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Application Form

This document is a digital certificate application form for Antoine Twagirumukiza from the District of Rusizi in Rwanda. It contains information about the applicant such as their name, national ID number, position, and contact details. It also includes documents required for the application and terms of use that the applicant must agree to. The authorized signatory for the institution approves the application and the applicant declares that they have read and understood the terms of use and will be responsible for the digital certificate if issued.

Uploaded by

Bizimana Gilbert
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177 views2 pages

Application Form

This document is a digital certificate application form for Antoine Twagirumukiza from the District of Rusizi in Rwanda. It contains information about the applicant such as their name, national ID number, position, and contact details. It also includes documents required for the application and terms of use that the applicant must agree to. The authorized signatory for the institution approves the application and the applicant declares that they have read and understood the terms of use and will be responsible for the digital certificate if issued.

Uploaded by

Bizimana Gilbert
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
You are on page 1/ 2

File Number:

DIGITAL CERTIFICATE APPLICATION FORM


GOVERNMENT ORGANIZATION

Compulsory (mandatory) items

SECTION 1: INSTITUTION INFORMATION

Application Number (*) 221011-1731-6850

Organization Name (*) DISTRICT RUSIZI TIN (*) 102040317

Shorten Organization RUSIZI MD/CEO/DG Name (*) Dr Anicet KIBIRIGA


Name
(Abbreviation Name) (*)

SECTION 2: SUBSCRIBER/APPLICANT INFOMATION

Applicant Name (*) TWAGIRUMUKIZA Antoine National Id 1195980024455202


/Passport Number (*)

Department (*) FINANCE Position (*) Ag Division Manager

Mobile Number (*) 0788413193 Confirm Mobile Number 0788413193


(*)

E-mail (*) antoine.twagirumukiza@yahoo.com

DOCUMENT REQUIRED
1. DIGITAL CERTIFICATE APPLICATION FORM
2. Copy of National ID
3. Copy of passport for foreigners (*Mandatory for foreigners)
4. Digitally signed authorization letter from the institution's authorities (*Mandatory)

AUTHORIZED SIGNATORY (Signature of MD/CEO or the Head of the Institution)

I hereby authorize this applicant to get his/her digital certificate in the name of the institution
(Note: The provided digital certificate should never be shared, other employees can apply to get theirs the same institution)

Tel: +250788313060 or 4045, Email: pki@risa.gov.rw, Website: www.govca.rw


Subscribers Agreement

1. Subscription Agreement: A subscriber who uses this note of certification of Digital Certificate shall be subjected to the Subscription Commitments
provided by Government Certification Authority ("GOVCA" hereinafter), Licensed and Accredited by RootCA ("RURA") hereinafter.

2. Identification: GovCA reserves the right to collect information as required to check the identification of a subscriber, either an individual or a
corporate/systems, for the purpose of usage, issuance, re-issuance, renewal, suspension, and revocation of its certificate or changing information. A
subscriber is deemed to approve GovCA 's right by signing or putting a seal to the application for certification services.

3. Generation of Distinguished Name: GovCA reserves the right to generate a unique name called DN (Distinguished Name) for identification based on
its own relevant policy.

4. Processing Period: GovCA will do all the best to process all applications for certification as soon as possible. However, GovCA shall not be held
responsible for any delay in the processing due to unpredicted circumstances.

5. Management of Reference Number/Authorization Code: The reference number and authorization code generated by the system during the
certificate registration process uniquely belong to the subscriber. The loss of this reference number or authorization code prior to certificate issuance
will make it impossible to ensure the issuance and the security of the digital certificate. In case of such loss, the subscriber should immediately
inform GovCA or the RA (Registration Authority) of which he/she obtained the reference number and authorization code to prevent from any illegal
usage or information leakage.

6. Generation, storage and Protection of Private Key: The generation, Storage and Protection of Private Key shall be the sole responsibility of the
subscriber. In the case of disclosure or loss of the private key, the subscriber should report immediately to GovCA or RA. The subscriber shall be
responsible for any result that may come due to his/her carelessness, poor management or improper use of the private key.

7. Care of Information Related to Certificate Issued: The subscriber shall be responsible for any consequences due to poor safeguard of information
related to the issued certificate.

8. Suspension or Revocation: GovCA has the right to suspend or revoke the certificate at its sole discretion in the event of occurrence of a situation
stated in the Law governing information and communication technologies. (LAW N°24/2016 OF 18/06/2016).

9. Subscriber's Obligation for Prompt Report: The subscriber shall be responsible for any result that may come due to his/her failure to report
occurrence of any problem for which he/she has not reported in time.

10. Immunity: GovCA shall not be responsible for any result, including an inability to use the certification service or a functional problem that may
come due to an error made by the subscriber in handling computer equipment or in processing his or her business or special characteristics of the
hardware or software of his/her computer. GovCA shall not also be responsible for any delay or inability or related consequences that may come due
to such a delay or inability in provision of public certification service resulting from force majeure, including malfunction of the computer or
communication system or other external factors beyond its control.

APPLICANT DECLARATION

I hereby agree that I have read and understood the GovCA terms of use as in the subscriber agreement (found on page 2 of this document) and will
abide by the same. I confirm that the information provided in this form is true and valid. I will take full responsibility of the digital certificate that will be
provided to me.

Applicant Name: TWAGIRUMUKIZA Antoine

Date: October / 11 / 2022

TO BE FILLED BY REGISTRATION OFFICE


I declare that I have checked and verified that the form is well filled
RA Manager:
and contains the necessary information and supporting documents
that allow the applicant to be registered. Date:
I hereby take full responsibility for any missing information or
document related with this application.

RA Manager’s Digital Signature Area

Tel: +250788313060 or 4045, Email: pki@risa.gov.rw, Website: www.govca.rw

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