DutchGrid Certification Authorities Registration

Reserved for CA operations use ........ - ......
/O=dutchgrid/O=users/O=somewhere/CN=John Doe
□  ID Document valid    □  PoP Challenge verified    □  RA Signature OK   
Surname
Doe
Given names
John
Place of Birth
Someplace
Date of birth
01 Jan 1900
Nationality
NL
Identity paper type and number(s)
Passport NL12345678
SOFI number (optional)
Send this form by mail or fax to
	        DutchGrid MS CA
	        NIKHEF c/o Someone
	        P.O. Box 12345
	        NL 1009 DB Amsterdam
	        The Netherlands
	        
	        fax: +31 20 592 5155
	      
The first twenty (20) characters of your proof-of-posession challenge:
0123456789ABCDEF0123