Digital Certificate and Client Registration Form - Australian Customs ...

Digital Certificate and Client
Registration Form
IMPORTANT INFORMATION: PLEASE READ
Prior to completing this form you must have:
• purchased and installed your digital certificate(s)
• identified your User Agreement signatory
• read and signed your User Agreement, ready to accompany this form (if you are registering for the first time).
This form should be read in conjuction with the ‘Digital Certificate and Client Registrations - Revised Processes’ fact
sheet.
Client details
Client Type (check appropriate box):
Australian Business Number (ABN) entity
Organisation (non-ABN)
Individual
Company name (if applicable):
Organisation name (if applicable):
Individual name (if applicable):
Postal address:
Business address:
Contact person and title:
Telephone Number:
Email address:
Are you an in-house software developer? Yes No
Are you using an EDI software package? Yes No
If you answered ‘yes’ to the previous question, what EDI software package are you going to use?
Certificate details of the person
who signed the User Agreement
Digital certificate holders name (as detailed in the certificate):
Certificate type (Check only one of the following boxes):
Type ABN-DSC grade 2 certificates (authorised officer or non-authorised officer)
Type 2 - grade 2 non-individual certificates
E-mail Address:
Type 1 - grade 2 individual certificates
Type 3 - To register this certificate, refer to the
Notes section of this form.
Tick box if the digital certificate holder on this form is the User Agreement signatory:
User Agreement signatory
(This is the person who has signed the accompanying User Agreement )
Signature:
Date:
NOTES:
• Only one User Agreement needs to be signed per company/organisation/individual.
• All fields are mandatory.
• You must have an ABN/DSC certificate prior to registering a Type 3 (device) ceritficate.
• Additional digital certificates for this client record, including Type 3 (device) certificates, can be provided within ‘additional certificate details’ sections -
see reverse.
Completed form(s) should be posted along with the signed User Agreement to:
Postal Address
Courier Address
Attention: Cargo Support
Attention: Cargo Support
Australian Customs Service
Australian Customs Service
Customs House
Ground Floor, Customs House
Locked Bag 3000
10 Cooks River Drive
Sydney International Airport NSW 2020 Sydney International Airport NSW 2020
B323 (October 2006)

Additional
Additional
certificate details
Digital Certificate holders name (as detailed in certificate):
Certificate Type (select the appropriate certificate for this form):
Type ABN-DSC grade 2 certificates (authorised officer or non-authorised officer)
Type 1 - grade 2 individual certificates
Type 2 - grade 2 non-individual certificates
Type 3 (device) certificates
E-mail Address (contained in your certificate):
Signature:
Date:
Additional
certificate details
Digital Certificate holders name (as detailed in certificate):
Certificate Type (select the appropriate certificate for this form):
Type ABN-DSC grade 2 certificates (authorised officer or non-authorised officer)
Type 1 - grade 2 individual certificates
Type 2 - grade 2 non-individual certificates
Type 3 (device) certificates
E-mail Address (contained in your certificate):
Signature:
Date:
Additional
certificate details
Digital Certificate holders name (as detailed in certificate):
Certificate Type (select the appropriate certificate for this form):
Type ABN-DSC grade 2 certificates (authorised officer or non-authorised officer)
Type 1 - grade 2 individual certificates
Type 2 - grade 2 non-individual certificates
Type 3 (device) certificates
E-mail Address (contained in your certificate):
Signature:
Date:
More information and assistance
For enquiries relating to digital certificate and client registration processes go to www.customs.gov.au and follow the links to Cargo Support or phone
1300 558 099.
For enquiries relating to digital certificates purchases and installation go to www.verisign.com.au or phone (03) 9674 5500.