Letter of Identity Proof by Organization (To be printed on organization letter head / Office seal. To be signed by HRD of Organization / Authorized Signatory / Government Department in-charge. To be used ifthe Organizational 10 card isnot available for the applicant.) To: eMudhra Limited Bangalore Subject: Organizational ID Proof of the applicant Organization Name: _ Org ID Number (available) | | Designation 7 ~ Department 7 "hereby confirm the Identity of the above Individual. I'm the Authorized Personnel to certify the Identity on behalf of the Organization. For the Organization, (Seal & Signature) Name: Designation:APPLICATION FORM - SIGNATURE / ENCRYPTION CERTIFICATE FOR GOVERNMENT ORGANIZATION Application 1D: (S) | | | TT Poe Ct ttt) emudhra (For Office Use Only) PLEASE FILL IN BLOCK LETTERS ONLY. ALL FIELDS ARE MANDATORY rs ecson alte hp mua costco | APPLICANT INFORMATION ‘fc recent passport tes \ crt ' 1 \ size photograph of soca) | || | LUE PPE sze poten of Date of Bit) | Gender hale (Female Natonatty [TT [1] 11 sianed across organisation _| | al TTT TTT Name | Thr] [ eparment | | | i aa org Address | | | cl eLAss ro T Ciclass1 | Tclass2 [) Class 3 ew CLD vee: sue [| ("signature [7] Emerton |} Combo PAN of Applicant 7 fo ea VALIDITY: Ananose LEELTI |)0Te ee eset ea i = : i pj [Cr vesr 12 ours em EE PETE PTTL TTI [TETTTT ] DOCUMENT PROOF (atiesies by Authorized Signatory of the Orgenization) Document equi [G1 Copt Apc Goement Cat /Lotarfom Ogun Pa ip [A sore min Orgel Cad Steed Ltr f nanan ety 1 capo Pan cate Asean PA proves {apt har aot een Aaa pred DECLARATION BY APPLICANT AUTHORIZATION ereby agree tha nave ead ard understood he provsons of eMudna Carteaton Prats Sistrent (CPS) 0d the sbserber agreement and wil sid by ie seme The omaon proved nth lo ue cree fe best st my krowlodge 1 accep pibalg my eareteintomanon neva repost. am aa of eke cited incase of Class 1 Ceiicatewen soni the privat kay ona device ober san FIPS 140.12 vated ‘rplgrapi edule. lace Signature ofthe applicant (set pes On) ‘TO BE FILLED BY RA OFFICE ONLY hereby autarce ti appa on atl ofthe ‘xaniatin herby ont hate nuns of Applcant gen stow. n cate ols 3, ear {he Prytal Veriton c Ap Aunorized Signatory (Sign and Seal) | declarethat the sppeant has povided comet ifomaton m ms appleaten fom. | have checed ar verfed the appcaton fem and supporing documents | hereby {ake ful responsibilty fr any wrong veritestion made, or wrang documents sutaited for iieation. RAName, Code & Seal Signature of RA ‘eMudhra Limited, 21d Floor, Sai Arcade, £6, Outer Ring Road, Deversbeesanaale, Opp intel, Bangalore 560 103, Karnataka, Phone ; +81 80.6740 1400 Fax: +81 80 4227 5108. Ema: info@e-Mudra com Website: worte-Mushea.com, Pairs