Class 2
Individual Certificate
Customer identification Number : __________________________________ (for office use only)
Validity 1 year 2 year Type Only signing Sign & Encrypt
Applicant Name
Surname First Name Middle name
Email ID Date of Birth
Residential Address
(As mentioned in attached
supporting)
Town/City/District State/Union Territory
PIN Contact No MO
Identity Detail of Applicant
*PAN Post office Driving Passport Govt. Copy of Bank Account Passbook containing photo &
Card ID Card License ID Card signed by applicant with attestation by concerned
Bank officer
* For PAN based DSC please provide the PAN Card Details and enclose the copy of same
I hereby agree that I have read and understood (n) Code Solutions CA CPS and the subscribe agreement and promise to abide the same I have read
arid understood guidelines for storage of private keys mentioned in (n) Code Solutions CPS and risk involved by using other storage devices to store
private keys. I shall be held responsible for all risks arising out of not using USB Crypt tokens to store private Key.
DETAILS REQUIRED IF APPLIOCANT IS FFOREIGN NATIONAL Nationality
Visa Details Passport No.
1. Please fill the form in English only legible format 6. All supporting should be attested by Gazetted officer Bank manage
2. The details are required to obtain Class 2 individual Certificate or Post Master. Alternatively the applicant can present against to
and will bear Object Identification as 2.16.326.100.2.2 LRA for verification and attestation.
3. Increase key pair has been compromised/lost/defeated, please 7. The validity of address proof in case of utility bills shall not be older
apply for revocation of certificate. than 3 months from the date of application
4. Incomplete application is labeler for Rejection. 8. For any assistance Please get in touch with us at
5. Please refer to the CPS for more information [email protected] or call 1800-233-1010
Date
Place Signature of Applicant
Verified by (n) Code office For LRA use only
All Document Checked & Verified by All Document Checked & Verified by
Seal & Signature LRA Name. Seal & Signature
