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Digital Signature Certificate Subscription Form

This document is a digital signature certificate subscription form for office use only. It requires the subscriber's signature to acknowledge that the information provided is complete and accurate. The subscriber is responsible for transactions on behalf of the organization and the employer must ensure timely revocation of the certificate if the employee leaves. The form collects the subscriber's personal details, identity proof details, declaration, and authorization for organizational digital signature certificates.

Uploaded by

Sunny Prasad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
78 views1 page

Digital Signature Certificate Subscription Form

This document is a digital signature certificate subscription form for office use only. It requires the subscriber's signature to acknowledge that the information provided is complete and accurate. The subscriber is responsible for transactions on behalf of the organization and the employer must ensure timely revocation of the certificate if the employee leaves. The form collects the subscriber's personal details, identity proof details, declaration, and authorization for organizational digital signature certificates.

Uploaded by

Sunny Prasad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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For office use only

Digital Signature Certificate Subscription Form


I , _______________________________________________________ acknowledge by my signature, that the Subscriber information in this document
is complete and accurate as per our office records. I fully understand that the Subscriber is responsible to transact on the Organisations behalf and I will
ensure timely revocation of Digital Signature Certificate in case the employee leaves the company in future.
Signature & Organisation seal*
SafeScrypt CA Services brought to you by:

Photo Identity Proof* Address Proof*
Identity Proof Name Address Proof Name

Identity Proof Number
( Eg: Pan Card, DL, Passport, ...)
Note*: Subscriber's signature should appear on the Photo ID Proof.
( Eg: Passport, DL, Latest
Telephone Bill, ...)
I hereby declare that all the information provided on this Subscription Form for the purpose of obtaining a digital certificate is true and correct to the best of
my knowledge. I am aware, as a subscriber for a digital signature certificate, the duties and responsibilities are applicable under the IT Act, India and the
SafeScrypt CAs CPS https://www.safescrypt.com/pdf/cps.pdf .
Signature of the Subscriber*
Date*: Place*: D D M M Y Y Y Y
Note*: Subscriber has to sign before the Authorised LRA/Partner for Class3 DSC.
* Self Attested Photo
Name*:

Address (Residential address in case of Individual or Organization address in case of DSC with ORG )
Organisation Name * :
(Mandatory in case of ORG DSC)
Door No/Building Name * :
Road/ Street/ Post Office * :
Town/ City/ District * :
State/ Union Territory * :
Country* : PIN Code*
Telephone Number* (with STD Code): :
Mobile Number* :
Date of Birth*: Gender *: Male Female D D M M Y Y Y Y
Designation :
Section 4: Authorisation (*only for ORG DSC)
Section 3: Declaration
Section 2: Identity Proof Details
Section 1: Subscriber Details
Partner Name:

City:

Date of Issuance:
I hereby declare that the subscriber has personally appeared before me and submitted the
original document copies of ID proof. I have verified the same with TRUE COPY.
Date * Name * D D M M Y Y Y Y
Signature and Seal *
Note*: Safescrypt at its discretion, will make a telephone call to verify the details of the Subscriber.
Attestation By Sify Authorised LRA/Partner(*For Class3 DSC Only)
Individual
With
Org Name
Class of Certificate Type of Certificate Certificate Validity
Signing
Encryption
Class 2
Class 3
1 Year
2 Years
Sify Technologies Limited, 2nd Floor, Tidel Park, #4 Rajiv Gandhi Salai, Taramani, Chennai - 600113. E-Mail: enquiries@safescrypt.com
Email id* :

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