8/13/2019 TCS DSC Form ClassII IndividualNew

1/2

Digital Signature Certificate Enrollment Form For Request No * -

Type of Subscriber * Class of Certificate * Validity of Certificate * Type of Certificate *

Registration Authority^

CSP^

Subscriber Details Surname Given ame * !nitials

ame *

"mail !# *

$rgani%ation ame **

**

Residential Address *

To&n'City'#istrict * Postal Code *

Country * State *

(andline umber )obile *

Identity and ddress !roof " ##ES#ED$

Photo !dentity Proof * Address Proof *

$rgani%ation Proof **

Subscriber Declaration

! 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 ofmy no&ledge+ As a subscriber ! have read and understood the re,uirements specified in TCS CA Certificate Practice Statement -CPS./ Subscriber

Agreement and &ill abide by it+ ! am fully a&are of the security ris s involved in holding the private ey in a P01+

Subscriber Signature *

#ate * Place *

2 344353467 Tata Consultancy Services (imited+

$rgani%ation 8nit

Affi9 recent passport si%ephotograph of the

subscriber+ Subscriber tosign across the

photograph e9tended toenrollment form+

Alternative "mail !#

Subscriber PA

8/13/2019 TCS DSC Form ClassII IndividualNew

2/2

%etter of ut&ority "For Com'any and (o)ernment sers +nly$

! :::::::::::::::::::::::::::::::::::::::::::::: in the capacity of::::::::::::::::::::::::::::::::::::::::::::of the $rgani%ation/

:::::::::::::::::::::::::::::::authori%e the Subscriber to carry out all the necessary formalities on behalf of the $rgani%ation for the application

of a Class :: #igital Signature Certificate &ith the validity period of ::::::::::::::::::::::+

Signature ; Seal of Authori%ing Person *

R Declaration

! hereby inform that ! have received and verified the documents submitted by the Subscriber+

RA Contact Address *

RA ame *

RA Signature *

#ate * Place *

Instructions,6+ 0ields mar ed &ith * are ND #+R. +3+ 0ields mar ed &ith ** are +!#I+N % for !ndividual users+7+ 0ields mar ed &ith ^ are to be filled by dministrator +