Voter Id Application Form Mumbai - PDF by nmi70476


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									                                             PND DIGISIGN
     Shop No.3/4, Madhav Krupa, Maratha Colony, Near Movie Gem Cinema, Dahisar (East), Mumbai: 400 068
Tel: (022) 28284033 / 28282998 / 98209 44649 Email: website:

As per the new Interoperability Guidelines ver 2.1 guidelines issued by
Controller of Certifying Authorities (CCA), DSC issued till 31/12/2011
                               will have one year validity only.........
                                             INSTRUCTIONS / CHECKLIST
1.   Please fill the form in BLOCK LETTERS
2.   The Certificate will be issued only if the application form is complete in all aspects.
3.   Along with the completed and signed application form, please attach following documents as mentioned below
     SelfAttested & AttestedbyAttestationOfficer:
      Attachments           Document 1 is compulsory, any one of Document 2 & one of Document 3 listed below &
                            Document 4 only if Signature required as a Director:
      Document 1            Latest Photograph of the Applicant to be pasted and Signed across.
      Document 2            Identity Proof: An attested copy of any one of the following [Attestation should be done by
                            a gazetted officer /CA/CS/Bank Attestation (from nationalized banks only)] PAN card/Voter Id
                            Card/Passport /Driving License, PF Statement / PF Book, Ration Card.
      Document 3            Proof of Residential Address in the applicant’s name: Attested copy of any one of latest
                            utility bill ( electricity, telephone or mobile), Passport, Voter ID Card, Driving License, Latest
                            LIC receipt of Applicant, ration card in the applicant’s name.
     Note: All the documents should be compulsorily Attested by the Attesting Officer,
     incomplete forms with respect to this will not be processed.

4.   Email Address is mandatory and a valid and active email ID to be given.

5.   Enclosed Cheque (At par Cheque or Draft In case of out of Mumbai) in the favour of        “PND DIGISIGN” and send
     at the above mentioned address.

                                      COST STRUCTURE OF KIT AS FOLLOWS:

     TYPE       DSC +               BACKUP         USB            USB             USB             DRIVERS/            MRP
                SERVICE               C.D.         TOKEN          TOKEN           TOKEN           SOFTWARE          (1 YEAR
                                                   (UKEY)         (PSA)           (ALLADIN)       CD               VALIDITY)
     KIT 0              √                                                                                               900
     KIT 1              √                √                                                                             1000
     KIT 2              √                √              √                                              √                1400
     KIT 3              √                √                              √                              √                1650
     KIT 4              √                √                                              √              √                1900

                                                       PAYMENT DETAILS
          Cheque (At par cheque or DD in case of out of Mumbai) in favour of “PND DIGISIGN”
             Name of the applicant : _______________________________________________________________
                    Cheque No.: _________ Dated _________ Amount: ____________ for KIT _________
           Drawn on ______________________________________________________________

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