IMPORTANT: READ ME FIRST

1. Use blue ink only for signing the document.

2. Sign on the application must exactly match the sign on the PAN Card or
Passport copy. Any discrepancies will result in rejection of the
application by the Registering Authority.
3. There must be two signs on the DSC application, 1 across the photo
and the other in the place provided.
4. PAN Card copy is mandatory for Indian Nationals. Notarised passport
copy is mandatory for foreign nationals.
5. PAN Card copy must be self-attested and attested by a Gazetted
Officer (Green Ink Only) or Bank Manager (Blue Ink Only). Gazetted
officer seal / bank manager seal with branch information is a must.
6. Address proof copy must be self-attested and attested by a Gazetted
Officer (Green Ink Only) or Bank Manager (Blue Ink Only). Gazetted
officer seal / bank manager seal with branch information is a must.
7. Do not complete the application. Send in the blank application with
photo and signature, our team will complete the application for you.
8. Courier one signed blank DSC application for SIFY and one signed blank
DSC application signed for E-Mudhra. In case of rejection of
application, we can retry with other Registering Authority.

9. Courier the signed application and attachments to:

IndiaFilings.com
6 Dhanammal Street,
Spurtank Road, Chetpet,
Chennai 600 031 INDIA

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APPLICATION FORM - SIGNATURE / ENCRYPTION CERTIFICATE

FOR INDIVIDUAL
(E)

Application ID: (S)

(For Office Use Only)

PLEASE FILL IN BLOCK LETTERS ONLY. ALL FIELDS ARE MANDATORY

More Instructions available at: http://www.e-mudhra.com/instruction.html

Affix recent passport

size photograph of
the applicant duly
signed across

APPLICANT INFORMATION
L A S T N A M E

Date of Birth

I R S T

D DMMY YY Y

Gender

N A M E

Male

M I D D L E

N A M E

Female Nationality

Address

CLASS:
Class 1
City

Pin code

State

Class 2

Class 3

Encryption

Combo

TYPE:
Signature

Mobile

PAN

VALIDITY:
1 Year

Email ID

2 Years

DOCUMENT PROOF (attested by Bank Manager OR Post Master OR Gazetted Officer (Group A /Group B) , against producing the originals)
Proof of Address (Any one of below)*

Proof of Identity (Any one of below)*

(Having applicant photo and Signature, as part of it)

AADHAAR Card.

Passport.

Voter ID Card.

PAN Card of applicant (Mandatory if PAN provided)

Driving License (DL)/ Registration certificate (RC).

Driving License.

Passport.

Post Office ID Card.

Bank Account Passbook containing the photograph and signed by an individual with
attestation by the concerned Bank official.
Photo ID card issued by the Ministry of Home Affairs of Centre/State Governments
Any Government issued photo ID card bearing the signatures of the individual.

ID Number

Telephone Bill (Not older than 3 Months)

Water Bill (Not older than 3 Months).
Gas Connection/Bill (Not older than 3 Months).
Electricity Bill (Not older than 3 Months).
Bank Statements signed by the bank (Not older than 3 Months).
Service Tax/VAT Tax/Sales Tax registration certificate.

Attesting Officer *

Property Tax/ Corporation/ Municipal Corporation Receipt.

Self attested copy of ID Card/Contact details of attesting officer.

DECLARATION
I hereby agree that I have read and understood the provisions of e-Mudhra Certification Practice Statement (CPS) and the subscriber agreement and will abide by the same. The
information provided in this form is true & correct to the best of my knowledge. I accept publishing my certificate information in e-Mudhra repository. I am aware of risks associated in
case of Class 1 Certificate, when storing the private key on a device other than a FIPS 140-1/2 validated cryptographic module.

Date
Place

Seal & Stamp (If any)

Signature of the applicant

(As in ID proof | Blue Ink Only)

TO BE FILLED BY RA OFFICE ONLY

I declare that the applicant has provided correct information in this application form . I have checked and verified the application form and supporting documents. I hereby
take full responsibility for any wrong verification made, or wrong documents submitted for the application.

Date

RA Name, Code & Seal

Signature of RA

eMudhra Limited, 3rd Floor, Sai Arcade, 56, Outer Ring Road, Deverabeesanahalli, Opp Intel, Bangalore 560 103.
Karnataka. Phone : +91 80 4336 0000 Fax : +91 80 4227 5306. Email : info@e-Mudhra.com Website: www.e-Mudhra.com.
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