f= PHILIPPINE NATIONAL PKI RR ain arr st Uma inetrtone: 4. Please he orm in BLOCK LETTERS ONLY. 2. Required fields are marked with an asterisk (*). 3. Present one (1) copy and the original documents to our Registration hahouty besesbeens and seston z see ee ee ox teed cata 5. Any discrepancy or inconsistency in the form will lead to delay and/or mt raeobon 1 CERTIFICATE CLASS 2. CERTIFGATE TYPE | 3: METHOD OF ACTIVATION a eV Song aise tor are Sol cain Dania EET ror ere rere io re Be a one cum ZOSR 4E Gondor | Malo Fomaloy/ | 4 Nationality | pupa eae ot 8 | aonsco aw | 298608017 [ssssne W6SISNe | mares [x Phinesih No. [12-050916736-f aL Papbigna [121179598633 mone ae Tale Caan eee 16" Oot ig /Conpny | Romina TT 4P* Orpaizatonal Unt/Dopartmant Dion |. eAARINRATIONALYEEATIRALSEHERE a0 Marta tas [veinje Maries Widow aA Empoment Sts |yHoring Suen Sltonsoyed —Unonpayed Sota iizon ate [te | ilar — Ye ee | ee Bae | Biv) SE, Satan ars Nave ZARAGOSA | LEONILA | BAAY bvasness | ames ‘4U Father’sName | ONG NORBERTO DELIMA. DECEASED CORE RTS esl ees Se Oaoreaeste Saad | ana © eanngey | PORAEON Se a Pies apes | a ima Susie [pei Fenatheen | meee a oie aise aiaheoceth “ane SM Sweet SN Barangay | cxeaLounto soMnepanvcly [causa ae aaa a Racin 3S EmalAddoss | enm@tndasovsh ST Face. [ aba Ra Ren eta bat Roan se DICT Building, C.F. Garcia Avenue, Ditman, Quezon City, 1101, Philippines +63 (02) 920-0101 wavedict govph6. DECLARATION Thereby agree that | have read and understood the provisions of the Subscriber's Agreement: that lintormation provided and documents submited in relation to this application is ue and correct to the bes of my knowledge; ta! Iam duly authorized to make tis application; ‘atl consent tothe subscriber agreement and wl bide by the same; tha laccop! the publcaon of my certicae information. | authorge and expressly give consent tothe National PKI through is authorized representatives) to arly my personal information fom watever source i deems appropiate Date: _ cana Place: _CHUBILETTE __ Nama of Applicant: _GRLIANEVEZ Signature: 7. CHECKLIST OF DOCUMENTS TO BE SUBMITTED ALONG Present the ft oignal documents with photocopy to our Registration Author for verication and attestation Required Documents: Birth ceticate issued by PSA OR vad Passport ‘lon Certicate of Registration (ACR) card for foreigners Unifed Mut purpose Identiication Card (UNID) Compliant Card Inthe absence of UMID-compliant card, any two (2) of the following cards are allowed as valid ID's Driver's License Profesional Regulation Commission (PRC) ID ‘National Burau of Investigation (NBI) Clearance Postal ID Voters ID ‘Government Service Insurance System (GSIS) e-Card Government Oes and GOCC 1D, e.9. Armed Forces of he Philippines (AFP ID), Home Development Mutual Fund (HOMF) ‘Socal Secuy System (SSS) Card ‘Senior Citizen Card (Overseas Workers Welfare Adminstration (OWWA) ID oFwin Integrated Bar Of The Philippines 1D Department af Social Wellare and Development (DSWD) Certiaton Company Ds Issued by Private Entities or Institutions Registered wih or Supervised or Regulated either by the BSP. SEC, or IC {8 DISCLAIMER ‘The collected persona information is ulized solely for documentation and processing purposes within the DICT and ie not shared with any outside parties, accordance with the Data Privacy Act of 2012 TO BE FILLED BY RA OFFICE ONLY "declare thatthe applicant has provided correct information inthis application form. | have checked and verified the application form and supporting documents A Code: Name: Signature: RA. Sealand stamp Date: Pace: ‘THIS FORM IS NOT FOR SALE DICT Building, CP. Garcia Avenue, Diliman, Quazon Cy, 110%, Philippines +63 (02) 920-0101 wavedict govph‘SUBSCRIBER AGREEMENT PLEASE READ THIS AGREEMENT CAREFULLY BEFORE USING THE DIGITAL CERTIFICATE ISSUED TO YOU OR YOUR ORGANIZATION. BY APPLYING FOR A DIGITAL CERTIFICATE, YOU ARE AGREEING TO BE BOUND BY THE TERMS OF THIS AGREEMENT. IF YOU HAVE PROBLEMS UNDERSTANDING THIS AGREEMENT, E-MAIL US AT support pnpki@dict goxph. 1.0 Definitions ‘Applicant:The individual that applies for (or seeks renewal ol) a Digital Certificate naming it as the * Subject Certtication Practice Statement (CPS) - A statement of the practices that a certification authority employs in issuing, ‘managing, revoking, and renewing or re-keying certificates, Cerificate Policy (CP) - A named set of rules that indicate s the applicability of a certificate to a particular community andlor class of application with common security requirements. For example, a particular GP might indicate applicability of a type of certificate to the authentication of parties engaging in business-to-business transactions forthe trading olgoods or services within a given price range. Certificate Revocation List ("CRL") - A collection of electronic data containing the list of serial numbers revoked or suspended by the Certificate Authority Online Certificate Status Protocol ("OCSP") - An Internet Protocol IP) used to obtain the realtime revocation status of a digital certlicate, Its used as an online faster alternative to CRL. list, Public Key - A mathematical key which is available publicly and which is used to verity Digital Signatures created with the ‘matched Private Key and to encrypt electronic data which can only be decrypted using the matched Private Key Private Key - A mathematical key which is kept private to the owner and which is used to create Digital Signatures or to decrypt electronic data Registration Authority (RA) - An entity that is responsible for one or more of the following functions: the identification and authentication of certificate applicants, the approval or rejection of certificate applications, initiating certificate revocations fr suspensions under certain citcumstances, processing subscriber requests to revoke or suspend their certiticates, and approving or rejecting requests by subscribers to renew or re-key their certificates. RAs, however, do not sign or issue certiicates (Le., an RA is delegated certain tasks on behalf of a CA), ‘Subscriber - A subject of a certilicate who is issued a certificate. 2.0 Authority to Use Digital Certificates 21 Grant of Authority As from the Effective Date up to the validity period of any issued Digital Certticate ("Valid from* date to "Valid to" date), PNPK\ grants tothe Subscriber the authority to use the requested Digital Certificate in conjunction with Private Key andior Public Key operations, The obligations ofthe subscriber (see section 4.0) with respect to Private key protection are applicable from the effective date. 22 Limitations on Authority The digital certificate cannot be used for purposes other than what is allowed in this Sub- seriber Agreement and the CPS, 3.0 Use of PNPKI Digital Certificate ‘The subscriber shall use the certificate for its lawtul and intended use only. The certificate shall be used in accordance with its Key-Usage field extensions. Allissued certificate by PNPK| cannot be used for purposes other than what is allowed inthis subscriber agreement and by the GPS. PNPK\ shall not be lable for any claims arising from prohibited use. 31 Acceptance of a Digital Certificate ‘The following conduct constitutes certificate acceptance: 4) A certilicate shall be deemed accepted when itis in the subscriber or representative's contro; ') Failure of the subscriber to object tothe certificate or its content witin five (5) calendar days; or ©) The subseriber uses the certificate, 8.2 Revocation of Digital Certificates A certicate shall be revoked when the bind between the subject and the subjects public Key is no longer valid. An ‘end-user subscriber certificate can be requested for revocation under any of the folowing conditions: 2) When a verified request for revocation is received by PNPKI CA or RA; 'b) When any ofthe information found inthe certificate is changed or no longer applicable; ) When the Private Kay, or the media holding the Private Key, associated with the certificate is compromised: ) When the PNPKI CA determines that the end-user entiy is no longer complying with the requirements of by the CPS and this subscriber agreement ; oF When the PNPKI CA has the reason to believe thatthe certificate was issued in a manner that is nat in accordance with the procedures required by the CPS and this subscriber agreement. 1) When subscribor requested revocation of the Certificate; DICT Building, CP Garcia Avene, Oliman, Quezon City, 1101, Philippines +63 (02) 920-0101 wavedict govph4.0 Subscriber Obligations This Agreement governs the subscriber's application for, acceptance, and use of, a digital certificate issued by the RA 42) The provisions of the Root GA CP/CPS, GovCA GPICPS, and other pertinent documents are binding upon the subscriber. b) Ailthe information provided in the digital certificate application form is true and correct. ©) The use ofthe digital certticate shall be forthe sole use of the subscriber. 4) The subscriber will not, under any circumstances, allow any other person to use the digital certiicate. Any such Use by another person constitutes a compromise ofthe associated private key, requiring the revacation ofthe digital certificate, 9) The subscriber shall protec the confidentiality of the private key associated with his or her digital certicate as well ‘as any PIN number or other means used to activate the private key. {) The subscriber shall remain solely responsible for the maintenance of the confidentiality a the cortificate. {9) The subscriber shail not use the digital certticate for any unlawul purpose, of for any purpose that does not have anything to do with accessing the PKI information systems or transactions using the digital certificates. h) The subscriber shall promptly request the RA to revoke the digital certficate upon knowing or suspecting inaccurate information, loss, exposure or compromise ofthe associated private key. i) The subscriber shall not tamper, interfere with, or reverse-engineer any technical implementation of the digital Certficate or its use, or in any manner seek to compromise the secuty provided by the FA and the National PKI system, |) The subscriber accepts the risk of an undetected compromised digital certificate or associated private key, which may be used to impersonate the said subscriber. 5.0 Permission to Publish Information ‘The Subscriber agrees that PNPKI may publish the serial number of the Subscribers Digital Cerificate in connection with PNPKis dissemination of CRUs and OCSP. 6.0 Disclaimer PNPK{ shall not be liable for any claims arising from prohibited use of Digital Certicates issued by GovCA. PNPKI will not be lable if the user has not respected his obligations mentioned in the CPS and inthis agreement, 7.0 Term and Termination This agreement shall terminate upon 1a) The expiry date of any Digital Certificate issued to the Subscriber ) Any failure to comply with any of the subscriber obligations mentioned in this Subscriber Agreement 8.0 Effect of termination Upon termination of this Subscriber Agreement for any reason, PNPKI may revoke the Subscriber's Digtal Certiicate in ‘accordance with PNPK\ revocation procedures. 9.0 CP and CPS Information The digital certticate contains information provided by the subscriber, which is authenticated by the RA in accordance with the requirements set out in the CA GP and OPS, availabe for viewing and download at dict gov.phipnpk Date: _08/12/2020 Place: CALUBIANLEYTE Name of Applicant; _GELLIANEVE Z.0NG. Signature: (Please sign in the presence of an administering officer) DICT Building, CP Garcia Avene, Oliman, Quezon City, 1101, Philippines +63 (02) 920-0101 wavedict govph