PND DIGISIGN103, 1st Floor, Simandhar, Wamanrao Sawant Road, Opp. Jana Seva Bank, Dahisar (E), Mumbai – 400068.

Tel: (022) 28284033 / 28282998 / 98209 44649 Email: pnddigisign@gmail.com website: www.pnddigisign.com

INSTRUCTIONS / CHECKLIST

1.Please fill the form in BLOCK LETTERS & in BLUE INK ONLY2.The Certificate will be issued only if the application form is complete in all aspects.3.Along with the completed and signed application form, please attach following documents as mentioned below:

AttachmentsDocument 1 Attested Copy of all documents according to your organisation structure as listed on last

page. Organizational documents can be attested by Authorized signatory. Attestation inBLUE INK ONLY

Document 2 [Attestation by the Gazetted Officer (List attached) / Bank Manager / PostMaster), details of the attesting officer like name, designation, branch addressand branch landline contact no. should also be mentioned. Signature ofAttesting Officer in BLUE INK ONLY].

Document 3 Authorisation Letter to be signed by Other Director / Partner & Seal on form

Latest Photograph of the Applicant to be pasted and Signed across.

Note: 1. In case tax return is not submitted, the Organization should provide a self-affidavit stating the reason.

2. In case, the organization name is different from that in PAN, the proof ofname change is required.

3. In case of Proprietor, any one Business License (like Shop & Establishment /VAT / Service Tax) is required.

4. Unique Email Address & Mobile Number is mandatory.

5. Mobile verification (Tele-Verification) to be done by applicant after processing of application.(If due to any reason mobile/tele-verification fails then Original Application will not be given back as it willbe submitted to company. Even amount will not be refunded.)

6. The authentication credentials to download the DSC would be sent through SMS ONLY on the ApplicantsMobile Number. Two SMS will be sent for two authentication credentials for Signing & Encryption DSC.

7. Video Verification: In case of Class 3, video verification is mandatory

PND DIGISIGN103, 1st Floor, Simandhar, Wamanrao Sawant Road, Opp. Jana Seva Bank, Dahisar (E), Mumbai – 400068.

Tel: (022) 28284033 / 28282998 / 98209 44649 Email: pnddigisign@gmail.com website: www.pnddigisign.com

List of Group ‘A’ /Group ‘B’ Gazetted officers

Group ‘A’ Gazetted officers includei) All India services though posted to statesii) Promotes from states to the cadre of Assistant

commissioner and aboveiii) Police officers (Circle Inspector and above)iv) Additional District Civil surgeonsv) Executive Engineers and abovevi) District Medical Officer and abovevii) Lt. Col and aboveviii) Principals of Government Colleges and aboveix) Readers and above of Universitiesx) Patent Examiner etc.

Group ‘B’ Gazetted officers includei) Section Officerii) BDO(Block Development Officer)iii) Tahsildariv) Junior Doctors in Government Hospitalsv) Assistant Executive Engineervi) Lectures in Government collegesvii) Headmaster of Government high schoolsviii) 2nd Lieutenant to Majorix) Magistrate

(Notary & SEO Attestation will not acceptable)

Please make payment by Demand Draft in the favour of “PND DIGISIGN” or you can make paymentby NEFT (Ask for Bank Details) and send the receipt of NEFT along with this form.

COST STRUCTURE OF KIT AS FOLLOWS:

TYPE DSC FOR 2YEAR +

SERVICE

DriverCD

USBTOKEN

Validity MRP(RS.)

KIT 3 √ √ Safenet 2 Year 6000/-

Provide your GST Details for BillingCompany Name

Company Address

GST No

PAYMENT DETAILS

Issue DD in favour of “PND DIGISIGN”Name of the applicant: ________________________________________________________________

DD No.: _________________ Dated ______________ Amount: _______________ for KIT _________

Drawn on ______________________________________________________________

Board Resolution Format

(On Company Letterhead)

CERTIFIED TRUE COPY OF RESOLUTION PASSED AT THE MEETING OF THE

BOARD OF DIRECTORS OF _____________________________________________

HELD ON _____________ AT ____________ A.M. AT THE REGISTERED OFFICE

OF THE COMPANY

=================================================================

Resolution No.1:

The board of directors passed the following resolutions unanimously.

“RESOLVED THAT the company has decided to obtain Class 3 Organisation DigitalSignature Certificate form the company approved by CCA.

Resolved further that _____________________, Director/Manager is authorised to apply forthe said Digital Signature certificate.

Resolved further that this shall continue until there is any change effected through aresolution passed by the Board of Directors.

(Director) (Director)

Certified True Copy

For ____________________________

Director

(Sign & Seal)