Class 3 certificate for individual or organizational use that is valid for 1 or 2 years. It collects subscriber details like name, date of birth, address, ID proof details. For organizational certificates, an authorized signatory must acknowledge the subscriber's authority. The subscriber declares all information is true and correct and acknowledges duties under applicable laws. For Class 3 certificates, the subscriber must sign before an authorized representative of the certificate authority.

Uploaded by

Sanjay K Sharma
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© © All Rights Reserved
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35 views1 page

Digital Signature Certificate Subscription Form

This document is a digital signature certificate subscription form for obtaining a Class 2 or Class 3 certificate for individual or organizational use that is valid for 1 or 2 years. It collects subscriber details like name, date of birth, address, ID proof details. For organizational certificates, an authorized signatory must acknowledge the subscriber's authority. The subscriber declares all information is true and correct and acknowledges duties under applicable laws. For Class 3 certificates, the subscriber must sign before an authorized representative of the certificate authority.

Uploaded by

Sanjay K Sharma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Digital Signature Certificate Subscription Form

Class 2

Class of Certificate

Type of Certificate

Class 3

Individual

Signing

With
Org Name

Encryption

Certificate Validity

1 Year
2 Years

Section 1: Subscriber Details


Name*:

Designation :
D
D
M
M
Y
Y
Y
Y
Date of Birth*:
Gender *:
Male
Address (Residential address in case of Individual or Organization address in case of DSC with ORG )

Organisation Name *

* Self Attested Photo

Female

(Mandatory in case of ORG DSC)

Door No/Building Name *

Road/ Street/ Post Office *

Town/ City/ District *

State/ Union Territory *

Country*

PIN Code*

Telephone Number* (with STD Code):


:
Mobile Number*

Email id*

:
Section 2: Identity Proof Details

Photo Identity Proof*

Address Proof*

Identity Proof Name

Address Proof Name

( Eg: Pan Card, DL, Passport, ...)

( Eg: Passport, DL, Latest


Telephone Bill, ...)

Identity Proof Number


Note*: Subscriber's signature should appear on the Photo ID Proof.

Section 3: Declaration
I hereby declare that all the information provided on this Subscription Form for the purpose of obtaining a digital certificate is true and correct to the best of
my knowledge. I am aware, as a subscriber for a digital signature certificate, the duties and responsibilities are applicable under the IT Act, India and the
SafeScrypt CAs CPS https://www.safescrypt.com/pdf/cps.pdf .

Signature of the Subscriber*


Date*:

Place*:

Note*: Subscriber has to sign before the Authorised LRA/Partner for Class3 DSC.

Section 4: Authorisation (*only for ORG DSC)


I , _______________________________________________________ acknowledge by my signature, that the Subscriber information in this document
is complete and accurate as per our office records. I fully understand that the Subscriber is responsible to transact on the Organisations behalf and I will
ensure timely revocation of Digital Signature Certificate in case the employee leaves the company in future.

Signature & Organisation seal*


For office use only
Attestation By Sify Authorised LRA/Partner(*For Class3 DSC Only)
I hereby declare that the subscriber has personally appeared before me and submitted the
original document copies of ID proof. I have verified the same with TRUE COPY.
Signature and Seal *
Date * D

Name *

Partner Name:
Date of Issuance:
City:

Note*: Safescrypt at its discretion, will make a telephone call to verify the details of the Subscriber.

SafeScrypt CA Services brought to you by:


Sify Technologies Limited, 2nd Floor, Tidel Park, #4 Rajiv Gandhi Salai, Taramani, Chennai - 600113. E-Mail: [email protected]

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