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Class Type Application ID Validity: Name: Pan: Date of Birth: / / Mobile: Gender: Address

This document is a digital signature application form for an individual applicant. It requests information such as the applicant's name, PAN, mobile number, date of birth, gender, address, email, ID proof, address proof, and a passport photo. The applicant must select a digital signature class and validity period. The applicant declares that the information provided is correct and agrees to terms and conditions. A registration authority must also sign to declare that the portal information matches the submitted application and documents.

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arjunsinghrajkumar
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54 views

Class Type Application ID Validity: Name: Pan: Date of Birth: / / Mobile: Gender: Address

This document is a digital signature application form for an individual applicant. It requests information such as the applicant's name, PAN, mobile number, date of birth, gender, address, email, ID proof, address proof, and a passport photo. The applicant must select a digital signature class and validity period. The applicant declares that the information provided is correct and agrees to terms and conditions. A registration authority must also sign to declare that the portal information matches the submitted application and documents.

Uploaded by

arjunsinghrajkumar
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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Digital Signature Application Form - Individual

Fill using BLUE ink in Block letters


Certifying Authority

Class Class 1 Class 2 Class 3 Validity Application ID

Type Signature Encryption Combo 1 Year 2 Years 3 Years

Applicant Information

Name:

PAN: Mobile:
Affix Passport Size Photo
Date Of Birth: / / Gender:

Address: ture
s Signa
Cros

City: State: Pincode:

Email ID:

Document Proof
All supporting documents should be attested by Gazetted Officer or Bank Manager or Post Master and the name, designation, office address
and contact number of the Attesting Officer should be clearly visible.

ID Proof
Passport PAN Card of applicant (Mandatory if PAN provided) Driving License Post Office ID Card
Bank Account Passbook containing the photograph of the applicant and signed by the concerned Bank official
Photo ID card issued by the Ministry of Home Affairs of Central / State Government
Any Government issued photo ID card bearing the signature of the individual

Address Proof
Voter ID Card Driving License (DL) / Registration Certificate (RC) Passport
Telephone Bill (Not older than 3 Months) Water Bill (Not older than 3 Months) Electricity Bill (Not older than 3 Months)
Gas Connection / Bill (Not older than 3 Months) Bank Statements attested by the bank (Not older than 3 Months)
Property Tax / Corporation / Municipal Corporation Receipt

Declaration by Applicant Information for GST Invoice


I have read, understood & agree to the terms & conditions Same as Above GSTIN:
mentioned in the VSign CPS & the subscriber agreement.
Billing Name:
I confirm that the information provided by me in the digital
signature application form is correct. I am aware that Section 71 Billing Address:
of the IT act stipulates that if anyone makes a misrepresentation
or suppresses any material fact from the CCA or CA for State:
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. RA Declaration
I declare that the information entered on VSign portal is as per the
application form and documents submitted by the subscriber.

Date: Date:

Place: RA Code:
Applicant’s Signature Registration Authority Signature & Seal

VERASYS TECHNOLOGIES PRIVATE LIMITED, 2nd Floor Bhavna Building, V.S. Marg, Prabhadevi Mumbai- 400025
Website: www.vsign.in | Contact: 91 22 43156000 | Email: [email protected]

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