Cl

ass2
I
ndi
vidualCer
tif
icat
e

Regi
str
ati
on Form f
orCl
ass2 Di
git
alCert
ifi
cat
e
Cust
omerI
dent
if
icat
ionNumber:_______________________________ (
forof
fi
ceuseonl
y)

Val
idi
ty 1Year 2Year Type Onl
ySi
ging Si
gn& Encr
ypt
Af
fi
xr ecent
passport
Appl
icantName si
zephot ogr
aph
ofthe
Sur
name Fi
rstName Mi
ddl
ename
appl
icant

Emai
lID Dat
eofBi
rth Appli
canttosignacross
t
hephotographextended
D D M M Y Y Y Y toappli
cati
onform

Resi
dent
ialAddr
ess

(Asmenti
onedi
nat
tached
suppor
ti
ng)
e-S afe , e-S ecure , e-S ure

Town/
Cit
y/Di
str
ict St
ate/
Uni
onTer
rit
ory

PI
N Cont
actNo. PH MO

I
dent
it
yDet
ailofAppl
icant Pl
eas
eti
ckanyoneandencl
oset
hecopyofs
ame

*
PAN Post
off
ice Dri
ving Passpor
t Govt
. CopyofBankAccountPassbookcont
iai
ningphot
o& signed
Car
d I
D Card Li
cense I
D Card byappl
icantwi
that
test
ati
onbyconcernedBankOf f
icer

*
ForPAN basedDSC,pl
spr
ovi
det
hePAN Car
ddet
ail
sandencl
oset
hecopyofsame.

IherebyagreethatIhavereadandunderstood(n)CodeSoluti
onsCACPSandt hesubscr
iberagr
eementandpr omi
setoabidethesame.Ihaver
ead
andunderstoodguideli
nesforstor
ageofpri
vatekeysment i
onedin(n)CodeSol
uti
onsCPSandr i
skinvol
vedbyusing ot
herstoragedevi
cest
ostor
e
pri
vatekeys.Ishallbehel
dr esponsi
blef
orallr
isksari
singoutofnotusi
ngUSBCr ypt
oTokenstost
oreprivat
ekey.

DETAI
LS REQUI
RED I
FAPPLI
CANTI
S FOREI
GN NATI
ONAL: Nat
ional
li
ty:

Vi
saDet
ail
s: Passor
tNo.:

I
NSTRUCTI
ONS:
6.Allsupport
ingdocument sshoul dbeat testedbyGazet tedoff
icerBank
MangerorPostMast er.Alternat
ivel
ytheappl icantcanpresent
origi
nal
stoLRAf orverif
icati
onandat testati
on.
7.TheVal i
dit
yofaddr esspr oofincaseofut il
it
ybill
sshallnotbeolder
than3mont hsf
rom thedat eofapplication.
8.Foranyassi st
ancePl easegeti ntouchwi thusat:
dscsupport@ncode. i
norcal l:1800-233-1010.

Dat
e:

Pl
ace: Si
gnat
ureofAppl
icant

Ver
ifi
edby(
n)CodeOf
fice ForLRA useonl
y

Al
lDocument
sChecked& Ver
ifi
edby: Al
lDocument
sChecked& Ver
ifi
edby:

Seal& Si
gnat
ure LRAName,Seal& Si
gnat
ure

(
n)
Tol
lFr
ee:18002331010

Page /
/1-2
 Cl
ass2
I
ndi
vidualCer
tif
icat
e

Regi
str
ati
on Form f
orCl
ass2 Di
git
alCert
ifi
cat
e
Cust
omerI
dent
if
icat
ionNumber:_______________________________ (
forof
fi
ceuseonl
y)

Document
sRequi
redf
orVer
ifi
cat
ion

Checkl
istoft
hedocumentt
obesubmi
ttedwi
thAppl
icat
ion

1 At
test
edcopyofanyonedocument
saspr
oofI
dent
ity.(
Pleaset
ickt
heonesubmi
tt
ed)

PAN Dri
ving Passpor
t PostOf
fice Gover
nment
OR OR OR OR
Car
d Li
cense I
D Card I
D Card

CopyofBankAccuontPassbook
OR
wi
thatt
est
edphotographbythebank

Documentaspr
oofofAddr
ess(
Pleaset
ickt
heonesubmi
tt
ed)
e-S afe , e-S ecure , e-S ure

2 At
test
edcopyofdocument
saspr
oofofAddr
ess.(
Pleaset
ickt
heonesubmi
tt
ed)

Tel
ephone Voter Passpor
t Gas
OR OR OR OR
Bil
l ID Card Connect
on

El
ectr
ici
ty Water Dri
ving Pr
opertyTax/Corpoat
ionTax
OR OR OR
Bi
ll Bi
ll Li
cense/RC Muni
cipalCor
porati
onReceipt

BankStat
ement Ser
vicesTax/VATTax/
OR OR
at
test
edbytheBank Sal
esTaxReg.Certi
fi
cat
te

PaymentDet
ail
s(Appl
icabl
eforappl
icantobt
aini
ngDSC f
rom anyof(
n)CodeOf
fi
ces)
Cheque/D.
D.t
obeDr
awni
nfavourof
(n)
CodeSol
uti
ons,Di
visi
onofGNFC Lt
d.(
Chequeshoul
dbe
Payabl
eatPar
)

Dat
e: BankName: DD /ChequeNo.: Amount:

(
n)CodeOf
fices Cor
por
ateOf
fi
ceAhmedabad:079-
40007300 dscsal
es@ncode.
in

Mumbai Del
hi Bangal
ore Chandi
gar
h Sur
at
022-
22048908 011-
26452279/
80 080-
25272525 0172-
2707732 0261-
3003690
mumbai
sal
es@ncode.
in nor
thsal
es@ncode.
in sout
hsal
es@ncode.
in punj
absal
es@ncode.
in sur
atsal
es@ncode.
in

(
n)
Tol
lFr
ee:18002331010

Page /
/2-2