Father’s Name :

(As Per Branch Code)

Request ID ................................

DGFT

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entity

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Note*: Safescrypt at its discretion, will make a telephone call to verify the details of this Subscriber.

Applicant D

etails

Authorisation m

ay be seperately provided on Letter H

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SafeScrypt CA Services brought to you by:Sify Technologies Limited, 2nd Floor, Tidel Park, #4 Rajiv Gandhi Salai, Taramani, Chennai - 600113.

For office use only

Subscriber’s Photo Identity Proof*

Organisation’s Address Proof*

Identity Proof Name

Address Proof Name

Identity Proof Number

(As Per Branch Code)

( Eg: Pan Card, DL, Passport, etc. )

Note*: Subscriber's signature should appear on the Photo ID Proof.

* Self Attested Photo

Name of Subscriber*:

Organisation Name * :

Organisation Address* :

Road/ Street/ Post Of :

Town/ City/ District * :

State/ Union Territory * :

Country* : PIN Code* :

Telephone Number* (with STD Code) : :

Mobile Number*

:

Date of Birth* :

IEC Code*

: Branch Code* :

Gender *: Male Female D D M M Y Y Y Y

Designation* :

Section 3 : Declaration

Section 2 : Identity Proof Details

Section 1 : Subscriber Details

Partner Name: Date of Issuance:

Email id* :

( Eg: Sales Tax, Latest Telephone

Bill, Electric Bill, Bank Statement,

etc. )

Certific ate Validity 1

Yea r 2 Yea rs

( Refer IEC Certi�cate

for Branch Code )

Organisation D

etails

City:

SafeEXIM Digital Ce rtificate Subscription For m

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over

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I hereby declare that all the information provided on 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 a digital signature certificate, the duties and responsibilities applicable under the IT Act, India and the

SafeScrypt CA’s CPS https://www.safescrypt.com/pdf/cps.pdf .

Signature of the Subscriber*

D D M M Y Y Y YDate*: Place*:

I , ______________________________________________________ acknowledge by my signature, that the Subscriber information in this document

is complete and accurate as per our office records. I fully understand that the Subscriber is responsible to transact on the Organisation’s behalf and I will

ensure timely revocation of Digital Signature Certificate in case

the employee

Signature & Organisation seal*

Name of the Authorising person _________________________________

leaves the company in future.

Designation of the Authorising person_____________________________

LRAA : M/s. M. DUTTA. 11, Old Post Ofce Street, Near High Court, Kolkata - 700001, Phone : 033 2230-7011, Mobile : 98360-27639

Section 4 : Authorisation

Important Instruc�on DGFT (SafeExim) Digital Signature (Non Aadhaar eKYC based)

The Controller of Cer�fying Authori�es of India ahs specified Iden�ty Verifica�on Guidelines and ahs made the same Mandatory w.e.f. July 01 2015. In accordance with the guidelines the Applicant should comply with the following.

Sec�on 71 of IT Act s�pulates that if anyone makse a misrepresenta�on or suppresses any material fcat from the CCA or CA for obtaining any DSC such person shall be punishable iwth imprisonment up to 2 years or with fine up ton eo lakh rupees or with both. The Subscriber being an Indian Na�onal can opt for Aadhaar eKYC based service for issue of Digital Signature to experience a more Simplified procedure rela�ng to documents requirements, mobile verifica�on and physical verifica�o.n The Aadhaar eKYC based Digital Signature Form will be separately available. A Biometric device will be provided for verifica�on.

� Please fill the form in BLOCK LETTERS in English. Use only Blue Ink . All signatures including DSC applicant, a�esta�on and authoriza�on should be with blue-ink only.

� Subscriber has cross-signed the photograph extending to the Applica�on Form.

� If the Signature on the Proof of Iden�ty or Proof of Address does not match with the Signature on the Subscrip�on Form, it should be validated by the bank where the Subscriber holds a bank account.

� In the case of applicant is unable to sign due to disability, paralysis, or other reasons, the DSC issuance should be through Aadhaar eKYC service.

� Power of a�orney is not allowed to sign the Subscrip�on Applica�on on behalf of subscriber.

� Inconsistent/incomplete applica�ons are liable to be rejected.

� Subscriber’s Email ID in the applica�on should be a valid and ac�ve, in order to issue the cer�ficate.

� Mobile Number of DSC Subscriber is Mandatory.

� USB Token (FIPS 140-1/2 level validated Hardware Token) is required for genera�on of Signing Cer�ficates.

� Proof of PAN is mandatory if PAN value is to be included in the Cer�ficate (Required for Income Tax)

� For Class 3 Digital Cer�ficate, a Video capture facility will be provided. Document for Indian Na�onals

Document as proof of iden�ty (Any one) a) Valid Passport b) Valid Driving License c) PAN Card d) Valid Post Office ID card e) Bank Account Passbook containing the photograph and

signed by an individual with a�esta�on by the concerned Bank official.

f) Valid Photo ID card issued by the Ministry of Home Affairs of Centre/State Governments.

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

A�esta�on A�esta�on of suppor�ng documents by RA or its Associates is no more allowed. Copy of suppor�ng document should be a�ested by Authorised execu�ve/Manager of the Bank or Post Maesrt or Group ‘A’ or Group ‘B’ Gaze�ed officer a� pehr ysical verifica�on of original documents and with his Seal & Signature specifying his Name, designa�on, office address and contact number which should be clearly visible. Group ‘A’ Gazetted officers include

a) All India services though posted to states b) Promotes from states to the cadre of Assistant commissioner and above c) Police officers (Circle Inspector and above) d) Addi�onal District Civil surgeons e) Execu�ve Engineers and above f) District Medical Officer and above g) Lt. Col and above h) Principals of Government Colleges and above i) Readers and above of Universi�es j) Patent Examiner etc.

Group ‘B’ Gazetted officers include a) Sec�on Officer b) BDO (Block Development Officer) c) Tahsildar d) Junior Doctors in Government Hospitals e) Assistant Execu�ve Engineer f) Lectures in Government colleges g) Headmaster of Government high schools h) 2nd Lieutenant to Major i) Magistrate etc.

Document for Organisa�on

Type of Organisa�on Document

Company Partnership Proprietorship Others

1. Copy of Organizatonal / Proprietor ‘ PAN Card

Yes Yes Yes Yes

2. Copy of Organisa�on’s Bank Statement (first 2 Pages)

Yes Yes Yes Yes

3. Copy of Incorpora�on / Registra�on Cer�ficate of Organisa�on

Yes Yes

4. Trade Licence in case of Proprietorship or Sales Tax/ VAT Registra�on Cer�ficate or Shop & Establishment Cer�ficate.

Yes

5. Copy of Memorandum Ar�cles / Partnership deed/ Bye Laws (First 2 pages)

Yes Yes Yes

6. Copy of Last Audit Report and Annual Return (First 2 pages)

Yes Yes

7. A�ested copy of last ITR with computa�on (First 2 pages)

Yes Yes Yes Yes

8. Copy of Resolu�on Empowering the Authorised Signatory

Yes Yes

9. Copy of Import Export Code (IEC Cer�ficate)

Yes Yes Yes Yes

Copies of Organisa�on Documents to be a�ested by the Authorising Person with seal For Documents rela�ng to Foreign Na�onal Refer Instruc�ons and For Documents rela�ng to Foreign Organisa�on similar documents as stated above shall be required:. For Documents rela�ng to Govt. Organisa�on, where the subscriber is a Govt. employee refer table below

Government Employee Iden�ty verifica�on requirements are as men�oned below:

a) Applicant’s Valid iden�ty card b) Forwarding Le�er by the Head of Office. c) A le�er/no�fica�on from Head of Department authorizing the Head of Office d) The a�esta�on of documents may be carried out by Head of the Office/Gaze�ed Officer. The a�esta�on should contain

Signature, Seal, Name, Designa�on, Office address and contact number of the a�esta�on Officer. e) For Class 3 cer�ficate Head of Department should cer�fy the physical verifica�on of subscriber with his signature and seal

men�oning his Name, designa�on, office address and contact number.

.

Sample Format of Resolu�on Extracts of the mee�ng of the [Partners/Board of Directors/Governing Body] of [Name of the Organisa�on] held on [Date] “Resolved that Mr. [Name of the person being appointed for authoriza�on], whose details, photo and signature given below, be and is hereby appointed to Authorize [all or any or selected Persons of the Organisa�on as per list ] at [Name of Branch/Unit/Department] for obtaining Digital Signatures of [Class ___ with Organisa�on Name having Validity____ years for Signing/Encryp�on/Both Signing & Encryp�on] on behalf of the Organisa�on.”

Name of the person Appointed for Authorisa�on: Designa�on : Department: Employee Code: Employee ID Card No : Address: Signature: Contact No. Date:

Photo of the Person with seal of the Organisa�on

Cer�fied true Copy For [Name of the Organisa�on] Signature of the Partner/Director/Chairman/Secretary/Head of Department