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Digital Signature Certificate Subscription Form

This document is a digital signature certificate subscription form for obtaining a 1-year or 2-year certificate. It collects subscriber details like name, address, identification details. For an organization certificate, an authorized person needs to acknowledge the subscriber's details. The subscriber declares that the information provided is true and correct. On approval, the authorized local registration authority will issue the digital signature certificate.

Uploaded by

phani raja kumar
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2K views1 page

Digital Signature Certificate Subscription Form

This document is a digital signature certificate subscription form for obtaining a 1-year or 2-year certificate. It collects subscriber details like name, address, identification details. For an organization certificate, an authorized person needs to acknowledge the subscriber's details. The subscriber declares that the information provided is true and correct. On approval, the authorized local registration authority will issue the digital signature certificate.

Uploaded by

phani raja kumar
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 Individual Signing 1 Year


Class of Certificate Type of Certificate Certificate Validity
Class 3
With Encryption 2 Years
Org Name
Section 1: Subscriber Details

Name*:

Designation :
* Self Attested Photo
Date of Birth*: D D M M Y Y Y Y Gender *: Male Female
Address (Residential address in case of Individual or Organization address in case of DSC with ORG )
Organisation Name * :
(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 CA’s CPS https://www.safescrypt.com/pdf/cps.pdf .

Signature of the Subscriber*

Date*: D D M M Y Y Y Y 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 Organisation’s 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 Partner Name:
original document copies of ID proof. I have verified the same with TRUE COPY.
Date of Issuance:
Signature and Seal *

Date * D D M M Y Y Y Y Name * 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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