Income Tax | ROC | MCA 21 | Digital Signature Certificate ... · PDF fileMale Female Nationality L A S T N A M E Date of Birth Gender City State Pin code PAN of Applicant Mobile APPLICANT

Income Tax | ROC | MCA 21 | Digital Signature Certificate| |2yrs Valid with Token |

E filing made easy with Digital Signature Certificate

NOW GET YOUR DSC THROUGH AADHAAR EKYC WITH IN 30* MINUTES

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022-28787701 +91 8692991000 022-40137701 +91 8652488877 022-65787701 +91 9699122899

!! Email id - [email protected] !!

!! Email id - [email protected] !!

INSTRUCTION /CHECKLIST Please fill the form in BLOCK LETTERS & BLUE INK ONLY. Certificate will be issued only if application form is complete in all aspect. Along with the completed and signed Application form, please attach following document as

mentioned below-:

Requirement-1 Latest Photo of the applicant to be pasted and Signed across Mandatory Blue Ink.

Requirement-2 PAN Card Copy as Identity Proof (Self Attested - Mandatory Blue Ink) Requirement -3

Address Proof (Self Attested – Mandatory Blue Ink) Any One of the following.

Aadhar Card Voter Identity Card Passport (Mandatory in case of Foreign Nation) Driving License Bank Statement Signed and stamped by Bank Authority Service Tax / Sales Tax registration certificate etc. Service Tax / Sales Tax registration certificate etc. Telephone Bill- (not later than 2 months) Electricity Bill - (not later than 2 months) Water Bill-(not later than 2 months

Requirement-4 UNIQUE EMAIL ADDRESS & MOBILE NUMBER IS MANDATORY.

All the Documents Should be Compulsorily Attestation By Gazetted Officer (List Attached)

/ Bank Manager / Post Master), details of the attesting officer like DESIGNATION, ADDRESS AND CONTACT NO. should also be Mentioned. SIGNATURE OF ATTESTING OFFICER IN BLUE INK ONLY.

List of Group ' A ' / Group 'B' Gazetted Officers

Group 'A' Gazetted Officers include All India Services though posted to

states Promotes Form States to the cadre of

Assistant commissioner and above Police Officers (circle Inspector and

above) Additional District Civil Surgeons Executive Engineers and above District Medical Officer and above Lt. col and above Principals of Government Colleges and

above Readers and above of Universities Patent Examiner etc.

Group 'B' Gazetted Officers Include Section Officer BDO (Block Development Officer) Tahsildar Junior Doctors in Government Hospitals Assistant Executive Engineer Lectures in Government Colleges Headmaster of Government high Schools 2nd Lieutenant to Major Magistrate

(NOTARY & SEO ATTESTATION WILL NOT ACCEPTABLE)

Enclose Cheque in the Favour of "Professional Leaders Consultancy Private Limited"

Enclose receipt of NEFT/IMPS Details are as under:

Name: Professional Leaders Consultancy Private Limited

1. A/C No. : 9938002100000675 IFSC: PUNB0993800 BANK: PANJAB NATIONAL BANK TYPE: CURRENT BRANCH: GOREGAON WEST

2. A/C No. : 0691102000007481 IFSC: IBKL0000691 BANK: IDBI BANK TYPE: CURRENT BRANCH: GOREGAON WEST

OFFICE : 131, FIRST FLOOR, TOPIWALA CENTER, JAWAHAR NAGAR ROAD, GOREGAON (WEST),MUMBAI-400062

Male Female Nationality

L A S T N A M E

Date of Birth Gender

City

State

Pin code

MobilePAN of Applicant

APPLICANT INFORMATION F I R S T N A M E M I D D L E N A M E Affix recent passport

size photograph of the applicant duly

signed across

APPLICATION FORM - SIGNATURE / ENCRYPTION CERTIFICATE

FOR GOVERNMENT ORGANIZATION

PLEASE FILL IN BLOCK LETTERS ONLY. ALL FIELDS ARE MANDATORY

Page 1 of 1 Version 2.8

Org Address

Email ID

More Instructions available at: http://www.e-mudhra.com/instruction.html

1 Year

Class 1 Class 2 Class 3

Signature Encryption Combo

CLASS:

TYPE:

VALIDITY:

2 Years

D D M M Y Y Y Y

OrganisationName

Department

DOCUMENT PROOF (attested by Authorized Signatory of the Organization)

eMudhra Limited, 3rd Floor, Sai Arcade, 56, Outer Ring Road, Deverabeesanahalli, Opp Intel, Bangalore 560 103. Karnataka. Phone : +91 80 4336 0000 Fax : +91 80 4227 5306. Email : [email protected] Website: www.e-Mudhra.com.

DECLARATION BY APPLICANTI 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 risksassociated in case of Class 1 Certificate,when storing the private key on a device other than a FIPS 140-1/2 validated cryptographic module.

(As in ID proof | Blue Ink Only)

AUTHORIZATION

Date

Place Authorized Signatory (Sign and Seal) Signature of the applicant

RA Name, Code & Seal Signature of RADate

TO BE FILLED BY RA OFFICE ONLYI declare that the applicant has provided correct information in this application form . I have checked and verified the application form and supporting documents. I herebytake full responsibility for any wrong verification made, or wrong documents submitted for the application.

I hereby authorize this application on behalf of the organization.I hereby confirm the mobile number of Applicant given above. In case of class 3, I confirm the Physical Verification of Applicant.

Document required:

Copy of Applicant’s Goverment ID Card / Letter from Organization / Pay Slip

Authorized Signatory Organisational ID Card / Self-Attested Letter of Organizational Identity

Copy of PAN Card of Applicant, if PAN provided

Application ID: (S) (E) (For Office Use Only)