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User Id: ------------------

RA Name: R3 eConsulting Private Limited - Registration Authority

TATA CONSULTANCY SERVICES LIMITED CERTIFYING AUTHORITY REQUEST FORM FOR CLASS 2 CERTIFICATE

USER TYPE INDIVIDUAL

Instructions:Items marked with * are mandatory. Items marked with ^ are prepopulated in the Certificate Enrollment form Items highlighted with black border are modified fileds and require reverification. If you want a DSC with PAN. Please select PAN card as proof of identity.

Validity of DSC * Surname *^ Father/Husband's Name ^ E-Mail Address *^ Alternative E-Mail Address

1 year

Gender* Given Name *^ Initials ^

i j k l m n

Male

j k l m n

Female

Organization Details
Name House Identifier Street Address City State Telephone Pin Code Country Mobile

India

Residential address
House Identifier * Street Address * City *^ State *^ Telephone * Pin Code *^ Country*^ Mobile

India

DOCUMENT CHECKLIST FOR INDIVIDUAL TYPE OF CERTIFICATE

Note:

Copies of one or more of the following must be provided to TCS-CA to authenticate the identity & proof of residence. Provide the appropriate identification details for the selected document. Attestation to be done by GAZZETTED officer or Notarization to be done by PUBLIC notary. In the case where the address on the photo-id proof provided e.g. copy of Passport or Driving License does not match with the address in address proof provided, an affidavit should be submitted along with the supporting documents and the application form.

Subscriber proof of identity and residence(any one ATTESTED copy required)

c d e f g

Identity and Residence Passport Driving License Identity PAN Card Ration Card Others Residence Latest Electricity Bill LIC Receipt Ration Card Others

Passport

c d e f g
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g

c d e f g c d e f g
PAN Card

Ration Card Others

c d e f g c d e f g

Passport Driving License

Latest Electricity Bill

c d e f g c d e f g c d e f g

Bank Account Passport Driving License

c d e f g
c d e f g c d e f g

Instructions

 All subscribers are advised to read Certificate Practice Statement of CA. be downloaded the The certificate shall Smart card etc.)ontologin same computer / Hardware device (USB token, by as same computer user
account from where the request was initiated. The certificate must not be shared with others or used by them on your behalf If you lose your key pair, you shall inform the RA Administrator immediately and apply for the revocation of your certificate.

After placing an online request for a certificate, the following activities shall not be carried out until the certificate is successfully downloaded:

- Formatting of the computer Deletion of computer user account used to logon when the request was - initiated - which the certificate request was initiated.
Reinstallation or upgrade of the Internet browser on the computer from

Application form must be submitted in person. Incomplete/Inconsistent application is liable to be rejected.

Instructions For Form Filling

Surname Given Name Father/Husband's Name Initials E-mail Address Alternative E-mail Address Organization Name Organization House Identifier Organization Street Address Organizationcity Organization PIN Code Organization State Organization Country

Enter your Surname. Maximum limit of 64 alphanumeric characters. Enter your Given Name. Maximum limit of 64 alphanumeric characters. Enter your Father/Husband's Name. Maximum limit of 64 alphanumeric characters. Enter your Initials. Maximum limit of 64 alphanumeric characters. Enter your E-mail Address. Maximum limit 0f 64 alphanumeric characters. Must be in the format of name@domain.com Enter your Alternative E-mail Address. Maximum limit 0f 64 alphanumeric characters. Must be in the format of name@domain.com Enter your Organization Name. Maximum limit of 64 alphanumeric characters. Enter your Organization House Identifier. Maximum limit of 60 alphanumeric characters. Enter your Organization Street Address. Maximum limit of 60 alphanumeric characters. Enter your Organizationcity. Maximum limit of 32 alphanumeric characters. Enter your Organization PIN Code. Maximum limit of 10 alphanumeric characters. Enter your Organization State. Maximum limit of 32 alphanumeric characters. Enter your Organization Country.

Organization Telephone Country Enter your Organization Telephone Country Code. Maximum limit of 2 numbers. Code Organization Telephone Area Enter your Organization Telephone Area Code. Maximum limit of 4 numbers. Code Organization Telephone Enter your Organization Telephone. Maximum limit of 15 numbers. Organization Mobile Country Code Enter your Organization Mobile Country Code. Maximum limit of 2 numbers. Organization Mobile Enter your Organization Mobile. Maximum limit of 15 numbers. Residential House Identifier Residential Street Address Residential City Residential PIN Code Residential State Residential Country Enter your Residential House Identifier. Maximum limit of 60 alphanumeric characters. Enter your Residential Street Address. Maximum limit of 60 alphanumeric characters. Enter your Residential City. Maximum limit of 32 alphanumeric characters. Enter your Residential PIN Code. Maximum limit of 10 alphanumeric characters. Enter your Residential State. Maximum limit of 32 alphanumeric characters. Enter your Residential Country

Residential Telephone Country Enter your Residential Telephone Country Code. Maximum limit of 2 numbers. Code Residential Telephone Area Code Enter your Residential Telephone Area Code. Maximum limit of 4 numbers. Residential Telephone Residential Mobile Country Code Residential Mobile Passport Ration Card Driving License Others
Documents checklist: Identity

Enter your Residential Telephone. Maximum limit of 20 numbers. Enter your Residential Mobile Country Code. Maximum limit of 2 numbers. Enter your Residential Mobile. Maximum limit of 20 numbers. Enter your Passport number as in the enclosed attested copy of your passport. Eg. A3608997. Maximum limit of 32 characters. Enter your Ration Card number as in the enclosed attested copy of your Ration Card. Eg. IN12345667876434554. Maximum limit of 32 characters. Enter your Driving License number as in the enclosed attested copy of your Driving License. Eg. DL9246/DEC/95. Maximum limit of 32 characters. Enter any Other Identity and residence proof. Maximum limit of 32 characters. Enter your PAN card number as in the enclosed attested copy of your PAN Card. Eg. AAAAA1111A. Maximum limit of 32 characters. Enter your Passport number as in the enclosed attested copy of your passport. Eg. A3608997. Maximum limit of 32 characters. Enter your Ration Card number as in the enclosed attested copy of your Ration Card. Eg. IN12345667876434554. Maximum limit of 32 characters. Enter your Driving License number as in the enclosed attested copy of your Driving License. Eg. DL9246/DEC/95. Maximum limit of 32 characters. Enter any Other Identity proof. Maximum limit of 32 characters. Enter your Bank Account number as in the enclosed attested copy of your bank statement. Eg. 000401532978. Maximum limit of 32 characters. Enter your LIC Receipt. Maximum limit of 32 alphanumeric characters. Enter your Latest Electricity Bill. Maximum limit of 32 alphanumeric characters.

Documents checklist: Identity and Residence

PAN Card Passport Ration Card Driving License Others

Documents checklist: Residence

Latest Electricity Bill Bank Account LIC Receipt

Passport Ration Card Driving License Others

Enter your Passport number as in the enclosed attested copy of your passport. Eg. A3608997. Maximum limit of 32 characters. Enter your Ration Card number as in the enclosed attested copy of your Ration Card. Eg. IN12345667876434554. Maximum limit of 32 characters. Enter your Driving License number as in the enclosed attested copy of your Driving License. Eg. DL9246/DEC/95. Maximum limit of 32 characters. Enter any Other residence proof. Maximum limit of 32 characters.
Applicant Declaration RA Declaration

I hereby confirm that I have read and understood the above instructions and will I hereby confirm that I have received and verified the documents submitted by follow the above instructions for obtaining and using the Digital Signature the subscriber. Certificate. Date: Place: Date: Signature of the Applicant Place:

Signature of the RA Officer

The certificate Request Form, Demand Draft and the supporting documents as per the document checklist have to be forwarded to the following address: Duly mark the envelope as 'APPLICATION FOR DIGITAL CERTIFICATE' R3 eConsulting Private Limited - Registration Authority R3 eConsulting Private Limited 304 Krishna Plaza III Floor H.No.6-2-953 KHAIRATABAD HYDERABAD - 500 004.