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PND DIGISIGN 103 1st Floor Simandhar Wamanrao Sawant Road Opp. Jana Seva Bank Dahisar E Mumbai 400068. Tel 022 28284033 / 28282998 / 98209 44649 Email pnddigisign gmail.com website www. pnddigisign.com INSTRUCTIONS / CHECKLIST Please fill the form in BLOCK LETTERS The Certificate will be issued only if the application form is complete in all aspects. PND DIGISIGN 103 1st Floor Simandhar Wamanrao Sawant Road Opp* Jana Seva Bank Dahisar E Mumbai 400068. Tel 022 28284033 / 28282998 / 98209 44649 Email pnddigisign gmail*com website www. pnddigisign*com INSTRUCTIONS / CHECKLIST Please fill the form in BLOCK LETTERS The Certificate will be issued only if the application form is complete in all aspects. Along with the completed and signed application form please attach following documents as mentioned below Attachments Document 1 Document 1 is compulsory any one of Document 2 one of Document 3 listed below. Latest Photograph of the Applicant to be pasted and Signed across. Identity An attested copy of any one of the following Attestation should Proof by Gazetted Officer / Bank Manager / Post Master a Passport b Copy of be done by Driving License c PAN Card d Post Office ID Card. e Copy of Bank Account Passbook containing the photograph and signed by an individual with attestation by the concerned Bank official f Photo ID card issued by the Ministry of Home Affairs of Centre/State Governments. g Any Government issued photo ID card bearing the signatures of the individual*. Proof of Residential Address in the applicant s name Attested copy of any a Telephone Bill b Electricity Bill c Water Bill d Gas connection e Bank one of Statements signed by the bank f Service Tax/VAT Tax/Sales Tax registration certificate g Driving License/RC h Voter ID Card i Passport j Property Tax/ Corporation/ Municipal Corporation Receipt. In case of any utility bills like electricity water gas and telephone bill the recent proof but not earlier than 3 months from the date of application should be attached* Note All the documents s h o u l d b e c o m p u l s o r i l y A t t e s t e d b y the Gazetted Officer / Bank Manager / Post Master incomplete forms with respect to this will not be processed* 4. Email Address Landline Number Mobile Number are mandatory. Enclosed Cheque At par Cheque or Draft In case of out of Mumbai in the favour of the above mentioned address. COST STRUCTURE OF KIT AS FOLLOWS TYPE KIT 2 KIT 3 DSC SERVICE USB TOKEN ePass 2003 ALLADIN DRIVERS/ SOFTWARE CD MRP 2 YEAR VALIDITY 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. Tel 022 28284033 / 28282998 / 98209 44649 Email pnddigisign gmail*com website www. pnddigisign*com INSTRUCTIONS / CHECKLIST Please fill the form in BLOCK LETTERS The Certificate will be issued only if the application form is complete in all aspects. Along with the completed and signed application form please attach following documents as mentioned below Attachments Document 1 Document 1 is compulsory any one of Document 2 one of Document 3 listed below.

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