Di Gi Tal Si Gnature Certi Fi Cate Subscri Pti On Form

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Department / Nature of Business :____________________________________

Di
git
alSi
gnat
ureCer
ti
fi
cat
eSubscr
ipt
ionFor
m

Usebl
ue-i
nkonl
yinc
ludi
ng
si
gnat
ure.

EnsuretheName,Des i
gna-
t
ion,AddressandCont act
numberoft heatt
est
ingoff
i-
cerinatleastoneoftheat-
t
estati
ondoc ument.

Iherebydecl ar
et hatallt
hei nf
ormati
onpr ovi
dedi nthi
sSubscri
ptionfor
mf orthepurposeofobtai
ningadi git
alcerti
fi
cat
eistrueandcor recttothebest
ofmyknowl edge.Iam awar e,asasubscriberforthedi
git
alsi
gnaturecer
ti
fi
cate,t
hedutiesandresponsibi
li
ti
eswhi chareappl
icableundertheSaf eScr
ypt
CACPS( ht
tps:
//www.safescrypt.
com/pdf
/cps.pdf)andalsoundertheSecti
on71ofI TActwhichsti
pulatesthatifanyonemakesami srepresentat
ionor
suppressesanymat er
ialfactfr
om theCCAorCAf orobt
aini
nganyDSCsuchper sonshallbepuni
shablewithimpr i
sonmentupt o2yearsorwi thfi
neup
toonelakhr upeesorwi thboth.

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