TATA CONSULTANCY SERVICES LIMITED CERTIFYING AUTHORITY REQUEST FORM FOR CLASS-3 CERTIFICATE SERVER / DEVICE CERTIFICATE

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1 TATA CONSULTANCY SERVICES LIMITED CERTIFYING AUTHORITY REQUEST FORM FOR CLASS-3 CERTIFICATE SERVER / DEVICE CERTIFICATE USER TYPE COMPANY Instructions: 1. Please fill the form in BLOCK LETTERS 2. Items marked with * are mandatory. 3. For the items marked with # (Details for at least one are mandatory) Affix recent passport-size photograph of the applicant. Applicant to sign across the photograph. DETAILS TO BE FILLED IN BY THE APPLICANT: * FULL NAME * Last Name/Surname First Name Middle Name Designation: GENDER *(Tick as applicable) Male Female ORGANISATION/OFFICE DETAILS * Organization Name Office Address Pin Code Administrative Ministry/ Department Government of India/ State Government Version Class-3 Certificate

2 Telephone No. Fax No. Area Code Area Code Telephone No. Fax No. Details of at least one are mandatory # EMPLOYEE IDENTIFICATION NO. # PASSPORT NO. # VOTER S IDENTITY CARD NO. # INCOME TAX PAN NO. # ADDRESS * (Mandatory - a valid and active ID that is accessed frequently) Date Signature of the Applicant In case the Application is for a device, then the following details of the Server/Device for which the Certificate is being applied for must be filled. Only Class-3 Certificate is issued for the same. Please Note that the Server administrator should be the applicant for this Certificate Request. WEB SERVER SERVICES IP ADDRESS URL / DOMAIN NAME PHYSICAL LOCATION Version Class-3 Certificate

3 Instructions 1. All subscribers are advised to read Certificate Practice Statement of CA. 2. The certificate shall be downloaded onto the same computer / Hardware device (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 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 Reinstallation or upgrade of the Internet browser on the computer from which the certificate request was initiated. 4. The certificate 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 for the revocation of your certificate. 6. Application form must be submitted in person. 7. Incomplete/Inconsistent application is liable to be rejected. Declaration I hereby confirm that I have read and understood the above instructions and will follow the above instructions for obtaining and using the Digital Signature Certificate. Date: Place: Signature of the Applicant TO BE FILLED BY RA OFFICE The above details have been verified and found to be correct. Name: Date: Signature of RA Office Version Class-3 Certificate

4 DOCUMENT CHECKLIST FOR COMPANY TYPE OF CERTIFICATE The following is a list of the supporting documents that you need to submit along with the Certificate Request Form. NOTE: NOTARIZATION WHERE REQURED, SHOULD BE DONE BY NOTARY PUBLIC. ATTESTATION TO BE DONE BY GAZZETTED OFFICER. Sl. No. Particulars Proof required / Checklist Status 1 Payment for certificate (to be drawn in favor of Tata Consultancy Services payable at Hyderabad) 2 Any of the following details as proof of right to do business (Notarized copy) Certificate of Incorporation or Articles of Incorporation or Memorandum of Association or Partnership Papers, in case of a Registered Partnership or Acts/ other valid business license document 3 Domain Name Registration Proof (attested copy) Demand Draft/Cheque/Pay Order Domain Name Authorization Letter - on the Company Letterhead signed by Authorized person (As per Annexure-A) (If the domain in the certificate request is not registered by the organization requesting for the certificate.) 4 Company s PAN Number (Attested photo copy) 5 Company s Bank Details (Bank Details on the Company Letter Head) or Attested copy of the Bank Statement provided by the Bank Details of the Company Directors or Partners to be submitted on the company Letter Head Name, Designation, Address and PAN or Voter s ID or Passport details to be given on the Company Letter Head. Version Class-3 Certificate

5 6 Certificate Request Form (As find above) - Duly filled in 7 Certificate Enrollment Form (Downloaded) Note 1: If a company applies for more than one certificate, then one original notarized copy of the Proof of Registration Number and other attested photocopies of the original would be required. 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 West/Central India Mumbai Tata Consultancy Services Limited Certifying Authority PKI Services, 11th Floor, Maker Towers E Block, Cuffe Parade, Colaba, Mumbai Phone: /6967/6958 North/East India Delhi Tata Consultancy Services Limited Certifying Authority PKI Services, 4th & 5th Floor, PTI Building, 4 Parliament Street, New Delhi Phone: Fax: South India Hyderabad Tata Consultancy Services Limited Certifying Authority PKI Services, deccanpark, 1-Software Units Layout, Madhapur, Hyderabad Tel: / 3525/3526 Fax: Version Class-3 Certificate

6 Annexure A Domain Name Authorization Letter Date: Domain Authorization Letter I confirm and warrant that: Certificate Applicant is (Certificate Applicant) Domain to be included in the certificate is (Domain) Registrant of the Domain is (Registrant) I am the registrant (and/or employed by the Registrant) and am duly authorized to sign this Domain Authorization Letter and to deal with all matters related to the registration of the Domain. TCS-CA has received a request from CERTIFICATE APPLICANT to issue Web Server Digital Certificate(s) under their name. CERTIFICATE APPLICANT desires to install the Digital Certificate on its web server(s) for the domain and ultimately to enable secure communications with its users. We have granted CETIFICATE APPLICANT the right to use the Domain as a common name in the Digital Certificate request referenced above and to otherwise use the Domain in connection with its business. We agree to indemnify TCS-CA and its directors, officers, agents, employees, contractors, parents, affiliates, or subsidiaries (collectively, the 'Indemnified Parties') and hold the Indemnified Parties harmless from and against any losses, costs, damages, and fees (including reasonable attorney's fees) incurred by the Indemnified Parties in connection with: Any breach on our part of any representation or obligation under this letter or any domain name registration agreement between us and the Registry governing the Domain name registration; or acts or omissions, the use of any product or service provided by us, or any other item furnished by us to the Applicant related to the use of the Digital Certificate (collectively, the 'Indemnity Conditions'). Upon appropriate notice, we shall defend, at its expense, any claim brought against one of more of the Indemnified Parties based on or arising out of one or more of the Indemnity Conditions. Regards, Full Name: Job Title: Company Name: Company telephone number: Signature: Version Class-3 Certificate

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