DutchGrid Certification Authorities Registration

Reserved for CA operations use ........ - ......
/O=dutchgrid/O=users/O=fooinc/CN=John Doe
ID Document valid PoP Challenge verified RA Signature OK
Surname
Doe
Given names
John
Place of Birth
Date of birth
Identity paper type, number, country
SOFI number (optional)
send this form by mail or fax to
DutchGrid MS CA NIKHEF c/o Djuhaeri Harapan P.O. Box 41882 NL 1009 DB Amsterdam The Netherlands fax: +31 20 592 5155

The first twenty (20) characters of your proof-of-possession challenge:

0123456789ABCDEF0123

Contact Information

Name
John Doe
Street addres (physical delivery address)
Organisation
Foo inc.
ZIP code
Phone number
Place (and province where applicable)
Email address

Signature

I have filled all data truthfully and to the best of my knowledge, and will abide by the certificate policy and practice statement of the DutchGrid Certification Authority.
Signature
Place and date
Please take this form to an RA, like .
Reserved for RA operations use
I, RA name have verified the identity of the requester based on the identity piece listed above, and confirm that the information is complete and accurate. I met the applicant in person on date and time of meeting at meeting place and have confirmed his affiliation with organisation name to the extent required in the CP/CPS.
Notes Signature of registration authority