Form for 3 Class Digital Signature

8/2/2019 Form for 3 Class Digital Signature

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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 DSCCLASS III

Digital Signature Certificate Application Check ListITo befille~ by applicant)

Name: User 10:. _e-Mail: v o . . . - - U 1 < 1 . , , " 0 - - 1 < , , 1 , . ,, . . - - 0 . ~ ~ ' r ~ O ' U9vv""ity:Company:

Ph I Cell No.: Q8'ko0639'J-?, En to llment Reques t Numbe r: _(For office use only) C ISPL DCFC Code No:. _

To be checked by RA Office or Digital Certificate Facilitation Centero Correct type of application form is used.o Recent photograph is affixed on the application form and signed across.o Complete office address and residential address is given.o Document checklist in the form reflects the correct documents attached.ooo

Certificate Enrollment Form, generated at the time of online enrolling process, is attached.Application form is signed correctly with proper dates. (Two signatures)Inform the customer not to upgrade c)r reinstall internet browser or operating system beforedownloading 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 ReceiptEnrollment Request Number: _

Received a completed. application form from . _for obtaining a Class III Digital Signature Certif icate. The applicant will receive notification over e-mail oncethe digital signature certificate is created and ready for download.Received with thanks Rs. . by Cash I DD I Chq No . ..,.- drawnon

_____ Bank.

Date: Seal and Signature of RAA I DCFC Admin

Registering Aut~Qrity: Chartered In fc rma tion S ys te ms P vt. L td .www.charteredinfo.comICISPL DCFC Code _


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TATA CONSULTANCY SI:RVICI:S UMITI:D - CERTIFYING AUTHORITYREQUEST FORM FOR CLASS-3 CERTIFICATE

USER TYPE - COMPANYInstructions:1. Please fill the form in BLOCK LETTERS2. Items marked with * are mandatory.3. For the iterns marked with #, details for at least one are mandatory

'1" I_________i.~l'..~~

Date of I corporation! Agreement!Partners ip (DD/MM/YYYY) *iPARTICULARS OF BUSINESS

A. Corporate / Branch / Reqlstered OfficeName

Flat/Door/Block No.

Name of Premises/Building/VillageRoad/Street/Lane/Post OfficeArea/Locality/TalukaSub-DivisionTown/City/District

State/Union Territory

Pin

Telephone No.

FaxWeb Page URL, if any

[I]~~~~~~~~~~~~.~~~~~~~

~_A~~~~~~~~_~~~~~

lliLil_~~~~~~~~~~~~~~~~~6~~~~~~~~~~~~~~II/) I A [ H F} R . A~QI2JJ IQ]!2-[ i I l - , - .l..--L..--'-----'---'----'---'---'1~13[7_~~~~~~--'

Version 1.1 -2- Class-3 Certificate (Company)


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Company Income Tax IT[PAN No. ,--'---1._..1..---'----'_--'----'----'PERSONAL DETAILS OF THE AUTHORISED APPLICANT * (Mandatory)FULL NAME *Last Name/SurnameFirst Name

Middle Name

ADDRESSFlat/Door/Block No.

Name of Premises/Building/VillageRoad/Street/Post Office

Area/Locality/TalukaSub-DivisionTown/City/District

State/Union Territory

Pin

Telephone No.

Fax

Mobile Phone No.

Nationality

[Lti,~A~~~~~~~~~~~~IV~~,~L~~~~~~~~~~~~~,-~~~~~~~~~~~~~

I~Rij.~A~~~~~~~~~~~~IsB]~~~~~~~~~~~IB~UN 1 > (2

IT]~~~~~~~~I '1~[I_2......--L.---J,...;:~..I-:......J.---I---' --...L-...J--- -I---.L..---L....--I--..-I...---J~~I~bL...:........L-.-:....L..-~..L--..I.--L..----L..-...L..-...J----L--l-~'----1---'

Visa details, in case of Foreign Plaltionals

Version 1.1 "3 - C/ass-3 Certificate (Company}


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Details f()r at least one is mandatory

Passport IssuingAuthority

PASSPORT DETAILS #Passport No. L I J _ . J . . . . . . . . - L . . - - - - ' L - - . . . . 1 - - - - - 1 . _ . J . . . . . . . . - L . . _ L - - - - L - - - - - 1 ._ ' _ - L . . _ l . . . _ - - L - _ _ ' - - '

L I J ~ ~ ~ ~ ~ ~ ~ ~L I J ~ ~ ~ ~ ~ ~ ~ ~Passport Expiry Date

YOTER'S IDENTITY CARD NO. ~~

IIINCOME TAX PAN NO. #

E-MAIL ADDRESS * (Mandato.,,)~~~ __~~ __~~~_I __[ E . . . . 1 - y - - - - 1 ._ . J . . . . . . . . - L . . . . . . 1 - l . . . - - - L - _ _ '_ '_ ~ _ l . . . _ ~ ~ _ _ ' _ ~ _ ~ ~TYPE OF DI(iITAL CERTIFICJ~TE; REQUIREDSigning Certificate (Single Key pair) D(This can be used for signing and/or encryption)

For AK tlRA M.AR!NS 't'HANSPO""~ Proprie tor

Date Signature of the Applicant

~--~----~---~~~~~~~~~~-,To be filled by TCS - RA OfficeThe above details have been verified and found to be correct.

III~

Signature of RAOfficeName:Date:

Seal:

Version 1.1 -4- Class3 Certificate {Company)


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DOCUMENT CHECKLIST FOR mMPANV TVP~ OF C~R.TIFICAT~The following is a list of the supporting documents that you need to submit along with theCertificate Request Form.NOTE:

NOTARIZATION TO BE DONE BY PUBLIC NOTARY. ATTESTATION TO BE DONE BY GAZZETTED OFFICER.

. ,Sr. Requirfd Documents I.Do(;ument Dg~Ument5No. submitted verified bvI : RA, I I,1 Certificate of IncorporationPublic &. Private Limi1l:edCompanies (anyone

NOTARIZED copy required) Certificate true copy of the Certificate of 0 0incorporation I Business commencement fromeither the company secretary I a Director of thecompany Certified true copy of the Memorandum and 0 0Articles of Association from either the Companysecretary I a Directory of the company

Copy of the latest Annual report. 0 0!Partnership Firms (arlY one required)i Certificate true copy of the partnership deed from 0 0

either a Class I Gazette officer I Notarv IChartered Accountant. I Copy of One of the following: - 0 00 Latest Annual Report

Latest Balance sheet 0 00Latest Income Tax Return 0 00

Proprietorship Firms i(any one requin:td) Copy of the Latest bank statement certified by thebank manager of the bank where the account is 0 0held.

Copy of One of the following: - 0 00 Latest Balance sheet 00 Latest Income Tax Return 0

2 Subscriber Verification Documents (ahy oneattested copy requirelcl) 0 0 PassportVoter's ID 0 0 PANcard 0 0Version 1.1 -5- crass-a Certificate (Company)


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Identity Card - Attested by Authorized signatory ofthe company with photograph. 0 0 Driver's license 0 0 Ration Card 0 03 Proof of Address (anyone attested copyrequired) 0 0 Passport Ration card 0' 0

Driver's license 0 0 Latest Telephone bill 0 0 Latest ElectriCity bill 0 0 UC receipt 0 0 Authorization Letter on the company's letterhead 0 0attested by company's authorized person.4 Company PANNo. (Required) 0 05 Certificate Enrollment Form (downloaded from) + Letter of Authority 0 0

(Required)

Pric::ingDetails:Validity

Options Digital Signature Certificate USB Token Per'iod Priceontlon A 1 - 1 year RS.2,245/-Option B 1 i 1 1 year Rs. 3,125/-I

I

Option C 1 - 2 years Rs.3,928/-Option D 1 1 2 years Rs.4,808/-

Prices are inclusive of all Taxes

IRenewalDigital

SignatureCertifieate Validity I~eriod Price

1 1 year Rs. 2245/-*1 2 years Rs. 3,928/-*

The same USB token if procured earlier, can be used for the renewed certificate

V(}rsion 1.1 -s- Ciass-3 Certificate (Company)


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Declaration

I hereby agll"eethat I have read and understood the following instructions carefully andensure proper usage of the Digital Certificate.

1. The certificate should be downloaded onto the same machine/device from where therequest was initiated.

2. After placing an online request for a certificate, the following activities should not becarried out until the certificate is successfully downloaded:; j Formatting of the machine the machine;j Reinstallation or upgrade of the internet browser on the machine from which the

certificate request was initiated3. At the time of registration, a valid email 10 that is accessed regularly should be provided.4. Certiflcate revocation is permanent and ir1eversible. If my certificate is revoked, I will

have to reapply for a fresh certificate. The fame will be approved only after the paymentof necessary applicable charges.

5. The security level in the Internet Browser should be set to 'Medium' and all scriptingshould be enabled.

6. The 'Certificate Trust Chain' has to be downloaded for using my certificate. (Link:)

7. It is my responsibility to remember the passwords that are used whilegener.ating/exporting the certificates/keys.

8. Requirements with respect to Operating System and Internet Browser are as follows:" Operating System I

a. Supported Versions - Windows ZOOO/XPb. Recommended Versions - Windows 2000/XP

-- J Internet Browsera. Supported Versions - IE 5.5 and aboveb. Recommended Versions - IE 6.0 and above

for

Date Signature of the Applicant

Version1.1 -7- Class-3 Certificate (Company)


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Annexure-A: letter of Authority

I, VAL,lr7JOHPtf71t:;J) 1 - 1 , kHAkHR{~ in the capacity of the?eD PRE ITV~ of kHAkHRI=l i.IJAP-1 N/E. 'TI2A~s.t'oRT'f

authorize VA LtMC)/i (+M G!) H, r whose signature is attested below to carry out all thenecessary formalities on behalf of k H A ! e - - H Qf) ~I') f'\R..I?0 I E TR.AN~ PoR.If. for theapplication of a Class-3 Digital Signature Certificate with the validity period of Vj year(s).

Rl\ M/tRINE TRANSPOft'j/L

Signature and Designationof Authorizing Person }ilro!,rietcr

Signature and Designationof the Applicant

Signature and Designationof the Authorizing Person

Version 1. 1 8- Class3 Certifieate (Company)


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Payment' Detail~:The payment for the certificates can be made through Demand Draft only, in favor of "CharteredInformatrol1l Systems Pvt Ud"

I!

Demand [)raftNumber Date ~c-- B_a_n_k_D_e_ta_i_IS A_m_o_u_n_t _

The Certificate Request Form, Demand Draft and the Document Checklist along with allthe supportnng documents has to be forward@i at the following addre~s:Duly mark the envelope as 'APiPLICATION FORiCLASS III DIGITAL CERTIFICATE'corporate Office - NagpurDSCDepartmentChartered Information Systems Pvt. Ltd."Chartered House",West of Lata Mangeshkar Musical Park,Bhandara Road, Nagpur - 440 008 INDIAPh: 0712 - 6638888 (100 Lines), 9225245088TeleFax: 0712 - 6638899

Mumbai OfficeTirupathi Bhalla IMayur Maniyarqhartered Information Systems Pvt. Ltd.#904, Navjeevan Society, Building No.3,Larnington Road, Mumbai - 400 008 INDIAPh: 022 - 6522 8288, 2300 8088

Kolkata OfficeBiswajeet BhattacharyaChartered Information Systems Pvt. Ltd."Haveli" Block No. 15, 2nd Floor,17, Bal Mukund Macker Road, Near M.G. Metro,KOLKA TA - 700 007Ph: 033 - 4007 8355, 4007 8350, 99035 36765

Bangalore OfficeShrinivas IRaghavChartered Information Systems Pvt. Ltd.#207-B, Wing A enqaoe MajeStiC,tst Main(Kalidas) Road, Gandhinagar,Bangalore - 560009 INDIAPh: 080 - 40921639,9972932213

Delhi OfficeKapil BhimjiyaniChartered Information Systems Pvt. Ltd.#208, 3rd Floor, Dhaka Chambers,2068/39, Naiwala, Karolbagh,New Delhi - 110 005 INDIAPh: 011 -45037177, 09a71265511(Kapil)

ChennaiOfficeNarayanan IHukumChartered Information Systems Pvt. Ltd.1st Floor, Arihant Plaza, #84, Wall Tax Road,Above S81 Elephant Gate,Chennai - 600 003 INDIAPh: 044 -25330837,9841777268,9790930847

Ahmedabad OfficeSahailesh IViralChartered Information Systems Pvt. Ltd.D-50, 2nd Floor, B. G. Towers,Delhi Gate, Ahmedabad - 380 004 INDIAPh: 079 - 6605 4735,9974533506 (Viral)

Pune OfficeChitesh Dave93246 10283 (Chitesh)

Version 1.1 - 9- Class-3 Certificate (Company)