Sify rcai class form

RCAI Class 2 - Digital Signature Certificate (DSC) Application:
for individuals
Instructions for filling in the application form:
For official use only
This form is to be filled by the individual for whom the DSC is intended.
Please ensure that the form is complete in all respects. If you require assistance, please consult your authorized SafeScrypt representative.
Incomplete forms would delay the certificate issuance process. Therefore, please fill in all fields unless marked “optional”.
Use only BLOCK LETTERS to fill the form. Check all boxes wherever applicable You are urged to review our CPS while applying for a certificate.
Detailed instructions for certificate issuance will be provided by your authorized Additionally, address proof is to be submitted if you apply for RCAI class 2 Section: 1
Certificate Type : Individual
Certificate Validity * (Tick as applicable) Applicant details :
Address (Residential address in case of RC
Organization address in case of RCAI class 2 with ORG Name) Organisation Name * :(Mandatory in case of ORG DSC) Section 2:
Please submit a VALID e-mail address which will be used to receive the digital certificate. The same e-mail address should also be used while enrolling for the digital certificate online.*: Section 3a: Identity Proof Details
Please provide details of a government-issued photo identity proof being enclosed by you Acceptable photo IDs include passport, voter ID card, PAN card, and driver's license If you are presenting any other type of government-issued photo ID, please specify details in the 'Identity proof submitted' field below The photocopy of the specified photo-ID is required to be duly attested by your banker / public notary / gazette officer / Sify prevalidated signatory / Sify LRA Declaration:
I hereby declare that all information provided on this Certificate Application Form for the purpose of obtaining a digital certificate is true and correct to the best of my knowledge.
Section 4: Attestation by Banker / Notary / Gazette Officer / Sify Prevalidated Signatory / Sify LRA
I hereby declare that the applicant has presented to me the original documents of ID proof and I have attested the photocopies of the same as TRUE COPY I, as a Bank Manager, hereby certify that the applicant, as appearing above, maintains account with this bank /branch and his/ her (Applicable if attestation is by a Bank Manager) Note: Sify, at its discretion, will make a telephone call to verify the details of this attestation.
SafeScrypt CA Services brought to you by:
Sify Communication Limited, 2nd Floor, Tidel Park, 4, Rajiv Gandhi Salai, Taramani, Chennai - 600113
I (Name of the applicant) hereby declare that the details mentioned below are true & correct to my knowledge & belief. I hereby authorize Pinnacle Finserv Advisors Pvt Ltd to download my Digital Signature Certificate on mine behalf. It should be treated as downloading of Certificate is done at my end.
I (Name of the Professional) certify that I have submitted the fol owing details for ( name of the client ) my client mentioned above in order to get the DSC as required -: Signature of Proposer ( Signature of CA /CS / Tax Professional) REGISTERING AUTHORITY : PINNACLE FINSERV ADVISORS PVT LTD
Office: 65/65, Moti Mohal, Circular Road, Kanpur E-mail :, Visit us at


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