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<html> |
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<head> |
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<title>Certificate request</title> |
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<link rel="stylesheet" type="text/css" href="stylesheet.css"/> |
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<link rel="stylesheet" type="text/css" href="stylesheet-registration_form.css"/> |
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</head> |
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<body> |
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<div class="ui"> |
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<h1>Certificate request - Verification form</h1> |
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<p>Now you need to print this form containing your personal details and certificate |
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information, and bring it to your registration authority, |
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<a href="mailto:${org.ra.email}" c="${org.ra.name}">**your agent**</a> |
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of <a href="${org.url}" c="${org.name}">**agent organisation**</a>. |
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Don't forget to bring your proof-of-identity, such as a passport or driving license.</p> |
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</div> |
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|
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<div class="form"> |
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<h1>DutchGrid Certification Authorities Registration</h1> |
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|
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<table class="reserved"> |
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<tr> |
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<th>Reserved for CA operations use</th> |
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<td class="fillin" style="text-align: right">........ - ......</td> |
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</tr> |
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<tr> |
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<td colspan="2" class="fillin-fixed"><span c="${subject}">/O=dutchgrid/O=users/O=somewhere/CN=John Doe</span></td> |
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</tr> |
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<tr> |
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<td colspan="2"> |
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<span class="check">□ ID Document valid</span> |
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<span class="check">□ PoP Challenge verified</span> |
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<span class="check">□ RA Signature OK</span> |
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</td> |
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</tr> |
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</table> |
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|
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<div class="userdata"> |
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<table><tr> |
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<td class="userinfo"> |
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<table> |
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<tr><td colspan="2">Surname <div class="fillin" c="${surname}">Doe</div></td></tr> |
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<tr><td colspan="2">Given names <div class="fillin" c="${givenname}">John</div></td></tr> |
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<tr> |
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<td>Place of Birth <div class="fillin" c="${birthplace}">Someplace</div></td> |
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<td style="text-align:right">Date of birth <div class="fillin" c="${birthdate}">01 Jan 1900</div></td> |
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</tr> |
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<tr><td colspan="2">Identity paper type, number, country <div class="fillin"><span if="${identity}" c="${identity}, ${country}">Passport NL12345678, NL</span></div></td></tr> |
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<tr><td colspan="2">SOFI number <span class="comment">(optional)</span><div class="fillin" c="${sofi}"></div></td></tr> |
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</table> |
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</td> |
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<td class="ra"> |
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<h2 style="text-align:center">Send this form by mail or fax to</h2> |
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<address c="${org.ra.address}">DutchGrid MS CA |
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NIKHEF c/o Someone |
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P.O. Box 12345 |
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NL 1009 DB Amsterdam |
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The Netherlands |
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|
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fax: +31 20 592 5155 |
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</address> |
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</td> |
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</tr></table> |
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|
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<div class="pop"> |
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<h2>The first twenty (20) characters of your proof-of-possession challenge:</h2> |
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<div class="fillin" c="${modulus.first20}">0123456789ABCDEF0123</div> |
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</div> |
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|
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<div class="contact"> |
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<h2>Contact Information</h2> |
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</div> |
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|
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<table class="userinfo"> |
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<tr> |
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<td>Name <div class="fillin" c="${givenname} ${surname}">John Doe</div></td> |
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<td>Streed addres <span class="comment">(physical delivery address)</span> <div class="fillin" c="${street}">Bar avenue 0</div></td> |
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</tr> |
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<tr> |
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<td>Organisation <div class="fillin" c="${org}">Foo inc.</div></td> |
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<td>ZIP code <div class="fillin" c="${zip}">1234AA</div></td> |
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</tr> |
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<tr> |
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<td>Phone number <div class="fillin" c="${phone}">+31 (0)123 456789</div></td> |
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<td>Place <span class="comment">(and province where applicable)</span> <div class="fillin" c="${place}">Heaven</div></td> |
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</tr> |
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<tr> |
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<td>Email address <div class="fillin" c="${email}">john@heaven.mil</div></td> |
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</tr> |
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</table> |
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|
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<div class="signature"> |
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<h2>Signature</h2> |
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|
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I have filled all data truthfully and to the best of my knowledge, and will |
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abide by the <a href="http://ca.dutchgrid.nl/medium/policy/">certificate policy |
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and practice statement</a> of the DutchGrid Certification Authority. |
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|
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<table><tr> |
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<td class="signature-box" rowspan="2">Signature <div class="fillin"></div></td> |
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<td class="signature-info">Place and date <div class="fillin"></div></td> |
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</tr> |
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<tr><td><br/><br/></td></tr></table> |
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</div> |
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|
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</div> |
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|
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|
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<table class="reserved"> |
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<tr><th colspan="2">Reserved for RA operations use</th></tr> |
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|
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<tr><td colspan="2" class="ra"> |
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I, <span class="fillin"><sup>RA name</sup></span> have |
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verified the identity of the requester based on the identity piece |
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listed above, and confirm that the information is complete and |
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accurate. |
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I met the applicant in person on |
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<span class="fillin"><sup>date and time of meeting</sup></span> at |
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<span class="fillin"><sup>meeting place</sup></span> and have confirmed |
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his affiliation with <span class="fillin"><sup>organisation name</sup></span> |
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to the extent required in the |
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<a href="http://ca.dutchgrid.nl/medium/policy/">certificate policy |
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and practice statement</a>. |
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</td></tr> |
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<tr> |
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<td class="notes-box">Notes</td> |
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<td class="signature-box">Signature of registration authority<br/><br/><br/><br/></td> |
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</tr> |
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</table> |
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</div> |
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</body> |
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</html> |
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