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Chartered Information Systems Pvt. Ltd.

Delhi I Mumbai I Ghennai I Kolkata I Nagpur I Bengaluru I Pune I Ahmedabad

01

Year DSC

0 2Year

DSC

CLASS III
Digital Signature Certificate Application
ITo be fille~ by applicant)

Check List

Name:

City:
Company:

e-Mail:

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1<1.,,"0--1<,,1,.,,·..--0.

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User 10:. U9vv""

_

Ph I Cell No.:

Q8'ko0639'J-?,

Entollment Request Number:
(For office use only) CISPL DCFC Code No:.

_
_

To be checked by RA Office or Digital Certificate Facilitation Center

o

Correct type of application Recent photograph

form is used. form and signed across.

o o o o
o o

is affixed on the application

Complete office address and residential address is given. Document Certificate Application checklist Enrollment in the form reflects the correct documents attached.

Form, generated at the time of online enrolling process, is attached. correctly with proper dates. (Two signatures)

form is signed

Inform the customer not to upgrade c)r reinstall internet browser or operating system before downloading digital signalure. _
~ _

DSC Kit Sr. No.
DCFC Authority: __

CISPL RA Administrator:

_

Seal and Signature

of DCFC Authority

Seal and Signature of CISPL RA Administrator

-----------------------~-------------------.-------------------~---------~-------------~----*-------------------Acknowledgment I Receipt Enrollment Received Request Number: _ _ over e-mail once

a

completed.

application

form from Certificate.

.

for obtaining

a Class III Digital Signature

The applicant will receive notification

the digital signature certificate is created and ready for download.

Received with thanks Rs.
on

.
_____

by Cash I DD I Chq No . ..,.Bank.

drawn

Date:

Seal and Signature of RAA I DCFC Admin I

Registering Aut~Qrity:

Chartered Infcrmation Systems Pvt. Ltd. www.charteredinfo.com

CISPL DCFC Code

_

.TATA CONSULTANCY SI:RVICI:S UMITI:D .~l' . Corporate / Branch / Reqlstered Name i Office Flat/Door/Block No.1 -2- Class-3 Certificate (Company) . [I]~~~~~~~~~~~ ~. For the iterns marked with #. Please fill the form in BLOCK LETTERS Items marked with * are mandatory..[iIl-.COMPANY Instructions: 1. I _________~~ fi.-.--'-----'---'----'---'---' 1·~13[7_~~~~~~--' Fax Web Page URL.--L. A Pin ~QI2JJIQ] No. details for at least one are mandatory •••• '1" 3.. 2. Telephone !2. if any Version 1. Date of I corporation! Agreement! Partners ip (DD/MM/YYYY) * PARTICULARS OF BUSINESS A.l..CERTIFYING AUTHORITY REQUEST FORM FOR CLASS-3 CERTIFICATE USER TYPE .~~~~~~~ Name of Premises/ Building/Village Road/Street/Lane/ Post Office Area/Locality/Taluka ~_A~~~~~~~~_~~~~~ Sub-Division Town/City/District lliLil_~~~~~~~~~~~~~ ~~~~6~~~~~~~~~~~~~~ II/) State/Union Territory IA [H F} R.

.----L....-.---'----'_--'----'----' PERSONAL DETAILS OF THE AUTHORISED FULL NAME APPLICANT * (Mandatory) * Last Name/Surname First Name [Lti.--'---1.-:.1 "3 - C/ass-3 Certificate (Company} ..... Version 1... IT[ ..L.~L~~~~~~~~~~~ ~~.......J----I---. IT]~~~~~~~~ I'1 ~[I_2....--I--.-I..L.--L.Company Income Tax PAN No.....:~.---I---'--..L--.....I-:...---L..._.~A~~~~~~~~~~~~ IV~~.---J.J----L--l-~'----1---' Plaltionals in case of Foreign Nationality Visa details....-~~~~~~~~~~~~~ Middle Name ADDRESS Flat/Door/Block No.....L-.:...I. Fax Mobile Phone No.J..L-...L....L.-~. Name of Premises/ Building/Village Road/Street/Post Office I~Rij.1.-.---J J ~~I~b ..~A~~~~~~~~~~~~ IsB]~~~~~~~~~~~ IB~UN1> (2 Area/Locality/Taluka Sub-Division Town/City/District State/Union Territory Pin Telephone No.--L.

1-l.-L. ~~ INCOME TAX PAN NO.....-L.1-----1. __.----'L--..AR!NS 't'HANSPO""· ~ D Date Signature of the Applicant ~--~----~---~~~~~~~~~~-.J.._l...Details f()r at least one is mandatory PASSPORT DETAILS # Passport No......) ~~~ __~~ __~~~_I __ <[E...._L----L-----1....... Passport Issuing Authority Passport Expiry Date LIJ_..1 -4- Class·3 Certificate {Company) ..J.---L-__' _ _'_~_l.J.... I I Signature of RA Office Name: Date: Seal: I~ Version 1._--L-__'--' LIJ~~~~~~~~ LIJ~~~~~~~~ YOTER'S IDENTITY CARD NO.._...... REQUIRED Signing Certificate (Single Key pair) (This can be used for signing and/or encryption) AKtlRA M..... _ _'_-L.-L.RA Office The above details have been verified and found to be correct. To be filled by TCS ._~~ _ _'_~_~~ For I I Proprietor TYPE OF DI(iITAL CERTIFICJ~TE.1-y----1... # E-MAIL ADDRESS * (Mandato.....

Do(. 0 0 I Notarv I I · · • Copy of One of the following: 0 0 0 Latest Annual Report Latest Balance sheet Latest Income Tax Return 0 0 0 0 0 0 0 0 Proprietorship Firms i(any one requin:td) Copy of the Latest bank statement certified by the bank manager of the bank where the account is held. Requirfd . TVP~ OF C~R. Private Limi1l:ed Companies (anyone NOTARIZED copy required) • Certificate true copy of the Certificate of incorporation 0 0 I Business commencement from either the company secretary company I a Director of the · • • Certified true copy of the Memorandum and Articles of Association from either the Company secretary 0 0 I a Directory of the company Copy of the latest Annual report.TIFICAT~ documents that you need to submit along with the NOTE: • • Sr. Firms (arlY one required)i ! 0 0 Partnership Certificate true copy of the partnership deed from either a Class I Gazette officer Chartered Accountant..DOCUMENT CHECKLIST FOR mMPANV The following is a list of the supporting Certificate Request Form. I . I.1 -5- crass-a Certificate (Company) . 1 Documents : I No. ATTESTATION TO BE DONE BY GAZZETTED OFFICER. NOTARIZATION TO BE DONE BY PUBLIC NOTARY. I . Copy of One of the following: 0 0 Latest Balance sheet Latest Income Tax Return (ahy one 0 0 0 0 0 0 0 2 Subscriber Verification Documents attested copy requirelcl) Passport · • · 0 0 0 Voter's ID PAN card Version 1. .ument submitted Dg~Ument5 verified bv RA Certificate of Incorporation Public &.

Attested by Authorized signatory of the company with photograph.· · · 3 Identity Card . 3.808/- 1 1 1 IRenewal Digital Signature Certifieate 1 1 Validity I~eriod 1 year 2 years Price Rs. Company PAN No.928/-* The same USB token if procured earlier. Driver's license Ration Card attested copy 0 0 0 0 0 0 • • Proof of Address (anyone required) Passport Ration card Driver's license Latest Telephone bill Latest ElectriCity bill UC receipt Authorization 0 0' 0 0 0 0 0 0 0 • · • · • 4 5 Letter on the company's letterhead 0 0 0 0 0 0 0 attested by company's authorized person.928/Rs.4.125/Rs. 2245/-* Rs. can be used for the renewed certificate V(}rsion 1.3.2.245/Rs. 3. (Required) Certificate Enrollment Form (downloaded from )+ (Required) Letter of Authority 0 0 Pric::ingDetails: Validity Per'iod 1 year 1 year 2 years 2 years Options Digital Signature Certificate 1 1 i I I USB Token Price ontlon A Option B Option C Option D Prices are inclusive of all Taxes 1 - RS.1 -s- Ciass-3 Certificate (Company) .

The fame will be approved only after the payment of necessary applicable charges. 5. ) (Link: 7.0 and above for Date Signature of the Applicant Version1. I will 4. 6. the following activities should not be carried out until the certificate is successfully downloaded: . 8. have to reapply for a fresh certificate. 1.IE 5.Windows 2000/XP Internet Browser a. --J Supported Versions . If my certificate is revoked. The 'Certificate Trust Chain' has to be downloaded for using my certificate. It is my responsibility to remember the passwords that are used while gener. Requirements with respect to Operating System and Internet Browser are as follows: " Operating System I a. 2. After placing an online request for a certificate. a valid email 10 that is accessed regularly should be provided.IE 6. b.ating/exporting the certificates/keys.Windows ZOOO/XP Recommended Versions .1 -7- Class-3 Certificate (Company) . Certiflcate revocation is permanent and ir1eversible.j Formatting of the machine the machine Reinstallation or upgrade of the internet browser on the machine from which the certificate request was initiated 3. Supported Versions .Declaration I hereby agll"ee that I have read and understood ensure proper usage of the Digital Certificate. The security level in the Internet Browser should be set to 'Medium' and all scripting should be enabled.j . The certificate should be downloaded the following instructions carefully and onto the same machine/device from where the request was initiated. At the time of registration. b.5 and above Recommended Versions .

on behalf of r whose signature is attested below to carry out all the necessary formalities k H A!e--H Qf) f'\ R. VAL.t'oRT'f authorize VA LtMC)/i (+M G!) H.lr7JOHPtf71t:. year(s).I?0 IE TR. 'TI2A~s.J) ?eD 1-1.Annexure-A: letter of Authority I.IJAP-1 N/E.. kHAkHR{~ of in the capacity of the PRE ITV~ kHAkHRI=l ~I') i. for the application of a Class-3 Digital Signature Certificate with the validity period of Vj Rl\ M/tRINE TRANSPOft'j /L Signature and Designation of Authorizing Person }ilro!.AN~ P oR.If.1 ·8- Class·3 Certifieate (Company) .rietcr Signature and Designation of the Applicant Signature and Designation of the Authorizing Person Version 1.

tst Main (Kalidas) Road. Gandhinagar.9790930847 Ahmedabad Office Sahailesh I Viral Chartered Information Systems Pvt.3.G. 2nd Floor. 4007 8350. Bangalore . Ltd. New Delhi . Towers. #904. 2068/39. Karolbagh. 9225245088 TeleFax: 0712 .6638888 (100 Lines). Nagpur . #207-B. Wall Tax Road. 15. Dhaka Chambers. Bhandara Road.1 . Demand Draft and the Document Checklist along with all the supportnng documents has to be forward@i at the following addre~s: Duly mark the envelope as 'APiPLICATION FORi CLASS III DIGITAL CERTIFICATE' corporate Office .600 003 INDIA Ph: 044 -25330837.380 004 INDIA Ph: 079 . Arihant Plaza.440 008 INDIA Ph: 0712 .40921639. 2300 8088 Kolkata Office Biswajeet Bhattacharya Chartered Information Systems Pvt. D-50. Naiwala. Ahmedabad . Building No.4007 8355. Larnington Road. Ltd.9- Class-3 Certificate (Company) .9974533506 (Viral) Pune Office Chitesh Dave 93246 10283 (Chitesh) Version 1.6522 8288.Payment' Detail~: The payment for the certificates can be made through Demand Draft only. KOLKA TA .Nagpur DSC Department Chartered Information Systems Pvt. Bal Mukund Macker Road. West of Lata Mangeshkar Musical Park. "Haveli" Block No. Near M. in favor of "Chartered Informatrol1l Systems Pvt Ud" I ! Demand [)raft Number Date ~c-- B_a_n_k_D_e_ta_i_IS A_m_o_u_n_t _ The Certificate Request Form. Wing A enqaoe MajeStiC.9972932213 Delhi Office Kapil Bhimjiyani Chartered Information Systems Pvt. G. Navjeevan Society. 3rd Floor.9841777268. Delhi Gate. Chennai .560009 INDIA Ph: 080 . Ltd. B.400 008 INDIA Ph: 022 . "Chartered House".6605 4735. Mumbai . 1st Floor. 09a71265511(Kapil) ChennaiOffice Narayanan I Hukum Chartered Information Systems Pvt. 2nd Floor. Metro. Ltd. Ltd. 17. Ltd.110 005 INDIA Ph: 011 -45037177. #208.700 007 Ph: 033 . #84. 99035 36765 Bangalore Office Shrinivas I Raghav Chartered Information Systems Pvt. Above S81 Elephant Gate.6638899 Mumbai Office Tirupathi Bhalla I Mayur Maniyar qhartered Information Systems Pvt. Ltd.