Certificate Application Attestation Form

Instructions to Applicant 1. 2. 3. 4. #. Print out this Form after completing it as required Place a copy of your latest passport-size photograph on the top right corner Bring this Form to your banker for attestation. a) You are responsible for all fees charged by the banker nstruct the banker to read the instructions belo! and complete the "ckno!ledgment. $btain copies of three of %&s a) $ne !idely recogni'ed( go)ernment issued *hoto+ % such as b) *assport %ri)ing ,icense ncome -a. dentity /*"0) 1ard 2oters % card 3er)ice dentity 1ard issued to its employees by 3tate41entral 5o)ernment

-!o other %&s !hich are nationally )alid and !hich need not necessarily be photo+ %&s such as *assports %ri)ing ,icenses ncome -a. dentity /*"0) 1ards 2oters % card 3er)ice dentity 1ards issued to its employees by 3tate 4 1entral 5o)ernment 6ation 1ard *hoto 1redit 1ards 4 %ebit card Bank 4 7isan 4 *ost $ffice *assbooks *ension %ocuments such as 8.+3er)icemen&s *ension Book 4 *ension *ayment $rder 8.+3er)icemen&s 9ido! 4 %ependent 1ertificates :ediclaim or similar insurance cards 3tudent 331 4 ;31 4 graduation 4 post graduation degrees Birth certificate 3chool lea)ing certificate 8lectricity bill :obile 4 -elephone bill

You !ill need to< a) :ake a copy of each of the 3 forms of %&s b) ;a)e the copies 0otarised 4 attested by a 0otary *ublic or 5a'etted $fficer or your Banker =. Make and retain a copy of the completed form in a secure location. You !ill need to reference your name and e+mail address as listed belo! should you ha)e a question regarding this certificate application. For your $rganisation 0ame is to be included in the certificate then< a) 3ubmit *roof of 6ight to do Business document+ i) Pvt & Public Ltd Companies + 3elf attested !hose signature is verified by the banker" ncorporation certificate $6 :emorandum and "rticles of "ssociation ii) Partnership Firms # 3elf attested !hose signature is verified by the banker" *artnership %eed or *artnership 6eg 1ertificate iii) Proprietary Firms# 3elf attested !hose signature is verified by the banker" 3hop "ct4 3ales -a. 1ertificate 4 8.cise 1ertificate4 b) c) 3ubmit the ,etter of 8mployment 3ubmit the 3ignature 2erification ,etter

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Instructions to Banker

-he document you are attesting is part of the enrolment process for a 3afe3crypt %igital %. 3afe3crypt requires that the personal identity of the applicant be )alidated. 1. 1omplete the "ckno!ledgment in the 1ertificate "pplication "ttestation Form. 2. -he "pplicant must hold a )alid account in your bank. 3. You may retain a copy of the completed 1ertificate "pplication "ttestation Form 4. n this conte.t( the Banker is the Branch :anager of the bank !here the applicant holds a )alid bank account. -he banker can also be any other employee of the same bank of a grade equal to or higher than the Branch :anager.

$o be printed on letter head of organization" Certificate Application Attestation Form

Applicant Personal %ata as entered on the &nline 'nrollment Form" !ith the latest passport photograph# Full 0ame ?????????????????????????????????????????????? 8+mail "ddress??????????????????????????????????????????? *hone 0umber??????????????????????????????????????????? *ostal "ddress ?????????????????????????????????????????? ??????????????????????????????????????????????????????? ???????????????????????????????????????????????????????

*aste passport photo here

latest si'e

"pplicants 3ignature

%ate ???????????????

(anker to Complete the Follo!ing )ection Ackno!ledgment -he "pplicant personally presented himself to me( the Banker( for the purpose of identity )erification. 3ignature and photograph of :r.4:rs.4:s. ???????????????? !ho maintains an account !ith this Bank( as appearing abo)e( is hereby attested( !ith reference to the records maintained by the Bank. Bank :anager@s 3ignature< ?????????????????????? Bank :anager@s 0ame< ??????????????????????? Bank :anager@s official code number< ?????????????????????????????????? Bank 0ame and "ddress< ?????????????????????????????????????????????????? ??????????????????????????????????????????????????????????????????????? ??????????????????????????????????????????????????????????????????????? Banks $fficial *hone number< ?????????????????????????????

/*lace Bank 3eal43tamp to the right)

)ignature *erification Letter

Instructions -he 3ignature 2erification letter is required to )erify the identity of the "uthori'ed 3ignatory !ho attested the *$6 document( -elephone Bill and ,etter of 8mployment. -his letter is to be< 1. n the prescribed format only and preferably on the letterhead of the $rganisation in the 1ertificate 6equest

2. 1ompleted and 3igned first by the "uthorised 3ignatory of the $rganisation !ho attested the other documents 3. 1ompleted and 3igned lastly by the $rganisations official Banker -he Banker is the Branch :anager of the bank !here the $rganisation has a )alid bank account. -he banker can also be any other employee of the same bank of a grade equal to or higher than the Branch :anager. -he Banker must affi.A /1) ;is official seal on the document /2) ;is signature and full name ne.t to his official seal on the document /3) ;is official telephone number( so that 3afe3crypt may contact him in this regard

4. $nly a hard copy is )alid and must be filed. ;o!e)er( the order can be processed !ith a fa.ed copy pro)ided the original !ill be couriered to you at the earliest.

$o be printed on letter head of organization+banker

)ignature *erification Letter

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-his is to 1ertify that BBBBBBBBBBBBBBBBB.. /0ame of the $rganisation) !ith the $ffice at BBBBBBBBBBBBBBBBBBBBBB. /"ddress of the $rganisation) is maintaining a bank account /"4c 0o. BBBBBBBBBBB) !ith our Bank BBBBBB.BBBBBB. /Bank 0ame)( and operating that account in the normal course of its business4acti)ities. :r.4:s.4:rs..BBBBBBBBB..BB. is the authori'ed signatory for the operation of the account. ;is4;er signature as appearing belo! is duly attested /as per the records a)ailable !ith the bank).

/3ignature of the "uthorised 3ignatory) 0ame < ??????????????????? ??????????????????? %esignation < ????????????????????

/3ignature of the Branch :anager) 0ame < ??????????????????????? %esignation<

*hone 0o< ?????????????????????

%ate< ???????????????????

(ank )eal"

This letter is required only if the applicant is not authorised to sign in companys bank account

Letter of 'mployment
Instructions -he ,etter of 8mployment is to be submitted !hen the 1ertificate "pplicant requires the name of his $rganisation to be displayed in his certificate. -his letter should accompany the *$6 %ocument and the 3ignature 2erification ,etter. -his letter is to be< 1. n the prescribed format only and printed on the letterhead of the $rganisation in the 1ertificate 6equest

2. 1ompleted and 3igned by the "uthorised 3ignatory !hose signature is verified by the banker" of the $rganisation( !ho attested the other documents 3. -he "uthorised 3ignatory/!hose signature is )erified by the banker) must affi.< -he $rganisations seal on the document ;is signature and full name ;is official telephone number and e+mail id( so that 3afe3crypt may contact him in this regard 4. $nly a hard copy is )alid and must be filed. ;o!e)er( the order can be processed !ith a fa.ed copy pro)ided the original !ill be couriered to you at the earliest. #. 3ubmit all documentation to us or by courier to the follo!ing address< *ision )olutions
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FF -o be *rinted on the 1ompany ,etter ;ead GG

Letter of 'mployment Certificate Applicant 5nformation First 0ame< ??????????????????????? ,ast 0ame< ???????????????????????? 8mail %< ?????????????????????????? ( /0ame of the "uthorised 3ignatory) ??????????????????????( certify that on /%ate) ????????????( /0ame of the 1ertificate "pplicant) ????????????????????? is an employee of our organi'ation /$rganisation 0ame) ????????????????????? and that the "pplicant&s 8mployee % is /8mployee %) ???????????????. office records. ackno!ledge by my signature( that the "pplicant information in this document is complete and accurate as per our

/3ignature of "uthorised 3ignatory) %etails of Authorised )ignatory Full 0ame< ????????????????????????? $rganisation 0ame< ????????????????????????? %esignation< ????????????????????????? 8mail "ddress< ????????????????????????? *hone 0umber< ?????????????????????????

/1ompany 3eal)