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DGFT Form

1) The document is a digital certificate subscription form for obtaining a 1 or 2 year digital certificate from SafeEXIM. 2) It requests basic subscriber details like name, designation, date of birth, gender, organization name, address, phone number, email, and identity proof details. 3) The subscriber declares that the information provided is true and correct and acknowledges their duties and responsibilities under the applicable laws. 4) An authorizer from the subscriber's organization also needs to sign to acknowledge the subscriber's role and responsibility to revoke the certificate if they leave the organization.

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Zankar R Parikh
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225 views

DGFT Form

1) The document is a digital certificate subscription form for obtaining a 1 or 2 year digital certificate from SafeEXIM. 2) It requests basic subscriber details like name, designation, date of birth, gender, organization name, address, phone number, email, and identity proof details. 3) The subscriber declares that the information provided is true and correct and acknowledges their duties and responsibilities under the applicable laws. 4) An authorizer from the subscriber's organization also needs to sign to acknowledge the subscriber's role and responsibility to revoke the certificate if they leave the organization.

Uploaded by

Zankar R Parikh
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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sify safescrypt

SafeEXIM Digital Certificate Subscription Form


Certificate Validity 1 year 2 years Request Id

Section 1 : Subscriber Details


NAME:
Sign half across
(of applying
photo & half on
individual)
form with BLUE PEN

Designation:
Date of Birth: Gender: Male Female

Organisation Name:

IEC Code: Branch Code:


· Use blue-ink only
Organisation Address: including signature
(as per Branch Code)
· Ensure the Name,
Road/Street/PO: Office:
Road/Street/Post Designation, Address
and Contact number
Town/City/District: of the attesting
officer is present in at
State/Union Territory:
: least one of the
Country: attestation document

Postal Code:
Telephone Number (with STD Code):

Mobile Number: (unique to the dsc):

E-mail Id :(unique to the dsc):

Section 2 : Identity Proof Details


Photo Identity Proof Address Proof
Identity Proof Name
Address Proof Name
(e.g. PAN or Passport or Driving Licence of
(Organisation address proof )
applying individual)
Identity Proof Number
Note: Subscriber’s signature should appear on the Photo ID Proof

Section 3 : Declaration
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 CA
CPS https://www.safescrypt.com/ pdf/cps.pdf and also under the Section 71 of IT Act which stipulates that if anyone makes a misrepresentation or suppresses any
material fact from the CCA or CA for obtaining any DSC such person shall be punishable with imprisonment up to 2 years or with fine up
to one lakh rupees or with both.
Signature of the Subscriber (Applying Individual): Use Blue Pen Only
Date: Place:

Section 4 : Authorisation
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 Organisation’s behalf and I will
ensure timely revocation of Digital Signature Certificate in case the employee leaves the company in future.

Signature of Authoriser with Organisation Stamp/Seal: Use Blue Pen Only

-- FOR OFFICE USE ONLY --


Partner Name: Sify RA: Date of Issuance:

Safescrypt CA Service brought to you by: Sify Technologies Ltd.

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