Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your requestor information in Section 1. Fill in your first name, middle name, last name, email address, and telephone number.
3. Enter your agency name along with the address or room number where applicable. Complete the fields related to Fed. Gov’t-issued picture ID by providing the ID number and type.
4. If applicable, provide details for any Non-Fed. Gov’t-issued picture ID by specifying the ID number and type for each certification.
5. In the 'Certificate for Revocation' section, enter the user's name or common name (cn) as it appears in the records.
6. Indicate the user’s agency by printing the agency name clearly. Select the revocation reason from the provided options by checking the appropriate box.
7. At the bottom of Section 1, the requestor must provide their signature and the date of execution, affirming the correctness of the information provided.
8. Move on to Section 2, which must be completed by the registration authority. The registration authority should fill in their first name, last name, telephone number, and email address.
9. In Section 2, the registration authority must enter the date of the revocation request and verify picture IDs as needed.
10. The registration authority must sign and date the form, declaring the accuracy of the information provided in Section 2.
11. Complete any remaining fields concerning the PKI credential type, serial number if applicable, and indicate whether the PKI credential revocation has been completed.
12. After filling in the form, you can save your changes, download, print, or share the completed form as needed.

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