Digital Signature Application Form

OFFICE OF THE PRESIDENT
DEPARTMENT OF INFORMATION COMMUNICATIONS TECHNOLOGY
APPLICATION FORM – DIGITAL SIGNATURE
Instructions:
1. Please fill the form in BLOCK LETTERS
2. Items marked with * are mandatory.
Affix Recent
Passport Size
Photo
DETAILS TO BE FILLED BY APPLICANT
Full name *
Surname:
First Name:
Middle Name:
N.I.N
Gender Male Female
(*Tick as applicable):
Residential Address
*Mobile No:
*Telephone No:
*E-Mail:

*Office Address
Office Number:
E-Mail:
The information provided above in the Application Form for obtaining a Digital Certificate is
true and correct to the best of my knowledge.
Date
Signature of the Applicant
Required Documents
1 Applicant Verification Documents
Document Submitted Document Verified By
Passport Size Photo
National Identity Card
Letter of Authority
TO BE FILLED BY OFFICER
The above details have been verified and found to be correct.
Date
Signature of Officer
Note:
Application for a new Digital Certificates must be supported by a valid passport size photograph
and the National Identification Card. If the person is transacting on behalf of a company, the
company should provide an official letter addressed to the Principal Secretary of Department of
Information Communications Technology to this effect and also indicate the NIN of the person
or persons who will be undertaking these transactions.