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TATA CONSULTANCY SERVICES LIMITED -

CERTIFYING AUTHORITYREQUEST FORM FOR CLASS-2/CLASS-3 CERTIFICATE

Instructions:1. Please fil l the form in BLOCK LETTERS2. Items marked with * are mandatory.3. For the items marked with # (Details for at least o:le are mandatory)

FULL NAME *Last Name/Surname

First Name

Middle Name

9ENqE&* (Tick asMale

Besi@!-Ad.@*

Pin Code

Mobi le Phone No.

Teleph$e No.

applicable

I Female

Telephone No,Area Code"F

Qffhe-AdglEits *

Date

Theinformationprov|dedaboveinthRequestFortt forprocurlngaDscfrcmTcs.cAisiruL ano correct to the best of my knowledge'

Signature of the APP|icant

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CERnFYIIIG AUTHORITY llttri {Of*sltmAHcY sFnv|cgsaA.f,A F{o8-.tzd by th! .o*troltlt-of iettitfnS ruahontF3

CHECKLIST FOR INDIVIDUAL TYPE OF CERTIFICATE

The following is a list of the supporting documents that you need to submit along with theCertificate Request Form.

!.gIE:. ATTESTATION TO BE DONE BY GAZZETTED OFFICER.. NOTARIZANON TO BE DONE BY PUBLIC NOTARY,

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Aoplicant verification Documents (any oneatteited copy required). Passport. Voter's ID. Bank Account Details. Driver! license. Ration Card. Afi/ Cther

Online Certificate Enrollment Form with RequestNumber + Letter of Authority (Available forprinting on completion of Online Enrollment)

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Ir$rlstlcEr1. All subscribers are advised to read Certificate Practice Statement of cA.2. The certificate shall be downloaded onto the same computer / Hardware devlce (USB token.

Smart Card etc,) by login as same computer user account from where the request was initiated.3. After placing an online request for a certificate, the following activities shall not be carrled out

until the certiflcate ls successfully downloaded:Formattlng of the computerDeletlon of comDuter user account used to logon when the request was initiatedRelnstallatlon or upgrade of the Internet browser on the computer from which the certificaterequest was initiated.

4. The certlflcate must not be shared with others or used by them on your behalf.5. If you lose your key pair, you shall inform the RA Administrator immediately and apply ior the

revocation of your certificate6. Application form must be submitted in pe6on.7. Incomplete/Inconslstent applicatlon is liable to be rejected.

DecEr3li$ot hereby confirm that I have read and understood the ab6ve instructions and wlll follow thea;.:ae instructions for obtaining and using the Digital Signature Certificate.

Date:Place: Signature of the Applicant

5. If you lose your key pair, you shall inform the RA Administrator immediately and apply ior the

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