Digital Signature Certificate – Enrollment Form For Request No*^ -
Type of Subscriber* Class of Certificate* Validity of Certificate* Type of Certificate*
Government Class-2 2 Yrs Signing Certificate
Registration Authority^
CSP^
Subscriber Details
Surname Given Name* Initials
Name* Yadav Ritesh
Father's Name* Date of Birth * 2 Feb - 1986
Mr. Anil Yadav
Affix recent passport size
Designation* Role * Verifying Officer photograph of the
Assistant Passport Officer
subscriber. Subscriber to
sign across the photograph
SPHQ/DPHQ (if applicable) extended to enrollment form.
Request Type Fresh Renewal Replace
Email ID* sample1@mea.gov.in
Alternative Email ID sample2@mea.gov.in
Subscriber PAN BYNKK7****
Organization Name** Ministry of External Affairs
Organization Unit** Passport Seva Project
Residential Address* B-72 Laxmi Nagar
Town/City/District* Delhi Postal Code* 201301
Country* State*
India Delhi
Landline Number Mobile*
+91 011 265***** 9889******
Identity and Address Proof (ATTESTED)
Photo Identity Proof* PAN Card Address Proof* Voter ID Card
Organization Proof**
© 2002-2013 Tata Consultancy Services Limited. Version 1.0
Subscriber Declaration
I hereby declare that all the information provided on the application form for the purpose of obtaining a digital certificate is true and correct to the best of
my knowledge. As a subscriber I have read and understood the requirements specified in TCS CA Certificate Practice Statement (CPS), Subscriber
Agreement and will abide by it. I am fully aware of the security risks involved in holding the private key in a PFX.
Subscriber Signature* SAMPLE
Date* 3 Nov-13 Place* Delhi
Letter of Authority (For Company and Government Users Only)
I ___________________SAMPLE________________ in the capacity of____________________SAMPLE________________________of the Organization,
____________ _______SAMPLE_______authorize the Subscriber to carry out all the necessary formalities on behalf of the Organization for the application
of a Class _2_ Digital Signature Certificate with the validity period of ___________2 Yrs___________.
Signature & Seal of Authorizing Person* SAMPLE
RA Declaration
I hereby inform that I have received and verified the documents submitted by the Subscriber.
RA Contact Address*^
RA Name*^
RA Signature*^
Date*^ Place*^
Instructions:
1. Fields marked with * are MANDATORY.
2. Fields marked with ** are OPTIONAL for Individual users.
3. Fields marked with ^ are to be filled by Administrator.
4. Type of Subscriber - Accepted values are: INDIVIDUAL, COMPANY or GOVERNMENT.
5. Class of Certificate - Accepted values are: CLASS 1, CLASS 2 or CLASS 3.
6. Validity of Certificate - Accepted values are: 6 MONTHS, 1 YEAR or 2 YEARS.
7. Type of Certificate - Accepted values are: SIGNING or ENCRYPTION.
8. Organization Name - Accepted value for Individual users is: PERSONAL.
9. Address, Town/City/District, State, Country and Postal Code fields should be filled as per Address Proof document
10. Photo Identity Proof - Accepted values are: PAN CARD, PASSPORT, BANK A/C PASSBOOK WITH PHOTO, DRIVING LICENSE
or PHOTO IDENTITY CARD.
11. Address Proof - Accepted values are: LATEST TELEPHONE BILL, LATEST ELECTRICITY BILL, LATEST BANK STATEMENT,
PASSPORT, DRIVING LICENSE, WATER BILL, GAS CONNECTION, SERVICE TAX, VAT TAX, SALES TAX REGISTRATION
CERTIFICATE, VOTER IDENTITY CARD or PROPERTY TAX.
12. Organization Proof is applicable for only Company type of Users. Following values are accepted:
a. PUBLIC & PRIVATE LIMITED: CERTIFICATE OF INCORPORATION / BUSINESS COMMENCEMENT / MEMORANDUM AND
ARTICLES / LATEST ANNUAL REPORT.
b. PARTNERSHIP FIRMS: PARTNERSHIP DEED
c. PROPRIETORSHIP FIRMS: LATEST BANK STATEMENT / LATEST INCOME TAX RETURN / LATEST BALANCE SHEET /
SALES TAX CERTIFICATE / BUSINESS COMMENCEMENT LICENSE.
13. All Supporting documents should be attested by Gazetted officers or Bank Manager or Post Master or Registration Authority under
TCS-CA.
14. In the case of foreign nation, all the validation documents must be notarized by the public notary of the respective country in English.
© 2002-2013 Tata Consultancy Services Limited. Version 1.0
