IMPORTANT: READ ME FIRST

1. Use blue ink only for signing the document.

2. Sign on the application must exactly match the sign on the PAN Card or

Passport copy. Any discrepancies will result in rejection of the application by the Registering Authority.

3. There must be two signs on the DSC application, 1 across the photo and the other in the place provided.

4. PAN Card copy is mandatory for Indian Nationals. Notarised passport copy is mandatory for foreign nationals.

5. PAN Card copy must be self-attested and attested by a Gazetted Officer (Green Ink Only) or Bank Manager (Blue Ink Only). Gazetted officer seal / bank manager seal with branch information is a must.

6. Address proof copy must be self-attested and attested by a Gazetted Officer (Green Ink Only) or Bank Manager (Blue Ink Only). Gazetted officer seal / bank manager seal with branch information is a must.

7. Do not complete the application. Send in the blank application with photo and signature, our team will complete the application for you.

8. Courier one signed blank DSC application for SIFY and one signed blank DSC application signed for E-Mudhra. In case of rejection of application, we can retry with other Registering Authority.

9. Courier the signed application and attachments to:

IndiaFilings.com 6 Dhanammal Street, Spurtank Road, Chetpet, Chennai – 600 031 INDIA

Digital Signature Certificate Subscription Form

Use blue-ink only including signature.

Ensure the Name, Designa-tion, Address and Contact number of the attesting offi-cer in at least one of the at-testation document.

I hereby declare that all the information provided in 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 the digital signature certificate, the duties and responsibilities which are applicable under the SafeScryptCA 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 orsuppresses 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.

Male Female Nationality

L A S T N A M E

Date of Birth Gender

City

State

Pin code

MobilePAN

DECLARATION

I 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 risks associated in case of Class 1 Certificate, when storing the private key on a device other than a FIPS 140-1/2 validated cryptographic module.

Date

Place Seal & Stamp (If any) Signature of the applicant

RA Name, Code & Seal Signature of RA

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 INDIVIDUAL

PLEASE FILL IN BLOCK LETTERS ONLY. ALL FIELDS ARE MANDATORY

Page 1 of 1 Version 2.8

Date

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

TO BE FILLED BY RA OFFICE ONLY

D D M M Y Y Y Y

DOCUMENT PROOF (attested by Bank Manager OR Post Master OR Gazetted Officer (Group ‘A’ /Group ‘B’) , against producing the originals)

Proof of Identity (Any one of below)* Proof of Address (Any one of below)*

AADHAAR Card.

Voter ID Card.

Driving License (DL)/ Registration certificate (RC).

Passport.

Telephone Bill (Not older than 3 Months)

Water Bill (Not older than 3 Months).

Gas Connection/Bill (Not older than 3 Months).

Electricity Bill (Not older than 3 Months).

Bank Statements signed by the bank (Not older than 3 Months).

Service Tax/VAT Tax/Sales Tax registration certificate.

Property Tax/ Corporation/ Municipal Corporation Receipt.

Passport.

PAN Card of applicant (Mandatory if PAN provided)

Driving License.

Post Office ID Card.

Bank Account Passbook containing the photograph and signed by an individual withattestation by the concerned Bank official.

ID Number

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 : info@e-Mudhra.com Website: www.e-Mudhra.com.

Photo ID card issued by the Ministry of Home Affairs of Centre/State Governments

Any Government issued photo ID card bearing the signatures of the individual.

Attesting Officer *Self attested copy of ID Card/Contact details of attesting officer.

(Having applicant photo and Signature, as part of it)

(As in ID proof | Blue Ink Only)

I 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.

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