GZ. Chartered Information Systems Pvt. Ltd. Delhi| Mumbai | Chennai | Kolkata | Nagpur | Bengaluru | Ahmedabad | Pune (11 Year sc C1 2 Year psc Digital Signature Certificate Application Check List (Tobe ied bysppticant) Name: User ID: City: e-Mail ‘Company: Ph {Cell No. Enrollment Request Number: (For office use only) CISPL CFC Code No: To be checked by RA Office or Digital Certificate Facilitation Center Correct type of application form is used, Recent photograph is affixed on the application form and signed across. Complete office address and residential address is given. Document checklist in the form reflects the correct documents attached and are attested. Certificate Enrollment Form, generated at the time of online enrolling process, is attached. Application form is signed correctly with proper dates. (Two signatures) oooo0o0o00 Inform the customer not to upgrade or reinstall internet browser or operating system before downloading digital signature. DSC Kit Sr. No. DCFC Authority: CISPL RA Administrator: ‘Seal and Signature of DCFC Authority Seal and Signature of CISPL RA Administrator Acknowledament / Receipt Enrollment Request Number: Received a completed application form from for obtaining a Class 2 Digital Signature Certiicate, The applicant will receive notification over e-mail once the digital signature certificate is created and ready for download, Received with thanks Rs. by Cash / DD / Chq No. drawn on Bank. Date: Seal and Signature of RA / DCFC Admin Registoring Authority: Chartres information Systems Pv. Ll ciseL 0cFC Code ‘wenn charterer. corta TATA CERTIFYING AUTHORITY REA CONLASANCY SeNICES copa creo espana, Alo recent passport ‘Sze photograph of the applicant Applicant to ‘TATA CONSULTANCY SERVICES LIMITED - CERTIFYING AUTHORITY REQUEST FORM FOR CLASS 2 CERTIFICATE - Individual RA OFFICE NAME: CHARTERED INFORMATION SYSTEMS PVT. LTD. - REGISTRATION AUTHORITY Instructions:ltems marked with * are mandatory. sian acoss the photograph Validity of Osc t year LJ 2 years Gender mate L] Female E-Mail Address Organization Details Address city Pin Code Telephone Mobile Residential address Address” ci Pin code* stare coun Telephone Mobile DOCUMENT CHECKLIST FOR INDIVIDUAL TYPE OF CERTIFICATE Note: Copies of one or more of the following must be provided to TCS-CA to authenticate the identity & proof of residence. Provide the appropriate identification details for the selected document Attestation to be done by GAZZETIED officer or Notarization to be done by PUBLIC notary. Subscriber proof of identity and residence(any one ATTESTED copy required) Haney ard Recidence Mantty Address Proof e The certificate must not be shared with others or used by them on your regan cena " rn _Reinstallation or upgrade of the Tnternet browser on the computer fom iG codhce tests ed = Formatting ofthe computer fe Ifyou laze your key pate, you chall inform the RA Adminizerstor immedistsly and apply for the revocation of your cerficazs, 1 Application form must be submitted in person. Incomplete/Inconsistent application is lable to be reiacted Applicant Dedaration RA Declaration |heroty confirmthat Ihave read and understosd!the above instructions _| hereby confi thet Ihave received end verified the documents submited ‘andl wil follow the above instructions for obtshing and usingthe Distal | by the subscriber Sunature Catitcate. te: ate Place Signature of the Appicant |Place: Signature ofthe RA Officer