NOTE: IF YOU WANT TO OBTAIN THE DSC FROM (n)code or Sify or for Pvt Ltd company DSC then call me on

Transcription

1 Please Note that for Class 3 Organizational DSC the following papers will be required physically with blue ink seal and blue ink sign on application form as well as all the supporting documents. FOR PROPRIETORSHIP APPLICATION FORM WITH PROPER SEALED AND SIGNED AUTHORISATION LETTER ON COMPANY LETTER HEAD (FORMAT ATTACHED) ORGANISATIONAL ID PROOF ON COMPANY LETTER HEAD (FORMAT ATTACHED) PAN OF APPLICANT AADHAAR / VALID DL / VOTER ID / VALID PASSPORT (ANY ONE) OF APPLICANT LATEST ITR COPY / DECLARARATION ON LETTER HEAD (IF ITR NOT AVAILABLE) FORMAT ATTACHED. LATEST BANK STATEMENT WITH BANK AND FIRM/COMPANY NAME. ALL ABOVE PAPER SHOULD BE SEALED AND SIGNED BY PROPRIETOR AS SHOWN IN PAN WITH BLUE INK ONLY. FOR PARTNERSHIP FIRM APPLICATION FORM WITH PROPER SEALED AND SIGNED AUTHORISATION LETTER BY OTHER PARTNER ON COMPANY LETTER HEAD (FORMAT ATTACHED) ORGANISATIONAL ID PROOF OF APPLICANT ON COMPANY LETTER HEAD (FORMAT ATTACHED) ORGANISATIONAL ID PROOF ( OF OTHER PARTNER WHO IS AUTHORISED TO APPLICANT TO OBTAIN DSC ON BEHALF OF FIRM) ON COMPANY LETTER HEAD (FORMAT ATTACHED) PAN OF APPLICANT AADHAAR / VALID DL / VOTER ID / VALID PASSPORT (ANY ONE) OF APPLICANT LATEST ITR COPY / DECLARARATION ON LETTER HEAD (IF ITR NOT AVAILABLE) FORMAT ATTACHED. LATEST BANK STATEMENT WITH BANK AND FIRM/COMPANY NAME. FIRST 3 PAGE OF PARTNERSHIP DEED. PAN CARD OF FIRM. ALL ABOVE PAPER SHOULD BE SEALED AND SIGNED BY PROPRIETOR AS SHOWN IN PAN WITH BLUE INK ONLY. NOTE: IF YOU WANT TO OBTAIN THE DSC FROM (n)code or Sify or for Pvt Ltd company DSC then call me on Address to send all the documents- Scanned copy : rsparvat@gmail.com Physical Copy : Ramashankar parvat, Mahapaur Bangla Road, Bilaunji, Waidhan, Distt. Singrauli (M.P.) , Contact No

2 APPLICATION FORM - SIGNATURE / ENCRYPTION CERTIFICATE FOR ORGANISATION Application ID: (S) (E) (For Office Use Only) PLEASE FILL IN BLOCK LETTERS ONLY. ALL FIELDS ARE MANDATORY More Instructions available at: APPLICANT INFORMATION Name Date of Birth D D M M Y Y Y Y Organisation Name Gender Male Female Nationality Affix recent passport size photograph of the applicant duly signed across Org Address CLASS: Class 1 Class 2 Class 3 City State PAN of Applicant Aadhaar ID Mobile Pin code (NOTE : Either PAN and / or Aadhaar No. is mandatory) TYPE: Signature Encryption Combo VALIDITY: 1 Year 2 Years 3 Years DOCUMENT PROOF (attested by Authorized Signatory of the Organization) Organization Type: Company Partnership Proprietorship AOP/BOI LLP NGO/TRUST Document Name Copy of Applicant s Organizational ID Card / Letter from Organization / Pay Slip Company Partnership Proprietorship AOP/BOI LLP NGO/Trust Copy of Organizational PAN Card Copy of Bank Statement (First 2 Pages) Copy of Incorporation/Registration Certificate Copy of AOA & MOA / Rules / Bye laws (First 2 Pages) Copy of Last Income Tax Return / Audit Report & Annual Return / Self Affidavit with reason, if not available (First 2 Pages) Copy of Partnership Deed / Trust Deed / LLP Agreement containing the List of Partners / Signatories (2 Pages) Copy of Business Registration Certificate (S&E / ST / VAT / Any other Government Registration) Proof of Authorized Signatory (Board Resolution) Authorized Signatory Organizational ID Card / Self-Attested Letter of Organizational Identity Copy of PAN Card / Aadhaar Card of Applicant, either one is Mandatory DECLARATION BY APPLICANT I hereby agree that I have read and understood the provisions of e-mudhra Certification Practice Statement (CPS) and the subscriber agreement and will abide by the same. The information provided in this form is true & correct to the best of my knowledge. I accept publishing my certificate information in e-mudhra repository. I am aware of risks associated in case of Class 1 Certificate,when storing the private key on a device other than a FIPS 140-1/2 validated cryptographic module. Date Place TO BE FILLED BY RA OFFICE ONLY * * * * * * Signature of the applicant (As in ID proof Blue Ink Only) AUTHORIZATION I hereby authorize the above applicant, on behalf of our Organisation to apply for obtaining the Digital Signature/ Encryption Certificate issued by e-mudhra. I hereby confirm the Identity of the above Individual and My identity (Authorized Signatory). I m the Authorized Personnel to to certify the Identity on behalf of the Organization. Authorized Signatory (Sign and Seal) I declare that the applicant has provided correct information in this application form. I have checked and verified the application form and supporting documents. I hereby take full responsibility for any wrong verification made, or wrong documents submitted for the application. Date RA Name, Code & Seal Signature of RA, 3rd Floor, Sai Arcade, 56, Outer Ring Road, Deverabeesanahalli, Opp Intel, Karnataka. Phone : Fax : info@e-mudhra.com Website: Page 1 of 1 Version 3.0

3 Letter of Identity Proof by Organization (To be printed on organization letter head / Office seal. To be signed by HRD of Organization / Authorized Signatory / Government in-charge. To be used if the Organizational ID card is not available for the applicant.) Subject: Organizational ID Proof of the applicant Name of the Individual I hereby confirm the Identity of the above Individual. I m the Authorized Personnel to certify the Identity on behalf of the Organization. :

4 Letter of Identity Proof by Organization (To be printed on organization letter head / Office seal. To be signed by HRD of Organization / Authorized Signatory / Government in-charge. To be used if the Organizational ID card is not available for the applicant.) Subject: Organizational ID Proof of the authorized signatory Name of the Individual I hereby confirm the Identity of the above Individual. I m the Authorized Personnel to certify the Identity on behalf of the Organization. :

5 Authorization Letter by Organization (To be printed on organization letter head / Office seal. To be signed by Authorized Signatory / Government in-charge. To be used, if the authorization is not made on Application Form.) Subject: Authorization of the applicant by the organization I hereby Authorize the below applicant to apply for Digital Signature / Encryption Certificate, on behalf of the Organization. Name of the Applicant Class of Certificate Class 2 Class 3 Type of the Certificate Signature Encryption Combo DGFT :